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Bessis D, Bursztejn AC, Morice-Picard F, Capri Y, Barbarot S, Aubert H, Bodet D, Bourrat E, Chiaverini C, Poujade L, Willems M, Rouanet J, Dompmartin-Blanchère A, Geneviève D, Gerard M, Ginglinger E, Hadj-Rabia S, Martin L, Mazereeuw-Hautier J, Bibas N, Molinari N, Herman F, Phan A, Rod J, Roger H, Sigaudy S, Ziegler A, Vial Y, Verloes A, Cavé H, Lacombe D. Dermatological manifestations in Costello syndrome: A prospective multicentric study of 31 HRAS-positive variant patients. J Eur Acad Dermatol Venereol 2024. [PMID: 38595321 DOI: 10.1111/jdv.19996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Data on dermatological manifestations of Costello syndrome (CS) remain heterogeneous and lack in validated description. OBJECTIVES To describe the dermatological manifestations of CS; compare them with the literature findings; assess those discriminating CS from other RASopathies, including cardiofaciocutaneous syndrome (CFCS) and the main types of Noonan syndrome (NS); and test for dermatological phenotype-genotype correlations. METHODS We performed a 10-year, large, prospective, multicentric, collaborative dermatological and genetic study. RESULTS Thirty-one patients were enrolled. Hair abnormalities were ubiquitous, including wavy or curly hair and excessive eyebrows, respectively in 68% and 56%. Acral excessive skin (AES), papillomas and keratotic papules (PKP), acanthosis nigricans (AN), palmoplantar hyperkeratosis (PPHK) and 'cobblestone' papillomatous papules of the upper lip (CPPUL), were noted respectively in 84%, 61%, 65%, 55% and 32%. Excessive eyebrows, PKP, AN, CCPUL and AES best differentiated CS from CFCS and NS. Multiple melanocytic naevi (>50) may constitute a new marker of attenuated CS associated with intragenic duplication in HRAS. Oral acitretin may be highly beneficial for therapeutic management of PPHK. No significant dermatological phenotype-genotype correlation was determined between patients with and without HRAS c.34G>A (p.G12S). CONCLUSIONS AND RELEVANCE This validated phenotypic characterization of a large number of patients with CS will allow future researchers to make a positive diagnosis, and to differentiate CS from CFCS and NS.
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Affiliation(s)
- Didier Bessis
- Department of Dermatology, Saint-Eloi Hospital, University of Montpellier, Montpellier, France
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- INSERM U1058, Montpellier, France
| | | | - Fanny Morice-Picard
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- Department of Paediatric Dermatology, Pellegrin University Hospital of Bordeaux, Bordeaux, France
| | - Yline Capri
- Department of Clinical Genetics, Robert-Debré Hospital, Paris, France
- French National Reference Centre for Developmental Anomalies and Malformative Syndromes - Ile de France, Robert-Debré Hospital, AP-HP, Paris, France
| | - Sébastien Barbarot
- Department of Dermatology, Hotel Dieu Hospital, University of Nantes, Nantes, France
| | - Hélène Aubert
- Department of Dermatology, Hotel Dieu Hospital, University of Nantes, Nantes, France
| | - Damien Bodet
- Department of Paediatric Haematology-Immunology-Oncology, Caen Normandie Hospital and University of Caen, Caen, France
| | - Emmanuelle Bourrat
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- Department of Paediatric Dermatology, Robert-Debré Hospital, AP-HP, Paris, France
| | - Christine Chiaverini
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- Department of Dermatology, l'Archet 2 Hospital, University of Nice, Nice, France
| | - Laura Poujade
- Department of Dermatology, Saint-Eloi Hospital, University of Montpellier, Montpellier, France
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
| | - Marjolaine Willems
- Department of Clinical Genetics, Arnaud de Villeneuve Hospital, University of Montpellier, Montpellier, France
- French National Reference Centre for Developmental Anomalies - and Malformative Syndromes Sud Ouest Occitanie, University hospital of Montpellier, Montpellier, France
| | - Jacques Rouanet
- Department of Dermatology, d'Estaing Hospital and University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | | | - David Geneviève
- Department of Clinical Genetics, Arnaud de Villeneuve Hospital, University of Montpellier, Montpellier, France
- French National Reference Centre for Developmental Anomalies - and Malformative Syndromes Sud Ouest Occitanie, University hospital of Montpellier, Montpellier, France
| | - Marion Gerard
- Department of Clinical Genetics, Caen Normandie Hospital and University of Caen, Caen, France
| | | | - Smaïl Hadj-Rabia
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- Department of Paediatric Dermatology, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Ludovic Martin
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- Department of Dermatology, Angers Hospital University, Angers, France
| | - Juliette Mazereeuw-Hautier
- French National Reference Centre for Rare Diseases of the Skin and Mucous Membranes of Genetic Origin (MAGEC), University hospital of Montpellier, Montpellier, France
- Department of Dermatology, Larrey Hospital, University of Toulouse, Toulouse, France
| | - Nathalie Bibas
- Department of Dermatology, Larrey Hospital, University of Toulouse, Toulouse, France
| | - Nicolas Molinari
- Department of Statistics, La Colombière Hospital and University of Montpellier, Montpellier, France
| | - Fanchon Herman
- Department of Statistics, La Colombière Hospital and University of Montpellier, Montpellier, France
