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Hill C. [Trends in the frequency of cancer in France]. Bull Cancer 2024; 111:33-36. [PMID: 37858423 DOI: 10.1016/j.bulcan.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023]
Abstract
We present and discuss recent data on the frequency of cancer in France. In the male population, the incidence of cancer has been stable since 2010 and mortality is decreasing; changes in the incidence of all cancers are dominated by changes in the incidence of prostate cancer, which is highly dependent on the extent of screening. In the female population, cancer incidence is rising and mortality is falling; the increase in the incidence of all cancers is partly due to the rise in the incidence of lung cancer, a consequence of women taking up smoking in the early 1970s.
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Affiliation(s)
- Catherine Hill
- Institut Gustave-Roussy, 114, rue Edouard-Vaillant, 94805 Villejuif, France.
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Gorsane I, Zammouri A, Hajji M, Sallemi N, Aoudia R, Barbouch S, Ben Abdallah T. [Renal involvement in sarcoidosis: Prognostic and predictive factors]. Nephrol Ther 2021; 18:52-58. [PMID: 34756825 DOI: 10.1016/j.nephro.2021.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/15/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Sarcoidosis is a systemic granulomatous disease that primarily affects the respiratory system and lymphatic vessels. Renal involvement is rare, poorly studied and found in less than 10% of cases. The objective of our study was to identify factors of poor renal prognosis and predictive factors of renal involvement during sarcoidosis. METHODS It's a retrospective study including patients hospitalized in our department for sarcoidosis with renal involvement over a period of 40 years. To study renal survival, we identified two groups of patients with renal manifestations of sarcoidosis by following their evolution: group A (n=26) represents those with renal remission or deterioration of renal function but without progression to end-stage renal disease and group B (n=8) those with progression to end-stage renal disease. To detect the predictive factors of end-stage renal disease in patients with sarcoidosis, we compared the clinical and paraclinical characteristics of our patients (group 1) to those of 44 patients with sarcoidosis without renal impairment followed in our department during the same period (group 2). RESULTS Renal involvement was observed in 34 patients hospitalized for sarcoidosis (43.6%). There were 28 women and 6 men with a sex ratio of 0,21. The mean age at diagnosis of sarcoidosis was 47.1 years. The median time from sarcoidosis diagnosis to renal disease was 2 months (range 1-72). Tubulointerstitial nephropathy was the most frequent renal manifestation observed in 24 patients (70.6%). Hypercalcemia and hypercalciuria were found in 52.9% and 46.4% respectively. Renal failure was noted in 25 patients (73.5%). Corticosteroid therapy was initiated in 33 patients (97%) associated with immunosuppressive therapy in 3 cases. Predictive factors of end-stage renal disease were advanced age at diagnosis of nephropathy (P=0.007), comorbidities (P=0.002), multi-organ involvement (P=0.041), initial renal failure (P=0.013), interstitial fibrosis (P=0.006) and renal granulomas (P=0.007). Predictive factors of renal impairment during sarcoidosis were multi-organ involvement, inflammatory syndrome and hypercalcemia. CONCLUSION Renal envolvement, although rare during sarcoidosis, can influence the prognosis hence the great interest of its early detection to prevent progression to end-stage renal failure.
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Affiliation(s)
- Imen Gorsane
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie.
| | - Asma Zammouri
- Service de néphrologie, hôpital régional Houmt-Souk, Djerba, Tunisie
| | - Meriem Hajji
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
| | - Nadaa Sallemi
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
| | - Raja Aoudia
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
| | - Samia Barbouch
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de néphrologie, dialyse et transplantation rénale, hôpital Charles-Nicolle, BAB Souika, 1006, Tunis, Tunisie; Faculté de médecine de Tunis, Tunisie
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Boyer J, Cautenet A, Ligier F. [The evolution of child psychiatry emergencies: Results and reflections from a Nancy University Hospital study]. Encephale 2021; 47:348-355. [PMID: 33455741 DOI: 10.1016/j.encep.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Mental illness is one of the most common causes of disability, morbidity and mortality in childhood. According to the scientific literature, the prevalence of mental health disorders is an estimated 10% to 20% in the USA and similar results are found in France. Although primordial, outpatient care often appears insufficient with inequalities in its geographical distribution and its accessibility. These past decades have been marked by an increase in consultations for mental disorders in pediatric emergency departments. Is this trend indicative of a "defect" in the healthcare organization? Identifying the root causes of this inflation in psychiatric consultations seems of paramount importance in the improvement of healthcare policies. In France and worldwide, only a few studies deal with this subject. That is why we proposed to observe the evolution of the number of consultations for mental health reasons in the pediatric emergency department of Nancy University Hospital and to detail their characteristics. MATERIALS AND METHODS Ancillary comparative and retrospective study (2003-2013) on minors having received a child psychiatry consultation within the pediatric emergency department of Nancy University Hospital. RESULTS The number of consultations for mental health reasons increased by 119% (97 in 2003; 212 in 2013), while consultations for pediatrics reasons remained stable over the period studied. Consultations mainly dealt with females representing 55.6% of consultations in 2003 and 63.7% in 2013. Mean age of consultants was stable: 13.9 years (standard deviation=3.3 years) in 2003; 14.1 (2.5) years in 2013. Family structure witnessed a three-fold increase in the single-parent model. Regarding consultation motives, behavioral disorders were significantly more represented in 2013: 27.7% (RR=1.7; 95% CI 1.0-2.8; P<0.05) versus 16.5%. As far as diagnosis is concerned (ICD-10), emotional and behavioral disorders increased to 35.9% from 12.6% (RR=2.8; IC95% 1.6-5.1; P=0.0001). CONCLUSIONS In France, as well as in other western countries, the number of visits in pediatric emergency departments for mental health reasons more than doubled over a 10-year span. This growth mostly concerned externalizing disorders as a motive for consultation. Causes for this increase are multifactorial and closely related to the prevalence of psychiatric disorders in children. Some studies showed that economic factors played a major role on mental illness during such a downturn as the financial crisis of 2007-2008. Unemployment caused by economic crises can weaken pediatric caregivers and therefore their patients. Evolution of family structure and value also explains this trend. These past decades, the two-parent model, relevant till the 1960s, has evolved to a point where single parents are more quickly overwhelmed. Family values are now focused on consensus rather than duty and hedonism has become a central value. Women are more involved in the working world which became for all a performance field. Several studies have shown that social settings where competitiveness is the norm breed externalized disorders in children by advocating short-term efficiency. Moreover, the widespread use of screens in households as well as early exposure impact the psychomotor development, decrease the amount of sleep and may be responsible for the occurrence of many psychiatric disorders. There are some epidemiological reasons too. In 1971, Omran introduced a concept called "epidemiological transition" explaining how mental health issues appeared in the limelight through to the decline of infectious and cardiovascular diseases. This phenomenon has already occurred in western countries which could explain the increase in the prevalence of psychiatric disorders. In Africa, there is evidence it may have already started. Beyond all these considerations, the increase in consultations for mental disorders in pediatric emergency departments can be explained by a change in care consumption habits. Going straight to the local emergency department, accessible on a 24/7 basis, is easier than waiting for an outpatient appointment and is also free for the have-nots lacking proper insurance coverage. Scarce resources in ambulatory care may also explain the increased recourse to emergency services. Several reports have shown a lack of child psychiatrists and their uneven geographical distribution. For example, in the US only a third of children with mental disorders receive proper care, a lack which doubled between 1997 and 2010. Despite the reason for this trend, it is important to propose a better fitting of the healthcare system to the population needs, and to improve prevention and early identification. All these changes require further collective reflection.
