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Meillat H, Braticevic C, Zemmour C, Brun C, Cécile M, Faucher M, de Chaisemartin C, Lelong B. Real-world implementation of a geriatric-specific ERAS protocol in patients undergoing colonic cancer surgery. Eur J Surg Oncol 2020; 47:1012-1018. [PMID: 33261952 DOI: 10.1016/j.ejso.2020.11.128] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/11/2020] [Accepted: 11/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The aim of this single-center observational study was to evaluate the impact of implementing Enhanced Recovery After Surgery (ERAS) protocols, combined with systematic geriatric assessment and support, on surgical and oncological outcomes in patients aged 70 or older undergoing colonic cancer surgery. METHODS Two groups were formed from an actively maintained database from all patients undergoing laparoscopic colonic surgery for neoplasms during a defined period before (standard group) or after (ERAS group) the introduction of an ERAS program associated with systematic geriatric assessment. The primary outcome was postoperative 90-day morbidity. Secondary outcomes were total length of hospital stay, initiated and completed adjuvant chemotherapy (AC) rate, and 1-year mortality rate. RESULTS A total of 266 patients (135 standard and 131 ERAS) were included in the study. Overall 90-day morbidity and mean hospital stay were significantly lower in the ERAS group than in the standard group (22.1% vs. 35.6%, p = 0.02; and 6.2 vs. 9.3 days, p < 0.01, respectively). There were no differences in readmission rates and anastomotic complications. AC was recommended in 114 patients. The rate of initiated treatment was comparable between the groups (66.6% vs. 77.7%, p = 0.69). The rate of completed AC was significantly higher in the ERAS group (50% vs. 20%, p < 0.01) with a lower toxicity rate (57.1% vs. 87.5%, p = 0.002). The 1-year mortality rate was higher in the standard group (7.4% vs. 0.8%, p < 0.01). CONCLUSIONS The combination of ERAS protocols and geriatric assessment and support reduces the overall morbidity rate and improves 12-month oncologic outcomes.
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Affiliation(s)
- H Meillat
- Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France.
| | - C Braticevic
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - C Zemmour
- Inst. Paoli Calmettes, Dept. Clin. Res. & Invest., Biostat. & Methodolo. Unit, Marseille, France; Aix Marseille Univ., INSERM, IRD, SESSTIM, Marseille, France
| | - C Brun
- Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, France
| | - M Cécile
- Department of Medical Oncology, Institut Paoli Calmettes, Marseille, France
| | - M Faucher
- Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, France
| | - C de Chaisemartin
- Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France
| | - B Lelong
- Department of Digestive Surgical Oncology, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite, 13009, Marseille, France
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Collignon A, Hospital MA, Montersino C, Courtier F, Charbonnier A, Saillard C, D'Incan E, Mohty B, Guille A, Adelaïde J, Carbuccia N, Garnier S, Mozziconacci MJ, Zemmour C, Pakradouni J, Restouin A, Castellano R, Chaffanet M, Birnbaum D, Collette Y, Vey N. A chemogenomic approach to identify personalized therapy for patients with relapse or refractory acute myeloid leukemia: results of a prospective feasibility study. Blood Cancer J 2020; 10:64. [PMID: 32488055 PMCID: PMC7266815 DOI: 10.1038/s41408-020-0330-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 12/26/2019] [Revised: 04/06/2020] [Accepted: 04/23/2020] [Indexed: 02/05/2023] Open
Abstract
Targeted next-generation sequencing (tNGS) and ex vivo drug sensitivity/resistance profiling (DSRP) have laid foundations defining the functional genomic landscape of acute myeloid leukemia (AML) and premises of personalized medicine to guide treatment options for patients with aggressive and/or chemorefractory hematological malignancies. Here, we have assessed the feasibility of a tailored treatment strategy (TTS) guided by systematic parallel ex vivo DSRP and tNGS for patients with relapsed/refractory AML (number NCT02619071). A TTS issued by an institutional personalized committee could be achieved for 47/55 included patients (85%), 5 based on tNGS only, 6 on DSRP only, while 36 could be proposed on the basis of both, yielding more options and a better rationale. The TSS was available in <21 days for 28 patients (58.3%). On average, 3 to 4 potentially active drugs were selected per patient with only five patient samples being resistant to the entire drug panel. Seventeen patients received a TTS-guided treatment, resulting in four complete remissions, one partial remission, and five decreased peripheral blast counts. Our results show that chemogenomic combining tNGS with DSRP to determine a TTS is a promising approach to propose patient-specific treatment options within 21 days.