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Affiliation(s)
- J Boyer
- Pôle universitaire de psychiatrie de l'enfant et de l'adolescent, centre psychothérapique de Nancy, 1, rue du Docteur-Archambault BP 11010, 54521 Laxou cedex, France.
| | - A Cautenet
- Pôle universitaire de psychiatrie de l'enfant et de l'adolescent, centre psychothérapique de Nancy, 1, rue du Docteur-Archambault BP 11010, 54521 Laxou cedex, France
| | - F Ligier
- Pôle universitaire de psychiatrie de l'enfant et de l'adolescent, centre psychothérapique de Nancy, 1, rue du Docteur-Archambault BP 11010, 54521 Laxou cedex, France; EA 4360 APEMAC, Université de Lorraine, Nancy, France
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Ducos Y, Aghakhani N. Prognostic factors for unfavorable outcome after mild traumatic brain injury. A review of literature. Neurochirurgie 2020; 67:259-264. [PMID: 32593671 DOI: 10.1016/j.neuchi.2020.04.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/14/2019] [Revised: 03/08/2020] [Accepted: 04/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Unfavorable outcomes occur in 15-20% of patients with mild traumatic brain injury (mTBI). Early identification of patients at risk of unfavorable outcome is crucial for suitable management to be initiated, increasing the chances of full recovery. Many studies have been published on prognostic factors, but are not of a high level of evidence and certainty. A number of factors have been proposed and predictive models have been constructed that, although attractive, have not yet been externally validated. OBJECTIVES A review of literature (systematic search of PubMed and Google Scholar) assembled relevant available information about prognostic factors for unfavorable outcome after mTBI. We discuss the consistency of these findings, and the possibility and difficulty of using these factors in a daily practice. RESULTS It appears that the strongest and most consistent predictors are the number, severity and duration of symptoms present in the first few days after the trauma.
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Affiliation(s)
- Y Ducos
- Department of Neurosurgery, Paris, France
| | - N Aghakhani
- Department of Neurosurgery, Paris, France; Center for Evaluation and Multidisciplinary Care of Mild Traumatic Brain Injury, Bicêtre University Hospital, Paris, France.
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Deledalle FX, Doisy L, Daniel L, Garcia S, Lechevallier E, Bastide C, Boissier R. [Evolution of followed renal oncocytomas]. Prog Urol 2020; 30:514-521. [PMID: 32376210 DOI: 10.1016/j.purol.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 06/20/2019] [Accepted: 04/05/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Oncocytomas are primitive kidney tumours, considered benign but their evolution is not fully established. The local progression is generally admitted but few data explain what makes a oncocytoma to grow more or less quickly. The objective of our study is to analyse the evolution of followed renal oncocytomas after histologic confirmation and to identify factors that can influence their growth. MATERIAL AND METHODS This is a retrospective study in two centers (North Hospital and Hospital of the Conception of Marseille). All patients with renal oncocytoma diagnosed with percutaneous biopsy from September 2010 to April 2016 and followed for more than one year were included. Epidemiological, histological, and morphological data were collected at diagnosis, during follow-up and in case of strategy change (intervention). Statistical analysis of factors influencing oncocytomes growth was based on the Pearson correlation test. RESULTS Fifty-three patients were included. The median age for diagnosis was 65 years [39-85]. The sex ratio H/F was 6/5. The median follow-up was 34 months [12-180]. The average diagnosis size was 29 mm [12-90]. Thirteen patients (25%) were treated secondarily, including 70% by conservative treatment. The average growth was 0.25 (±0.23) cm/yr. The patients treated were younger and had a higher growth rate than the untreated (0.48±0.23cm/yr versus 0.18±0.18cm/yr, P<0,001). According to Pearson's analysis, there was a positive linear relationship (R=0.27, P=0.047) between velocity and initial size and a negative linear relationship (ρ=-0.44, P<0.001) between velocity and age at diagnosis. So tumor growth was faster if the patients were young and the tumor voluminous at diagnosis. DISCUSSION Rapid growth often leads to a cessation of surveillance in favour of an intervention strategy. For young patients, conservative treatment (partiel nephrectomy or ablative treatment) in the medium term is likely to be preferred, but for elderly patients or with important comorbidities follow-up is an alternative to an invasive attitude. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- F-X Deledalle
- Service de chirurgie urologique, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Laboratoire d'anatomopathologie, hôpital de-la-Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - L Doisy
- Service de chirurgie urologique, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Laboratoire d'anatomopathologie, hôpital de-la-Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - L Daniel
- Laboratoire d'anatomopathologie, hôpital de-la-Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - S Garcia
- Service de chirurgie urologique, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Laboratoire d'anatomopathologie, hôpital Nord, AP-HM, chemin des Bourrely, 13015 Marseille, France
| | - E Lechevallier
- Service de chirurgie urologique, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Laboratoire d'anatomopathologie, hôpital de-la-Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - C Bastide
- Service de chirurgie urologique, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Service de chirurgie urologique, hôpital Nord, AP-HM, chemin des-Bourrely, 13015 Marseille, France
| | - R Boissier
- Laboratoire d'anatomopathologie, hôpital de-la-Timone, AP-HM, 264, rue Saint-Pierre, 13005 Marseille, France
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Richard C, Debreuve-Theresette A, Patey M, Brabencova E, Filieri C, Zalzali M, Schvartz C. Long-term progression of non-invasive follicular thyroid neoplasm with papillary-like nuclear features: A single-center retrospective study of the French Marne-Ardennes thyroid cancer registry. Ann Endocrinol (Paris) 2020; 81:34-38. [PMID: 32057425 DOI: 10.1016/j.ando.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 11/15/2022]
Abstract
CONTEXT Non-invasive forms of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) were reclassified as non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in order to reduce overtreatment. A few studies showed neck lymphadenopathy at diagnosis, or even distant metastasis in patients with NIFTP. OBJECTIVE Our aim was to report the frequency, clinical features and long-term progression of histologically confirmed NIFTP, using data from the French Marne-Ardennes thyroid cancer registry, and to compare findings against FVPTC. METHODS This was a retrospective study on data for follicular variant of PTC (FVPTC) diagnosed between 1975 and 2015 obtained from the specialized Marne-Ardennes thyroid cancer registry. Pathology reports were used to select appropriate cases from a large series, and FVPTC specimens were reviewed by endocrine pathologists. Strict diagnostic criteria were used for reclassification as NIFTP. RESULTS In total, 115 cases were reviewed histologically out of 383 cases of FVPTC. Sixty-five met all criteria for NIFTP and were consequently reclassified. Incidence of NIFTP was 16.9% of cases of FVPTC. Fifty patients were women (76.9%); median age was 47 years. Mean NIFTP size was 2.6 cm. There were no significant differences in age, gender or tumor size between NIFTP and FVPTC. Fifty patients underwent total thyroidectomy and 15 lobectomy. There were no lymph node metastases at diagnosis, and none of the patients (N=17) who underwent central and/or lateral neck dissection had positive findings on microscopic examination. 46 patients (70.8%) received radioiodine (RAI). Patients were followed up for 1.9-27.3 years (median 14.6 years) after initial treatment. All patients remained in complete remission during follow-up. CONCLUSION Consistently with previous studies, our results showed the indolent course of NIFTP and that risk of recurrence after complete resection is very low (zero in our cohort), even when size is ≥4cm and in absence of adjuvant RAI treatment. Prospective studies are needed to confirm those results.
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Affiliation(s)
- Capucine Richard
- Nuclear medicine-thyroid Unit, Institut Godinot, 1, rue du Général-Koenig, 51100 Reims, France.
| | | | - Martine Patey
- Biopathology department, CHU de Reims, rue du Général-Koenig, 51100 Reims, France
| | - Eva Brabencova
- Biopathology department, Institut Godinot, 1, rue du Général-Koenig, 51100 Reims, France
| | - Carlo Filieri
- Nuclear medicine-thyroid Unit, Institut Godinot, 1, rue du Général-Koenig, 51100 Reims, France
| | - Mohamad Zalzali
- Nuclear medicine-thyroid Unit, Institut Godinot, 1, rue du Général-Koenig, 51100 Reims, France
| | - Claire Schvartz
- Nuclear medicine-thyroid Unit, Institut Godinot, 1, rue du Général-Koenig, 51100 Reims, France; Thyroid Cancer Registry of Marne-Ardennes, Institut Godinot, 1, rue du Général-Koenig, 51100 Reims, France
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Essayagh M, Rhaffouli AE, Essayagh S, Essayagh T. [Epidemiology profil of fever typhoid in Meknes (Morocco) 2013-2016]. Rev Epidemiol Sante Publique 2020; 68:45-9. [PMID: 31917023 DOI: 10.1016/j.respe.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 07/09/2019] [Accepted: 09/16/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Twenty million cases of typhoid and paratyphoid fever (TF) are observed annually worldwide with more than 200,000deaths. These fevers occur in areas where hygiene is precarious, mainly in developing countries. The objective of this study was to describe epidemiological patterns of TF in Meknes, Morocco in order to improve preventive measures. METHODS We conducted a case series study based on data from 2013 to 2016 in the Meknes TF surveillance system. Data collected included socio-demographic variables, place of residence, season, mode of water supply, and food consumed. Diagnosis of TF was confirmed with the Widal test. Data were analyzed with Epi-info version 7 and mapping was done with Qgis version 2.18.1. RESULTS Three hundred and twenty-two cases were reported with a male/female sex ratio of 0.9. Average age was 26±20years. Incidence increased from 13 per 100.000inhabitants in 2013 to 8 per 100.000 inhabitants in 2016. Two hundred and seventy-nine (87%) cases occurred in urban areas and 174 (54%) cases developed in summer. One death was recorded. CONCLUSION Public awareness campaigns on health education for hygiene are needed. Focus should be placed on transmission by food handlers.
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Amrani F, Prud'homme J, Maesano C, Annesi-Maesano I. [Evolution of urban air pollution in metropolitan France between 2008 and 2015]. Rev Mal Respir 2019; 36:1096-1106. [PMID: 31668925 DOI: 10.1016/j.rmr.2019.09.003] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Air pollution is a major public health issue and remains a major concern in France and around the world. Proof of this is that air pollution is one of the first environmental concerns of the French population. The purpose of this study was to establish a system for monitoring the actual concentrations of different atmospheric pollutants observed in major French cities. METHOD For 13 major cities in Metropolitan France we collected data from the measurement stations of Air Quality Monitoring agencies for various pollutants: NO2, O3, PM10, PM2.5. Using these data, we have produced monthly time series of these pollutants covering the period 2008-2015. We also calculated the slopes of these time series as well as the correlation coefficients. RESULTS The results do not show trends that are decreasing but rather stagnating, for the air pollutants considered. Our work therefore indicates that monitoring and taking steps to reduce air pollution must be increased.
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Affiliation(s)
- F Amrani
- Sorbonne universités, UPMC Univ Paris 06, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP UMRS 1136), épidémiologie des maladies allergiques et respiratoires (EPAR), faculté de médecine Saint-Antoine, 75012 Paris, France
| | - J Prud'homme
- Sorbonne universités, UPMC Univ Paris 06, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP UMRS 1136), épidémiologie des maladies allergiques et respiratoires (EPAR), faculté de médecine Saint-Antoine, 75012 Paris, France
| | - C Maesano
- Sorbonne universités, UPMC Univ Paris 06, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP UMRS 1136), épidémiologie des maladies allergiques et respiratoires (EPAR), faculté de médecine Saint-Antoine, 75012 Paris, France
| | - I Annesi-Maesano
- Sorbonne universités, UPMC Univ Paris 06, Inserm, Institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP UMRS 1136), épidémiologie des maladies allergiques et respiratoires (EPAR), faculté de médecine Saint-Antoine, 75012 Paris, France.
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Abstract
In psychiatry, clinical staging raises awareness of the need to understand disease trajectories and heterotypic continuity; it draws attention to individuals at risk of developing disorders, such as those with a family history or subsyndromal presentations; and it actively promotes greater attention to prevention strategies and interventions for individuals at ultra-high risk of developing a severe mental disorder. Staging paradigms have been increasingly applied in early intervention in psychoses, but there are issues in broadening the scope of clinical staging to the more prevalent affective disorders. For example, it is potentially more complex to devise a model that considers the varying clinical presentations of the late prodromal stage of bipolar disorder and where to locate depressive episodes that precede the first manic episode and how to describe subthreshold manic syndromes, especially hypomania. The above issues might be resolved if we had a greater understanding of the risk factors, biomarkers or endophenotypes for the onset and progression of bipolar disorder. This level of understanding is not yet available in psychiatry, but clinical staging may help us improve our knowledge of the pathophysiological correlates of disease progression and reduce our over-reliance on cross-sectional assessments of symptoms in bipolar disorders.
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Affiliation(s)
- J Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
| | - C Henry
- Institut pasteur, unité perception et mémoire, F-75015 Paris, France - Université Paris-Est, UMR S955, UPEC, F-94000 Créteil, France - AP-HP, Hôpital Henri-Mondor, Albert-Chenevier, pôle de psychiatrie, F-94000 Créteil, France
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Carta MG, Said M, Piras M, Moro MF. [An evolutionist approach of mood disorders from a transcultural perspective]. Encephale 2019; 45:530-532. [PMID: 30879780 DOI: 10.1016/j.encep.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 12/03/2018] [Accepted: 12/06/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The objective of this paper is to verify if traits and symptoms defined as pathological and maladjusted in certain contexts may produce adaptive effects in other contexts, especially if they occur in sub-threshold forms. METHODS A historical examination of how the symptoms of depression have changed in front of great social changes and an analysis of Sardinian migrants' thymic profiles toward several metropolises. RESULTS AND CONCLUSIONS Mood disorders have been increasing since the "English malady" in the 17th century, and we suppose that some forms of mood disorders might have an adaptive advantage. Otherwise, the increase of such an epidemic would have been self-limited. From a sociobiological point of view, it is highly probable that the environment of a rapidly evolving society can select people who are explorers and able to support accelerated biorhythms and that the condition of social change stimulates psychological and psychopathologic changes. It is also possible that hyperthymic persons modulate and create the new environment. If this model can explain the epidemic of mood disorders, its verification should guide future research.
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Affiliation(s)
- M G Carta
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italie
| | - M Said
- Razi Hospital, Faculty of medicine of Tunis, Tunis, Tunisia.
| | - M Piras
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Cagliari, Italie
| | - M F Moro
- Mailman School of Public Health Columbia University, New York, United States
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Batouche DD, Benatta NF, Tabeliouna K, Boudjahfa S, Touhami Y, Hakkoum S. [Hypertensive crisis and anticholinergic toxidrome secondary to accidental consumption of datura stramonium in two children]. Ann Cardiol Angeiol (Paris) 2018; 67:215-218. [PMID: 29759800 DOI: 10.1016/j.ancard.2018.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To identify a hypertensive clinical form of atropine or anticholinergic toxidrome secondary to accidental consumption of Datura seeds. PATIENTS AND METHODS We report two cases of Datura intoxication in two children who presented marked anticholinergic syndrome whose diagnosis was made by the anamnesis and the clinic. RESULT Patient 1: A 5-year-old boy, returns home agitated with balance disorders. He was admitted to pediatric resuscitation unit. His Glasgow score was 11/15. The child made inconsistent remarks. The neurological examination revealed mydriasis. Hemodynamically, the blood pressure was 145/91mmHg, the heart rate was 145 bpm. The rest of the examination noted a temperature of 37.5°, a bladder globe. Standard biological tests were normal. ECG found sinus tachycardia. Urine analysis revealed a positive alkaloid reaction with the presence of atropine. The evolution was favorable after 48hours. Patient 2: 45-month-old boy admitted to a state of severe agitation of toxic origin. The clinical examination showed a central and peripheral anticholinergic symptomatology with severe hallucinations, severe hypertension, and a heart rate at 190 bpm. The rest of the examination found erythema in the thorax and upper limbs, bilateral mydriasis. The toxicological report confirmed the presence of alkaloids. The evolution was favorable. CONCLUSION Hypertension crisis and other anticholinergic clinical signs of Datura stramonium intoxication achieve favorable outcomes in children.