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Affiliation(s)
- A Collignon
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - M A Hospital
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - C Montersino
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, TrGET Preclinical Platform, Aix-Marseille Université, Marseille, France
| | - F Courtier
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Predictive Oncology, Aix-Marseille Université, Marseille, France
| | - A Charbonnier
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - C Saillard
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - E D'Incan
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - B Mohty
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
| | - A Guille
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Predictive Oncology, Aix-Marseille Université, Marseille, France
| | - J Adelaïde
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Predictive Oncology, Aix-Marseille Université, Marseille, France
| | - N Carbuccia
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Predictive Oncology, Aix-Marseille Université, Marseille, France
| | - S Garnier
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Predictive Oncology, Aix-Marseille Université, Marseille, France
| | - M J Mozziconacci
- Department of Biopathology, Institut Paoli-Calmettes, Marseille, France
| | - C Zemmour
- Department of Clinical Research & Innovation, Institut Paoli-Calmettes, Biostatistics & Methodology Unit, Aix Marseille Université, INSERM, IRD, SESSTIM, Marseille, France
| | - J Pakradouni
- Department of Clinical Research & Innovation, Sponsor Unit, Institut Paoli-Calmettes, Marseille, France
| | - A Restouin
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, TrGET Preclinical Platform, Aix-Marseille Université, Marseille, France
| | - R Castellano
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, TrGET Preclinical Platform, Aix-Marseille Université, Marseille, France
| | - M Chaffanet
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Predictive Oncology, Aix-Marseille Université, Marseille, France
| | - D Birnbaum
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, Predictive Oncology, Aix-Marseille Université, Marseille, France.
| | - Y Collette
- Inserm, CNRS, Institut Paoli-Calmettes, CRCM, TrGET Preclinical Platform, Aix-Marseille Université, Marseille, France.
| | - N Vey
- Haematology Department, Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France.
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Bouabdallah R, Zemmour C, Schiano de Collela J, Slama B, Bladé J, Belmecheri N, Coso D, Montes de Oca C, Stoppa A, Aurran-Schleinitz T, Cournier S, Ivanov V, Mescam L, Blaise D. A PHASE II STUDY OF LENALIDOMIDE AND RITUXIMAB (R²) COMBINATION IN PATIENTS WITH HIGH-RISK REFRACTORY/RELAPSED DIFFUSE LARGE B-CELL LYMPHOMA. Hematol Oncol 2019. [DOI: 10.1002/hon.106_2631] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- R. Bouabdallah
- Hematology; Cancer Center Institut Paoli-Calmettes; Marseille France
| | - C. Zemmour
- Hematology; Cancer Center Institut Paoli-Calmettes; Marseille France
| | | | - B. Slama
- Hematology; Centre Hospitalier Henri Duffaut; Avignon France
| | - J. Bladé
- Hematology; Hôpital d'Instruction des Armées; Toulon France
| | - N. Belmecheri
- Hematology; Cancer Center Institut Paoli-Calmettes; Marseille France
| | - D. Coso
- Hematology; Cancer Center Institut Paoli-Calmettes; Marseille France
| | - C. Montes de Oca
- Hematology; Cancer Center Institut Paoli-Calmettes; Marseille France
| | - A. Stoppa
- Hematology; Cancer Center Institut Paoli-Calmettes; Marseille France
| | | | - S. Cournier
- Hematology; Cancer Center Institut Paoli-Calmettes; Marseille France
| | - V. Ivanov
- Hematology; Hopital La Conception; Marseille France
| | - L. Mescam
- Hematology; Cancer Center Institut Paoli-Calmettes; Marseille France
| | - D. Blaise
- Hematology; Cancer Center Institut Paoli-Calmettes; Marseille France
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Sabatier R, Pomel C, Colombo PE, Narducci F, Garnier S, Carbuccia N, Guille A, Birnbaum D, Zemmour C, Lambaudie E. Circulating tumour DNA as an early marker of recurrence and treatment efficacy in ovarian carcinoma, the CIDOC study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy316.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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5
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Gilhodes J, Leconte E, Zemmour C, Filleron T. Comparaison de différentes méthodes de sélection de variables dans le cadre de données à haute dimension : application aux données de survie. Rev Epidemiol Sante Publique 2018. [DOI: 10.1016/j.respe.2018.03.365] [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] Open