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Affiliation(s)
- D D Batouche
- Faculté de médecine, université Ahmed-Benbellah, 31000 Oran, Algérie.
| | - N-F Benatta
- Faculté de médecine, université Ahmed-Benbellah, 31000 Oran, Algérie
| | - K Tabeliouna
- Faculté de médecine, université Ahmed-Benbellah, 31000 Oran, Algérie
| | - S Boudjahfa
- Faculté de médecine, université Ahmed-Benbellah, 31000 Oran, Algérie
| | - Y Touhami
- Faculté de médecine, université Ahmed-Benbellah, 31000 Oran, Algérie
| | - S Hakkoum
- Faculté de médecine, université Ahmed-Benbellah, 31000 Oran, Algérie
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Abstract
Studying hematopoietic and mesenchymal stem cells for almost three decades revealed some similarities between the stem cell entity and the single-celled eukaryotes exhibiting the anaerobic/facultative aerobic metabolic features. A careful analysis of nowadays knowledge concerning the early eukaryotic evolution allowed us to reveal some analogies between stem cells in the metazoan tissues and the single-celled eukaryotes which existed during the first phase of eukaryotes evolution in mid-Proterozoic era. In fact, it is possible to trace the principle of the self-renewal back to the first eukaryotic common ancestor, the first undifferentiated nucleated cell possessing the primitive, mostly anaerobically-respiring mitochondria and a capacity to reproduction by a simple cell division "à l'identique". Similarly, the diversification of these single-cell eukaryotes and acquiring of complex life cycle allowed/conditioned by the increase of O2 in atmosphere (and consequently in the water environment) represents a prototype for the phenomenon of commitment/differentiation. This point of view allowed to predict the ex-vivo behavior of stem cells with respect to the O2 availability and metabolic profile which enabled to conceive the successful protocols of stem cell expansion and ex vivo conditioning based on "respecting" this relationship between the anaerobiosis and stemness. In this review, the basic elements of this paradigm and a possible application in cell engineering were discussed.
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Affiliation(s)
- Z Ivanovic
- CS21010, Établissement français du sang Aquitaine-Limousin, place Amélie-Raba-Léon, 33075 Bordeaux cedex, France; U1035 INSEM, université de Bordeaux, 33076 Bordeaux cedex, France.
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13
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Terzian Z, Urena M, Himbert D, Gardy-Verdonk C, Iung B, Bouleti C, Brochet E, Ghodbane W, Depoix JP, Nataf P, Vahanian A. Causes and temporal trends in procedural deaths after transcatheter aortic valve implantation. Arch Cardiovasc Dis 2017; 110:607-615. [PMID: 28411108 DOI: 10.1016/j.acvd.2016.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 09/10/2016] [Accepted: 12/16/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND The causes of procedural deaths after transcatheter aortic valve implantation (TAVI) have been scarcely detailed. AIMS To assess these causes and their temporal trends since the beginning of the TAVI era. METHODS From October 2006 to April 2014, 601 consecutive high-risk/inoperable patients with severe aortic stenosis underwent TAVI using the Edwards SAPIEN or SAPIEN XT or the Medtronic CoreValve. The transfemoral route was the default approach; the transapical or left subclavian approaches were alternative options. Patients were divided into three tertiles according to the date of the procedure. RESULTS Procedural death occurred in 45 patients (7.5%), with a median±standard deviation age of 83±7 years; 23 were men (51%) and the mean logistic EuroSCORE was 26±16%. The main cause of death was heart failure (n=19, 42%), followed by cardiac rupture (n=12, 27%), intensive care complications (n=9, 20%) and vascular complications (n=5, 11%). The mortality rate was higher after transapical than transfemoral TAVI (17% vs. 5%; P<0.001). The mortality rate decreased over time (11.9% in the first tertile, 6.0% in the second and 4.5% in the third [P=0.007]), driven by a reduction in heart failure-related deaths (6.5% in the first tertile vs. 1.5% in the third; P=0.011). Vascular complication-related deaths disappeared in the third tertile. However, there was no decrease in deaths related to cardiac ruptures and intensive care complications. CONCLUSIONS The procedural mortality rate of TAVI decreased over time, driven by the decrease in heart failure-related deaths. However, efforts should continue to prevent cardiac ruptures and improve the outcomes of patients requiring intensive care after TAVI.
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Affiliation(s)
- Zaven Terzian
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Marina Urena
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Dominique Himbert
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France.
| | | | - Bernard Iung
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Claire Bouleti
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Eric Brochet
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Walid Ghodbane
- Cardiac Surgery Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Jean-Pol Depoix
- Anaesthesiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Patrick Nataf
- Cardiac Surgery Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Alec Vahanian
- Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France
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14
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Thomas M, Bruant-Rodier C, Bodin F, Cribier B, Huther M, Dissaux C. [Why is it important to differentiate trichoblastic carcinomas (CT) from basal cell carcinomas (CBC). About 21 cases]. ANN CHIR PLAST ESTH 2017; 62:212-8. [PMID: 28385570 DOI: 10.1016/j.anplas.2017.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/01/2017] [Indexed: 11/20/2022]
Abstract
Trichoblastic carcinoma is a rare epithelial malignant epithelial tumor, its diagnosis is difficult and the therapeutic management is non-consensual. This retrospective study, carried out between 2009 and 2015, covered 21 cases and analyzed the diagnostic and therapeutic characteristics of trichoblastic carcinomas. Sex ratio is 2. Trichoblastic carcinoma predominated in the face (65% of cases), particularly in perinasal (30% of cases). Its clinical presentation is in 95% of cases as basal cell carcinoma, which is the first clinical diagnosis evoked. The average size of the tumors was 2.3cm in diameter (from 0.7cm to 15cm). The treatment of these tumors is surgical: the margins retained were on average 0.7cm (0.5cm to 1cm). The first excision was mostly performed under local anesthesia, healthy borders were found in less than 40% of cases, requiring another intervention under general anesthesia with reconstruction by flap or skin graft in nearly 80% of cases. The lymph node metastasis rate was 5%. Three cases of recurrence (17%) occurred between 18 months and 6 years follow-up, despite complete resection. One case recurred three times. These results highlight the difficulty of diagnosing trichoblastic carcinomas, often confused with basal cell carcinomas. Though larger, poorly limited and infiltrating, trichoblastic carcinomas are not really distinguished from basal cell carcinomas. Only the anatomopathological examination of the excision piece make it possible to conclude, the biopsy being most often insufficient. Their local aggressiveness requires a greater margin of excision. The micrographic analysis of Mohs, for the periorificial lesions of the face, would reduce margins, increase their reliability and limit the number of surgical revisions. Finally, the literature reports a high rate of ganglion and visceral metastases (between 9.5 and 11%). Initial search for distal lymph node or metastatic involvement is essential, as well as regular clinical follow-up.
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15
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Frémondière P, Thollon L, Marchal F. [The emergence of obstetrical mechanism: From Lucy to Homo sapiens]. Gynecol Obstet Fertil Senol 2017; 45:164-171. [PMID: 28256409 DOI: 10.1016/j.gofs.2017.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Abstract
The evolutionary history of modern birth mechanism is now a renewed interest in obstetrical papers. The purpose of this work is to review the literature in paleo-obstetrical field. Our analysis focuses on paleo-obstetrical hypothesis, from 1960 to the present day, based on the reconstruction of fossil pelvis. Indeed, these pelvic reconstructions usually provide an opportunity to make an obstetrical assumption in our ancestors. In this analysis, we show that modern birth mechanism takes place during the emergence of our genus 2 million years ago. References are made to human specificities related to obstetrical mechanism: exclusive bipedalism, increase of brain size at birth, metabolic cost of the pregnancy and deep trophoblastic implantation.
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Affiliation(s)
- P Frémondière
- CNRS, EFS, ADES UMR 7268, Aix-Marseille université, faculté de médecine, secteur Nord, boulevard Pierre-Dramard, 13916 Marseille, France; Département de Maïeutique de Montpellier, institut de biologie, université de Montpellier, 4, boulevard Henri-IV, 34000 Montpellier, France.
| | - L Thollon
- IFSTTAR, LBA UMRT 24, Aix-Marseille université, faculté de médecine, secteur Nord, boulevard Pierre-Dramard, 13916 Marseille, France
| | - F Marchal
- Département de Maïeutique de Montpellier, institut de biologie, université de Montpellier, 4, boulevard Henri-IV, 34000 Montpellier, France
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16
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Picart B, Pons M, Line A, François C, Poli Merol ML. [Therapeutic mega-ureter primitive before one year of life, retrospective study of 20years]. Prog Urol 2017; 27:103-9. [PMID: 28169124 DOI: 10.1016/j.purol.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 10/10/2016] [Accepted: 12/17/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION What is the proper way to manage complicated primary mega-ureter in infants under the age of one. This has already been discussed in the literature but the controversy remains. OBJECTIVE Evaluate the long-term results of the management of mega-ureter based support under the age of one. MATERIAL AND METHODS Single-center retrospective study from 1990 to 2010. All children under one year found were evaluated including clinical examination, ultrasound, scintigraphy and cystography. They were divided into two groups: group 1: children operated on before the age of one year, group 2 non-operated or operated children after the age of one year. We analyzed the long-term evolution of these children on the following criteria: reflux, pyelonephritis, changes in dilation, renal function, need for surgical revision or secondary surgery, and impact on bladder function. RESULTS In total, 54 patients were included in group 1 and 56 patients in group 2. In a median follow-up of 12 years. A total of 101 boys and 9 girls (sex-ratio 11.22). There were 57 left MUP (52%), 22 right (20%) and 31 bilateral (28%). A total of 71% of antenatal diagnosis. No difference on the emergence of complications: 25 (group 1) versus 31 (group 2) OR=0.69; 95% (0.307; 1.574); P=0.44. No difference between secondary surgery and revision surgery: group 1=12, group 2=22, OR=0.45; 95% CI (0.17, 1.09); P=0.06. No difference for daytime incontinence: OR=1.04; 95% CI (0.14; 7.64); P=0.67. Seventy-six children (69%) were finally made, 12 children operated twice (10.9%) and 34 children (31%) never made. CONCLUSION The main challenge of the MUP of management is the preservation of renal function. Sixty-nine percent of our children received surgery due to impaired renal function lower than 30% of urethral dilatation greater than 10mm associated with reflux or recurrent pyelonephritis. Clinical monitoring, regular ultrasound and isotopic testing are necessary and should be extended to adulthood. LEVEL OF EVIDENCE 5.
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Bauduer F. [Evolutionary medicine: A new look on health and disease]. Rev Med Interne 2017; 38:195-200. [PMID: 28104380 DOI: 10.1016/j.revmed.2016.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 09/27/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022]
Abstract
Evolutionary medicine represents an innovative approach deriving from evolutionary biology. It includes the initial Darwin's view, its actualization in the light of progresses in genetics and also dissident theories (i.e. non gene-based) particularly epigenetics. This approach enables us to reconsider the pathophysiology of numerous diseases, as for instance, infection, and our so-called diseases of civilization especially obesity, type 2 diabetes, allergy or cancer. Evolutionary medicine may also improve our knowledge regarding inter-individual variation in susceptibility to disease or drugs. Furthermore, it points out the impact of our behaviors and environment on the genesis of a series of diseases.
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Affiliation(s)
- F Bauduer
- UMR 5199 PACEA, université de Bordeaux, allée Geoffroy-Saint-Hilaire, 33615 Pessac cedex, France; Service d'hématologie, centre hospitalier de la Côte Basque, 64109 Bayonne cedex, France.
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18
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Haffen E, Poulet E. [Unsatisfactory response: definition and involvement]. Encephale 2016; 42:1S31-8. [PMID: 26879255 DOI: 10.1016/S0013-7006(16)30017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the treatment of unipolar depression, treatment response is a key issue in terms of evolution and prognosis. Within this concept, the inadequate response includes the worsening, the lack of response, partial response and poor tolerance. This lack of response may be related to intrinsic factors to the individual, but also to more extrinsic environmental factors. In this review, we explore this concept through its links with adherence and treatment duration. In this field, the concept of early response can be a powerful indicator of therapeutic response, which conditions the prescription of antidepressants beyond the strict framework of the sufficient period of 4 to 6 weeks. In addition to its impact on prognosis, the literature data show that the insufficient response is a significant burden in terms of medical and economic cost, and somatic comorbidity; and justifies a systematic identification of this dimension. Therefore self-reports (QIDS; BDI) will be preferred to the clinician-rated depression symptom rating scales (MADRS, HAMD) that require a specific training. Identifying predictors of non-response would be an attractive target for prescribers but the results to date are not operative.
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19
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Chene G, Lamblin G, Le Bail-Carval K, Beaufils E, Chabert P, Gaucherand P, Mellier G, Coppens Y. [Lucy's cancer(s): A prehistorical origin?]. ACTA ACUST UNITED AC 2016; 44:690-700. [PMID: 27839715 DOI: 10.1016/j.gyobfe.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/06/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The recent discovery of the earliest hominin cancer, a 1.7-million-year-old osteosarcoma from South Africa has raised the question of the origin of cancer and its determinants. We aimed to determine whether malignant and benign tumors exist in the past societies. METHODS A review of literature using Medline database and Google about benign and malignant tumors in prehistory and antiquity. Only cases with morphological and paraclinical analysis were included. The following keywords were used: cancer; paleopathology; malignant neoplasia; benign tumor; leiomyoma; myoma; breast cancer; mummies; soft tissue tumor; Antiquity. RESULTS Thirty-five articles were found in wich there were 34 malignant tumors, 10 benign tumors and 11 gynecological benign tumors. CONCLUSIONS The fact that there were some malignant tumors, even few tumors and probably underdiagnosed, in the past may be evidence that cancer is not only a disease of the modern world. Cancer may be indeed a moving target: we have likely predisposing genes to cancer inherited from our ancestors. The malignant disease could therefore appear because of our modern lifestyle (carcinogens and risk factors related to the modern industrial society).
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Affiliation(s)
- G Chene
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, CHU de Lyon, 59, boulevard Pinel, 69000 Lyon, France; EMR 3738, université Claude-Bernard Lyon 1, 69000 Lyon, France.
| | - G Lamblin
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, CHU de Lyon, 59, boulevard Pinel, 69000 Lyon, France
| | - K Le Bail-Carval
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, CHU de Lyon, 59, boulevard Pinel, 69000 Lyon, France
| | - E Beaufils
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, CHU de Lyon, 59, boulevard Pinel, 69000 Lyon, France
| | - P Chabert
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, CHU de Lyon, 59, boulevard Pinel, 69000 Lyon, France
| | - P Gaucherand
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, CHU de Lyon, 59, boulevard Pinel, 69000 Lyon, France
| | - G Mellier
- Département de gynécologie, hôpital Femme-Mère-Enfant, HFME, hospices civils de Lyon, CHU de Lyon, 59, boulevard Pinel, 69000 Lyon, France
| | - Y Coppens
- Chaire de paléoanthropologie, collège de France, 75005 Paris, France
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20
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Abstract
Jung's psychology proffers a sustained reflection on the traditional religious question of the relation of divine transcendence to immanence. On this issue his psychology affirms a position of radical immanence in its contention that the experience of divinity is initially wholly from within. Though this position remains on the periphery of religious and theological orthodoxy Jung is not alone in holding it among moderns. Paul Tillich adopts a similar stance with his controlling symbols of the divine as 'Ground of Being' and 'Depth of Reason'. Pierre Teilhard de Chardin understands divinity as the experiential energy of evolution itself working within nature and humanity toward greater configurations of universal communion as the basis of community. All of Jung's master symbols of individuation assume such an understanding of immanence uniting individual and totality. His psychology strongly suggests and contributes to the current emergence of a new religious sensitivity based on the awareness of the intra-psychic origin of all religions. In his later writings he held out such a position as a significant alternative to genocide.