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Mokart D, Saillard C, Zemmour C, Bisbal M, Sannini A, Chow-Chine L, Brun JP, Faucher M, Boher JM, Toiron Y, Chabannon C, Borg JP, Gonçalves A, Camoin L. Early prognostic factors in septic shock cancer patients: a prospective study with a proteomic approach. Acta Anaesthesiol Scand 2018; 62:493-503. [PMID: 29315472 DOI: 10.1111/aas.13060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Organ failures are the main prognostic factors in septic shock. The aim was to assess classical clinico-biological parameters evaluating organ dysfunctions at intensive care unit admission, combined with proteomics, on day-30 mortality in critically ill onco-hematology patients admitted to the intensive care unit for septic shock. METHODS This was a prospective monocenter cohort study. Clinico-biological parameters were collected at admission. Plasma proteomics analyses were performed, including protein profiling using isobaric Tag for Relative and Absolute Quantification (iTRAQ) and subsequent validation by ELISA. RESULTS Sixty consecutive patients were included. Day-30 mortality was 47%. All required vasopressors, 32% mechanical ventilation, 33% non-invasive ventilation and 13% renal-replacement therapy. iTRAQ-based proteomics identified von Willebrand factor as a protein of interest. Multivariate analysis identified four factors independently associated with day-30 mortality: positive fluid balance in the first 24 h (odds ratio = 1.06, 95% CI = 1.01-1.12, P = 0.02), severe acute respiratory failure (odds ratio = 6.14, 95% CI = 1.04-36.15, P = 0.04), von Willebrand factor plasma level > 439 ng/ml (odds ratio = 9.7, 95% CI = 1.52-61.98, P = 0.02), and bacteremia (odds ratio = 6.98, 95% CI = 1.17-41.6, P = 0.03). CONCLUSION Endothelial dysfunction, revealed by proteomics, appears as an independent prognostic factor on day-30 mortality, as well as hydric balance, acute respiratory failure and bacteremia, in critically ill cancer patients admitted to the intensive care unit. Endothelial failure is underestimated in clinical practice and represents an innovative therapeutic target.
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Affiliation(s)
- D. Mokart
- Polyvalent Intensive Care Unit; Department of Anesthesiology and Critical Care; Institut Paoli Calmettes; Marseille France
- Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie (GRRROH); Paris France
| | - C. Saillard
- Hematology Department; Institut Paoli Calmettes; Marseille France
| | - C. Zemmour
- Departement of Clinical Research and Innovation; Institut Paoli-Calmettes; Marseille France
| | - M. Bisbal
- Polyvalent Intensive Care Unit; Department of Anesthesiology and Critical Care; Institut Paoli Calmettes; Marseille France
- Groupe de Recherche en Réanimation Respiratoire en Onco-Hématologie (GRRROH); Paris France
| | - A. Sannini
- Polyvalent Intensive Care Unit; Department of Anesthesiology and Critical Care; Institut Paoli Calmettes; Marseille France
| | - L. Chow-Chine
- Polyvalent Intensive Care Unit; Department of Anesthesiology and Critical Care; Institut Paoli Calmettes; Marseille France
| | - J.-P. Brun
- Polyvalent Intensive Care Unit; Department of Anesthesiology and Critical Care; Institut Paoli Calmettes; Marseille France
| | - M. Faucher
- Polyvalent Intensive Care Unit; Department of Anesthesiology and Critical Care; Institut Paoli Calmettes; Marseille France
| | - J.-M. Boher
- Departement of Clinical Research and Innovation; Institut Paoli-Calmettes; Marseille France
| | - Y. Toiron
- Inserm, U1068; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
| | - C. Chabannon
- Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- CNRS, UMR7258; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- Aix-Marseille Medical University; Marseille France
- Cell Therapy Department; Institut Paoli Calmettes; Marseille France
| | - J.-P. Borg
- Inserm, U1068; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- CNRS, UMR7258; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- UM105; Aix-Marseille Université; Marseille France
| | - A. Gonçalves
- Inserm, U1068; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- CNRS, UMR7258; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- Aix-Marseille Medical University; Marseille France
- Department of Medical Oncology; Institut Paoli Calmettes; Marseille France
| | - L. Camoin
- Inserm, U1068; Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
- Centre de Recherche en Cancérologie de Marseille (CRCM); Marseille France
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De Nonneville A, Gonçalves A, Zemmour C, Cohen M, Classe J, Reyal F, Colombo P, Jouve E, Giard S, Barranger E, Sabatier R, Bertucci F, Boher J, Houvenaeghel G. Adjuvant chemotherapy in pT1ab node-negative triple negative breast carcinomas: Results of a national multi-institutional retrospective study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.024] [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: 11/13/2022] Open