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Képénékian L, Cebula H, Castinetti F, Graillon T, Brue T, Goichot B. Long-term outcome of macroprolactinomas. Ann Endocrinol (Paris) 2016; 77:641-648. [PMID: 27641080 DOI: 10.1016/j.ando.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Management of macroprolactinomas has dramatically changed in recent decades, from surgical to medical treatment as first-line therapy, with the development of dopamine agonists (DA). But few data exist on the long-term outcome of these patients. PATIENTS AND METHODS Retrospective descriptive multicenter study of patients with macroprolactinoma followed for at least 5 years between 1973 and 2008 at the University Hospitals of Strasbourg and Marseille. RESULTS Forty-eight patients were included with 27 men, hypopituitarism in 33.3% of all patients and mean serum prolactin (PRL) level at diagnosis 2218.2±4154.7μg/L. Among the patients, 58.3% received medical treatment, 25% had additional surgery and 12.5% surgery and radiotherapy. The mean follow-up duration was 196±100 months. At the end of follow-up, 10 patients (20.8%) were cured (i.e. normal PRL level and normal imaging, no symptoms and withdrawal of DA≥1 year), 33 (68.8%) were controlled (i.e. normal PRL level, normal or abnormal imaging, no symptoms, DA in progress) and 5 (10.4%) were uncontrolled. Uncontrolled patients had significant higher baseline PRL level (P=0.0412) and cabergoline cumulative dose (P=0.0065) compared to the controlled group. There was no increase in frequency of hypopituitarism. Clinically significant valvular heart disease was found in 2 patients but screening was not systematic. CONCLUSIONS Macroprolactinoma is currently most often a chronic disease controlled with DA. However, uncertainty about the adverse effects associated with high cumulative doses and the lack of data on the prognosis at very long-term should incite to revisit current strategies, including the role of surgery combined to medical treatment.
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Affiliation(s)
- Lori Képénékian
- Service de médecine interne, nutrition et endocrinologie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Hélène Cebula
- Service de neurochirurgie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Frédéric Castinetti
- CRN2M-UMR7286, service d'endocrinologie et centre de référence des maladies rares d'origine hypophysaire DEFHY, Aix-Marseille University, CNRS, Assistance publique-Hôpitaux de Marseille (AP-HM), hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 15, France
| | - Thomas Graillon
- Service de neurochirurgie, hôpital Timone, Assistance publique-Hôpitaux de Marseille (AP-HM), 264, rue Saint-Pierre, 13385 Marseille cedex 15, France
| | - Thierry Brue
- CRN2M-UMR7286, service d'endocrinologie et centre de référence des maladies rares d'origine hypophysaire DEFHY, Aix-Marseille University, CNRS, Assistance publique-Hôpitaux de Marseille (AP-HM), hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 15, France
| | - Bernard Goichot
- Service de médecine interne, nutrition et endocrinologie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Faculty of Medicine, University of Strasbourg, 4, rue Kirschleger, 67000 Strasbourg, France.
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Pan Q, Anderson J, Bertho S, Herpin A, Wilson C, Postlethwait JH, Schartl M, Guiguen Y. Vertebrate sex-determining genes play musical chairs. C R Biol 2016; 339:258-62. [PMID: 27291506 PMCID: PMC5393452 DOI: 10.1016/j.crvi.2016.05.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/19/2016] [Accepted: 04/26/2016] [Indexed: 12/21/2022]
Abstract
Sexual reproduction is one of the most highly conserved processes in evolution. However, the genetic and cellular mechanisms making the decision of whether the undifferentiated gonad of animal embryos develops either towards male or female are manifold and quite diverse. In vertebrates, sex-determining mechanisms range from environmental to simple or complex genetic mechanisms and different mechanisms have evolved repeatedly and independently. In species with simple genetic sex-determination, master sex-determining genes lying on sex chromosomes drive the gonadal differentiation process by switching on a developmental program, which ultimately leads to testicular or ovarian differentiation. So far, very few sex-determining genes have been identified in vertebrates and apart from mammals and birds, these genes are apparently not conserved over a larger number of related orders, families, genera, or even species. To fill this knowledge gap and to better explore genetic sex-determination, we propose a strategy (RAD-Sex) that makes use of next-generation sequencing technology to identify genetic markers that define sex-specific segments of the male or female genome.
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Affiliation(s)
- Qiaowei Pan
- Inra, Fish Physiology and Genomics Laboratory, 35042 Rennes, France
| | | | - Sylvain Bertho
- Inra, Fish Physiology and Genomics Laboratory, 35042 Rennes, France; University of Wuerzburg, Physiological Chemistry, Biocenter, 97074 Würzburg, Germany
| | - Amaury Herpin
- Inra, Fish Physiology and Genomics Laboratory, 35042 Rennes, France
| | - Catherine Wilson
- University of Oregon, Institute of Neuroscience, Eugene, OR 97403, USA
| | | | - Manfred Schartl
- University of Wuerzburg, Physiological Chemistry, Biocenter, 97074 Würzburg, Germany; Comprehensive Cancer Center Mainfranken, University Hospital, 97080 Würzburg, Germany; Texas Institute for Advanced Study and Department of Biology, Texas A&M University, College Station, Texas 77843, USA
| | - Yann Guiguen
- Inra, Fish Physiology and Genomics Laboratory, 35042 Rennes, France.
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Abstract
A brief history of the development of genomics is provided. Complete sequencing of genomes of uni- and multicellular organisms is based on important progress in sequencing and bioinformatics. Evolution of these methods is ongoing and has triggered an explosion in data production and analysis. Initial analyses focused on the inventory of genes encoding proteins. Completeness and quality of gene prediction remains crucial. Genome analyses profoundly modified our views on evolution, biodiversity and contributed to the detection of new functions, yet to be fully elucidated, such as those fulfilled by non-coding RNAs. Genomics has become the basis for the study of biology and provides the molecular support for a bunch of large-scale studies, the omics.
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Affiliation(s)
- Jean Weissenbach
- Commissariat à l'énergie atomique et aux énergies alternatives, Institut de génomique, Genoscope, 2, rue Gaston-Crémieux, 91000 Évry, France; CNRS, Unité de génomique métabolique UMR8030, 2, rue Gaston-Crémieux, 91000 Évry, France; Université d'Évry, Unité de génomique métabolique UMR8030, 2, rue Gaston-Crémieux, 91000 Évry, France.
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Batouche DD, Elhalimi K, Benatta NF. [Cardiac dysfunction secondary to an adrenergic storm or cardiomyopathy of stress among child victims of traumatism]. Ann Cardiol Angeiol (Paris) 2016; 65:171-174. [PMID: 27184510 DOI: 10.1016/j.ancard.2016.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/20/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To provide information specific to a catecholaminergic storm during a violent stress in children. PATIENTS AND METHODS Two clinical observations in children who suffered violent trauma. FIRST CASE a boy aged 12 years victim of a drowning in Stage 3 admitted to the pediatric intensive care 02.08.2015. He was intubated, ventilated, sedated with benzodiazepines and morphine. Cardiac exploration revealed a global hypokinesis with septal dyskinesia, a 45% FES offset a slight excess of ST, a troponin I to 31.46pg/mL NT-proBNB to 1291pg/mL. Dobutamine was set initially at 7 then 10 gamma/kg/min. The outcome was favorable on the heart level with improved SEF in 1 week. SECOND CASE 13-year-old girl, victim of complete hanging, admitted on 06/08/2015 for a post-anoxic encephalopathy. Intubated, ventilated and sedated with morphine and benzodiazepines. Cardiac exploration showed septal hypokinesia with a 35% FES, a lengthening of the QT interval on the ECG, a troponin I in ultra 1.27μg/L, NT-proBNB to 215pg/mL. The child was put up 15 gamma dobutamine/kg/min. The evolution was marked by improved heart function without disturbance wall motion after 7 days. CONCLUSION Our 2 clinical cases following accidental trauma violating represent observations of a picture simulating a syndrome of Tako-Tsubo without anginal pain objectified as our 2 patients were sedated and ultrasound abnormalities returned to normal in less than a week.