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de Nonneville A, Gonçalves A, Zemmour C, Cohen M, Classe JM, Reyal F, Colombo PE, Jouve E, Giard S, Barranger E, Sabatier R, Bertucci F, Boher JM, Houvenaeghel G. Adjuvant chemotherapy in pT1ab node-negative triple-negative breast carcinomas: Results of a national multi-institutional retrospective study. Eur J Cancer 2017; 84:34-43. [PMID: 28780480 DOI: 10.1016/j.ejca.2017.06.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 04/24/2017] [Revised: 06/19/2017] [Accepted: 06/27/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Triple-negative breast cancers (TNBCs) are considered as associated with poor outcome, but prognosis of subcentimetric, node-negative disease remains controversial and evidence that adjuvant chemotherapy (CT) is effective in these small tumours remains limited. PATIENTS AND METHODS Our objective was to investigate the impact of CT on survival in pT1abN0M0 TNBC. Patients were retrospectively identified from a cohort of 22,475 patients who underwent primary surgery in 15 French centres between 1987 and 2013. As rare pathological types may display very particular prognoses in these tumours, we retained only the invasive ductal carcinomas of no special type according to the last World Health Organisation (WHO) classification which is the most common TNBC histological type. End-points were disease-free survival (DFS) and metastasis-free survival (MFS). A propensity score for receiving CT was estimated using a logistic regression including age, tumour size, Scarff Bloom and Richardson (SBR) grade and lymphovascular invasion. RESULTS Of a total of 284 patients with pT1abN0M0 ductal TNBC, 144 (51%) received CT and 140 (49%) did not. Patients receiving CT had more adverse prognostic features, such as tumour size, high grade, young age, and lymphovascular invasion. CT was not associated with a significant benefit for DFS (Hazard ratio, HR = 0.77 [0.40-1.46]; p = 0.419, log-rank test) or MFS (HR = 1.00 [0.46-2.19]; p = 0.997), with 5-year DFS and MFS in the group with CT versus without of 90% [81-94%] versus 84% [74-90%], and 90% [81-95%] versus 90% [83%-95%], respectively. Results were consistent in all supportive analyses including multivariate Cox model and the use of the propensity score for adjustment and as a matching factor for case-control analyses. CONCLUSIONS This study did not identify a significant DFS or MFS advantage for CT in subcentimetric, node-negative ductal TNBC. Although current consensus guidelines recommend consideration of CT in all TNBC larger than 5 mm, clinicians should carefully discuss benefit/risk ratio with patients, given the unproven benefits.
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Affiliation(s)
- A de Nonneville
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France.
| | - A Gonçalves
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France.
| | - C Zemmour
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - M Cohen
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, Marseille, France
| | - J M Classe
- Institut René Gauducheau, Saint-Herblain, France
| | - F Reyal
- Institut Curie, Paris, France
| | | | - E Jouve
- Institut Claudius Regaud, Toulouse, France
| | - S Giard
- Centre Oscar Lambret, Lille, France
| | | | - R Sabatier
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - F Bertucci
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Medical Oncology, CRCM, Marseille, France
| | - J M Boher
- Department of Clinical Research and Investigation, Biostatistics and Methodology Unit, Institut Paoli-Calmettes, Aix Marseille University, INSERM, IRD, SESSTIM, Marseille, France
| | - G Houvenaeghel
- Aix-Marseille University, CNRS, INSERM, Institut Paoli-Calmettes, Department of Surgical Oncology, CRCM, Marseille, France
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Zemmour C, Gonçalves A, Pakradouni Demeestere J, Paoletti X. Application d’un modèle logistique à intercept aléatoire à un essai de phase Ib/II pour évaluer la toxicité répétée de la combinaison de doses de deux agents anti-cancéreux. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.03.043] [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: 11/16/2022] Open
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10
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Duclos Y, Grapperon A, Jouve E, Truillet R, Zemmour C, Verschueren A, Pouget J, Attarian S. Motor-evoked potential gain is a helpful test for the detection of corticospinal tract dysfunction in amyotrophic lateral sclerosis. Clin Neurophysiol 2017; 128:357-364. [DOI: 10.1016/j.clinph.2016.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 12/08/2016] [Accepted: 12/13/2016] [Indexed: 10/20/2022]
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Bruguerolle B, Jadot G, Valli M, Bouyard L, Zemmour C, Mouchet J, Bouyard P. [Determination of the free plasma fraction of drugs]. Therapie 1980; 35:554-5. [PMID: 7466736] [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: 01/25/2023]
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