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Affiliation(s)
- D D Batouche
- Service de réanimation pédiatrique, CHU d'Oran, Oran, Algérie.
| | - K Elhalimi
- Service de réanimation pédiatrique, CHU d'Oran, Oran, Algérie
| | - N F Benatta
- Unité enfant, service de cardiologie, CHU d'Oran, Oran, Algérie
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Mignerot L, Coelho SM. The origin and evolution of the sexes: Novel insights from a distant eukaryotic linage. C R Biol 2016; 339:252-7. [PMID: 27236828 DOI: 10.1016/j.crvi.2016.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 03/05/2016] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 10/21/2022]
Abstract
Sexual reproduction is an extraordinarily widespread phenomenon that assures the production of new genetic combinations in nearly all eukaryotic lineages. Although the core features of sexual reproduction (meiosis and syngamy) are highly conserved, the control mechanisms that determine whether an individual is male or female are remarkably labile across eukaryotes. In genetically controlled sexual systems, gender is determined by sex chromosomes, which have emerged independently and repeatedly during evolution. Sex chromosomes have been studied in only a handful of classical model organism, and empirical knowledge on the origin and evolution of the sexes is still surprisingly incomplete. With the advent of new generation sequencing, the taxonomic breadth of model systems has been rapidly expanding, bringing new ideas and fresh views on this fundamental aspect of biology. This mini-review provides a quick state of the art of how the remarkable richness of the sexual characteristics of the brown algae is helping to increase our knowledge about the evolution of sex determination.
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Affiliation(s)
- Laure Mignerot
- CNRS, Algal Genetics Group, UMR 8227, Integrative Biology of Marine Models, Sorbonne Universités, UPMC (Université Paris-6, station biologique de Roscoff, place George-Teissier, CS 90074, 29688 Roscoff cedex, France
| | - Susana M Coelho
- CNRS, Algal Genetics Group, UMR 8227, Integrative Biology of Marine Models, Sorbonne Universités, UPMC (Université Paris-6, station biologique de Roscoff, place George-Teissier, CS 90074, 29688 Roscoff cedex, France.
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Abstract
The evolutionary history of modern humans means much more than their demographic past. It includes the way in which humans have had to genetically adapt to the different environments they have encountered-nutritional, climatic or pathogenic-as well as the different epigenetic responses elicited by such environmental cues. Detecting how natural selection has affected human genome variability has proven to be a powerful tool to delineate genes and biological functions having played a key role in human adaptation, a variation which can also be involved in phenotypes of medical relevance. This article reviews several examples that illustrate well how different environmental pressures, particularly those imposed by pathogens and infectious diseases, have shaped the patterns of genetic and epigenetic variability currently observed in human populations.
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Affiliation(s)
- Lluis Quintana-Murci
- Unit of Human Evolutionary Genetics, CNRS URA3012, Institut Pasteur, 25-28, rue du Docteur-Roux, 75015 Paris, France.
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Horo K, Djè Bi H, Koné A, Koffi MO, Brou-Godé VC, Ahui Brou JM, Ouattara L, Touré K, Gnazé ZA, N'gom A, Kouassi BA, Koffi N, Aka-Danguy E. [Dynamic of indicators of ambulatory care of tuberculosis in the antituberculous center of Adjamé]. Rev Pneumol Clin 2016; 72:129-135. [PMID: 26651930 DOI: 10.1016/j.pneumo.2015.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 09/03/2015] [Accepted: 09/14/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Tuberculosis (TB) remains a real problem of public health in Côte d'Ivoire. The aim of our study is to describe the dynamic of anti-TB fight indicators in anti-TB center (CAT) of Adjamé. METHODOLOGY We realized a retrospective study, comparing the anti-TB activities of two periods (1999-2001 versus 2010-2012) at the CAT of Adjamé. Over two periods, 24,520 cases of TB were recorded in the registers of TB declaration. RESULTS Logistic regression results were the following ones. The proportion of the patients of Adjamé municipality increased to detriment of the patients coming from other municipalities. Our study showed an increase of TB contagious forms, a reduction of new cases of TB. The rate of screening of HIV infection increased. We noted a reduction of TB-HIV co-infection prevalence. The proportion of smear positive at the 2nd month decreased. We noted an increase of the rate therapeutic success and a reduction of lost at follow-up. CONCLUSION Important progresses were realized in the TB fight and TB-HIV co-infection.
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Affiliation(s)
- K Horo
- Service de pneumologie, centre hospitalier universitaire de Cocody, université Felix-Houphouet-Boigny, Abidjan, Côte d'Ivoire.
| | - H Djè Bi
- Service de pneumologie, CHU de Bouaké, université Ouattara-Allassane-Dramane, Bouaké, Côte d'Ivoire
| | - A Koné
- Service de pneumologie, centre hospitalier universitaire de Cocody, université Felix-Houphouet-Boigny, Abidjan, Côte d'Ivoire
| | - M O Koffi
- Service de pneumologie, centre hospitalier universitaire de Cocody, université Felix-Houphouet-Boigny, Abidjan, Côte d'Ivoire
| | - V C Brou-Godé
- Service de pneumologie, centre hospitalier universitaire de Cocody, université Felix-Houphouet-Boigny, Abidjan, Côte d'Ivoire
| | - J-M Ahui Brou
- Service de pneumologie, centre hospitalier universitaire de Cocody, université Felix-Houphouet-Boigny, Abidjan, Côte d'Ivoire
| | - L Ouattara
- Service de pneumologie, centre hospitalier universitaire de Cocody, université Felix-Houphouet-Boigny, Abidjan, Côte d'Ivoire
| | - K Touré
- Centre antituberculeux d'Adjamé, Abidjan, Côte d'Ivoire
| | - Z A Gnazé
- Centre antituberculeux d'Adjamé, Abidjan, Côte d'Ivoire
| | - A N'gom
- Service de pneumologie, centre hospitalier universitaire de Cocody, université Felix-Houphouet-Boigny, Abidjan, Côte d'Ivoire
| | - B A Kouassi
- Service de pneumologie, centre hospitalier universitaire de Cocody, université Felix-Houphouet-Boigny, Abidjan, Côte d'Ivoire
| | - N Koffi
- Service de pneumologie, centre hospitalier universitaire de Cocody, université Felix-Houphouet-Boigny, Abidjan, Côte d'Ivoire
| | - E Aka-Danguy
- Service de pneumologie, centre hospitalier universitaire de Cocody, université Felix-Houphouet-Boigny, Abidjan, Côte d'Ivoire
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Abstract
First, a short summary of the moral enhancement debate is drawn up. Then an argument first put forward by J. Harris is explored: this argument is directly related to I. Perrson's and J. Savulescu's conception of moral life. To conclude, it is suggested that they advocate a naïve idea of technology, conceived as a neutral means for value loaded ends.
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Affiliation(s)
- Jean-Yves Goffi
- PPL (EA 3699), université Pierre-Mendès-France, Grenoble-2, Ufr SH, bâtiment Arsh, 1251, avenue Centrale, DU de Saint-Martin-d'Hères, BP 47, 38040 Grenoble cedex 9, France.
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Abstract
In his famous book Le hasard et la nécessité (1970), Monod claims that natural evolution is based on the interplay between chance and necessity bringing about adaptive evolutionary change. This article addresses a set of related questions about Monod's conception of chance: what does he mean when he uses the term "chance"? Does he invoke one or many different concepts of chance? What are the implications of his conception about the issue of the deterministic or indeterministic nature of the biological world? Is Monod's view of what chance is relevant in contemporary biology? This paper, structured by these four questions, aims at providing a synthetic study of the way Monod conceptualizes chance, particularly highlighting the metaphysical and epistemological implications of his conception and its value in biology today.
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Affiliation(s)
- Francesca Merlin
- Institut d'histoire et de philosophie des sciences et des techniques (IHPST), université Paris 1 Panthéon-Sorbonne & CNRS, UMR 8590, 13, rue du Four, 75006 Paris, France.
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Guérin A, Lebel D, Marando N, Prot-Labarthe S, Bourdon O, Bussières JF. [Determinants of the evolution of hospital pharmacy in France and Quebec: Perception of hospital pharmacists]. Ann Pharm Fr 2014; 72:202-15. [PMID: 24780836 DOI: 10.1016/j.pharma.2014.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 01/02/2014] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hospital pharmacy practice has evolved differently between France and Quebec. While this development is part of broader systems, French and Quebec hospitals have undergone significant changes over the years to cope with challenges, among others, the economic and demographic realities. PURPOSE The main objective is to evaluate and compare the perception of French and Quebec hospital pharmacists about the factors that have contributed to the evolution of pharmacy practice in their respective context. METHODS This is a descriptive cross-sectional study. The study focuses on a sample of experienced hospital pharmacists in France and Quebec. We targeted a convenience sample of 50 respondents per country. An online questionnaire with 15 pharmaceutical activities to which are connected nine factors that may have influenced the implementation of each of these activities in each country was used. The mean score was calculated for each of the nine factors for each activity. The perception of French and Quebec hospital pharmacists was then compared. A P value less than 0.05 was considered statistically significant. RESULTS Two hundred and sixty hospital pharmacists were directly contacted in France and 79 in Quebec. Seventy-eight French pharmacists and 77 Quebec pharmacists responded to the survey, that is a respective response rate of 30% and 97%, respectively. The hierarchy of factors that contributed to the evolution of pharmacy practice was similar between the two countries, legislative and regulatory factors as well as the concern for risk management and quality dominate; scientific human, economic factors and training have a relatively similar position. For cons, the news factor (6th in France against the 10th position in Quebec) and the academic factor (10th position in France against the 6th position in Quebec) obtained inverse scores between France and Quebec. CONCLUSION There are few data on the determinants of the evolution of hospital pharmacy in France and Quebec. The hierarchy of factors that contributed to the evolution of pharmacy practice is similar between the two countries, although differences of rank were found for the news and academic factors. Further studies are needed to better understand the factors that influence the evolution of pharmacy practice in health care institutions.
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Affiliation(s)
- A Guérin
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine (CHUSJ), 3175, chemin de la Côte Sainte-Catherine, Montréal, Québec H3T 1C5, Canada
| | - D Lebel
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine (CHUSJ), 3175, chemin de la Côte Sainte-Catherine, Montréal, Québec H3T 1C5, Canada
| | - N Marando
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine (CHUSJ), 3175, chemin de la Côte Sainte-Catherine, Montréal, Québec H3T 1C5, Canada
| | - S Prot-Labarthe
- Département de pharmacie, hôpital Robert-Debré, AP-HP, 48, boulevard Serurier, 75019 Paris, France
| | - O Bourdon
- Département de pharmacie, hôpital Robert-Debré, AP-HP, 48, boulevard Serurier, 75019 Paris, France; Faculté de pharmacie, université Paris Descartes, 4, avenue de l'Observatoire, 75270 Paris cedex 06, France; Éducation et pratiques de santé EA 3412, université Paris Nord-13, 74, rue Marcel-Cachin, 93017 Bobigny cedex, France
| | - J-F Bussières
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine (CHUSJ), 3175, chemin de la Côte Sainte-Catherine, Montréal, Québec H3T 1C5, Canada; Faculté de pharmacie, université de Montréal, 2900, Édouard Montpetit, Montréal, Québec H3T 1J4, Canada.
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31
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Coppens Y. [About Australopithecus afarensis Lucy]. Gynecol Obstet Fertil 2013; 41:477. [PMID: 23988471 DOI: 10.1016/j.gyobfe.2013.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/10/2013] [Indexed: 06/02/2023]
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Calvacante T, Derrey S, Curey S, Langlois O, Fréger P, Gérardin E, Castel H, Proust F. Distal middle cerebral artery aneurysm: A proposition of microsurgical management. Neurochirurgie 2013; 59:121-7. [PMID: 23806761 DOI: 10.1016/j.neuchi.2013.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 04/20/2013] [Accepted: 04/23/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Based on a cohort of patients treated on distal middle cerebral artery (MCA) aneurysm by microsurgical approach, the objectives were to assess the following: the postoperative functional outcome, study the causes of early neurological deterioration and to determine the predictive factors of favourable outcome. PATIENTS AND METHODS From a neurovascular prospective database, this retrospective longitudinal study included all the patients treated for cerebral aneurysm located on the distal segment of the MCA over two decades (January 1990-December 2011). The patients were all treated by microsurgical clipping exclusion. Any aneurysm was associated to infectious angiopathy. Data were retrieved from the patient's medical charts. The outcome was analysed twice: during the immediate postoperative period and at 6 months according to the modified Rankin scale. The relative risk was estimated for each variable and the prognostic factors were assessed using a multivariate logistic regression model (P<0.05). RESULTS Twenty-eight patients, mean age 40±13.3 years (median: 43 years; range 6-70 years) were divided into the ruptured group (n=20) and unruptured group (n=8). In the ruptured group, the initial clinical status was good (WFNS I-III) in 12 patients (60%) and poor in eight (40%) with an intracerebral haematoma (ICH) in 11 (55%). For both groups, the aneurysm location on the distal MCA decreased at a rate from 64.8% of the insular segment to 25% of the opercular then 10.7% to the cortical. During the hospital stay, neurological deterioration occurred in 16 patients (57.2%). The diagnosed causes were cerebral ischaemia in 10 (35.6%), initial ICH in three (10.7%), hydrocephalus in two (7.1%) and epilepsy in one (7.1%). At 6 months, a favourable outcome (mRS 0-2) was observed in 19 patients (68.1%), a definitive morbidity in seven (24.9%) and death in two (7.2%). Based on the prognostic factors, only the absence of immediate postoperative neurological deterioration was identified as significant for a favourable outcome. CONCLUSION These rare cerebral aneurysms resulted in a high proportion of poor initial status related to a frequent ICH. Cerebral ischaemia was a major cause of the immediate neurological deterioration and the absence of immediate neurological deterioration was the single identified prognostic factor.
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Kpelao E, Diop A, Beketi K, Tine I, Thioub M, Thiam AB, Ba MC. [Challenge of the management of severe trauma of cervical spine in sub-developed country]. Neurochirurgie 2013; 59:111-4. [PMID: 23796721 DOI: 10.1016/j.neuchi.2013.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 03/27/2013] [Accepted: 04/26/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND PURPOSE The management of cervical spine injuries requires a multidisciplinary approach based on emergency management and rehabilitation. In our context this chain fails, especially on the post-hospital care. Our goal is to explain the difficulties we had in the management of these patients in Dakar. METHODS This retrospective cohort study (2005-2009) included 99 patients admitted for severe cervical spinal cord injury in two hospitals in Dakar. The clinical signs, treatment and outcome were studied. The follow up was between 3 and 54 months. RESULTS The average age of patients was 36.1 years and the traffic accidents were the main etiology (73.7%). Medical transport of patients was done in 65.7% with an admission average time of 64.86 hours. On admission, 57.6% of patients had Frankel score A or B. Dislocations (59.6%) and Tear drop fractures (16.2%) were the main lesions. The surgery was performed in 83.8% with a mean interval of 128.84 hours after the trauma. Outpatient rehabilitation was offered whatever the patient's neurological status. Recovery was complete in 20.2% and partial in 31.3% with a mortality rate of 37.4%. Most deaths occurred between 1 and 6 months (59.5%) mainly due to decubitus complications (56.8%). CONCLUSION The efficacy of the management of severe spinal cord injuries is based on reducing the preoperative time and rehabilitation.
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