| | - Alice Phan
- Department of Paediatric Dermatology, Femme-Mère-Enfant Hospital-HCL, University of Lyon, Lyon, France
| | - Julien Rod
- Department of Paediatric Surgery, Caen Normandie Hospital and University of Caen, Caen, France
| | | | - Sabine Sigaudy
- French National Reference Centre for Developmental Anomalies and Malformative Syndromes - Ile de France, Robert-Debré Hospital, AP-HP, Paris, France
- Department of Clinical Genetics, La Timone Hospital, AP-HM and University of Marseille, Marseille, France
| | - Alban Ziegler
- Department of Clinical Genetics, Hospital and University of Angers, Angers, France
| | - Yoann Vial
- French National Reference Centre for Developmental Anomalies and Malformative Syndromes - Ile de France, Robert-Debré Hospital, AP-HP, Paris, France
- Department of Molecular Genetics, Robert-Debré Hospital, AP-HP, Paris, France
| | - Alain Verloes
- Department of Clinical Genetics, Robert-Debré Hospital, Paris, France
- French National Reference Centre for Developmental Anomalies and Malformative Syndromes - Ile de France, Robert-Debré Hospital, AP-HP, Paris, France
| | - Hélène Cavé
- French National Reference Centre for Developmental Anomalies and Malformative Syndromes - Ile de France, Robert-Debré Hospital, AP-HP, Paris, France
- Department of Molecular Genetics, Robert-Debré Hospital, AP-HP, Paris, France
| | - Didier Lacombe
- Department of Clinical Genetics, Pellegrin University Hospital of Bordeaux, Bordeaux, France
- French National Reference Centre for Developmental Anomalies - and Malformative Syndromes SOOR, University Hospital of Bordeaux, Bordeaux, France
- INSERM U1211, Bordeaux, France
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Magaldi M, Nogue E, Molinari N, De Luca N, Dupuy AM, Leclercq F, Pasquie JL, Roubille C, Mercier G, Cristol JP, Roubille F. Predicting One-Year Mortality after Discharge Using Acute Heart Failure Score (AHFS). J Clin Med 2024; 13:2018. [PMID: 38610783 PMCID: PMC11012877 DOI: 10.3390/jcm13072018] [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: 02/23/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Acute heart failure (AHF) represents a leading cause of unscheduled hospital stays, frequent rehospitalisations, and mortality worldwide. The aim of our study was to develop a bedside prognostic tool, a multivariable predictive risk score, that is useful in daily practice, thus providing an early prognostic evaluation at admission and an accurate risk stratification after discharge in patients with AHF. Methods: This study is a subanalysis of the STADE HF study, which is a single-centre, prospective, randomised controlled trial enrolling 123 patients admitted to hospital for AHF. Here, 117 patients were included in the analysis, due to data exhaustivity. Regression analysis was performed to determine predictive variables for one-year mortality and/or rehospitalisation after discharge. Results: During the first year after discharge, 23 patients died. After modellisation, the variables considered to be of prognostic relevance in terms of mortality were (1) non-ischaemic aetiology of HF, (2) elevated creatinine levels at admission, (3) moderate/severe mitral regurgitation, and (4) prior HF hospitalisation. We designed a linear model based on these four independent predictive variables, and it showed a good ability to score and predict patient mortality with an AUC of 0.84 (95%CI: 0.76-0.92), thus denoting a high discriminative ability. A risk score equation was developed. During the first year after discharge, we observed as well that 41 patients died or were rehospitalised; hence, while searching for a model that could predict worsening health conditions (i.e., death and/or rehospitalisation), only two predictive variables were identified: non-ischaemic HF aetiology and previous HF hospitalisation (also included in the one-year mortality model). This second modellisation showed a more discrete discriminative ability with an AUC of 0.67 (95% C.I. 0.59-0.77). Conclusions: The proposed risk score and model, based on readily available predictive variables, are promising and useful tools to assess, respectively, the one-year mortality risk and the one-year mortality and/or rehospitalisations in patients hospitalised for AHF and to assist clinicians in the management of patients with HF aiming at improving their prognosis.
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Affiliation(s)
- Mariarosaria Magaldi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (M.M.)
- Cardiology Department, Montpellier University Hospital, Inserm U1046, CNRS UMR 9214, PhyMedExp, 34295 Montpellier, France (J.-L.P.)
| | - Erika Nogue
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier University, 34090 Montpellier, France
| | - Nicolas Molinari
- Institute of Epidemiology and Public Health, INSERM, INRIA, CHU Montpellier, University of Montpellier, 34090 Montpellier, France
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy; (M.M.)
| | - Anne-Marie Dupuy
- Département de Biochimie et Hormonologie, Centre de Ressources Biologiques, CHU de Montpellier, 34295 Montpellier, France;
| | - Florence Leclercq
- Cardiology Department, Montpellier University Hospital, Inserm U1046, CNRS UMR 9214, PhyMedExp, 34295 Montpellier, France (J.-L.P.)
| | - Jean-Luc Pasquie
- Cardiology Department, Montpellier University Hospital, Inserm U1046, CNRS UMR 9214, PhyMedExp, 34295 Montpellier, France (J.-L.P.)
| | - Camille Roubille
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, CEDEX 5, 34090 Montpellier, France
- Department of Internal Medicine PhyMedExp CHU Montpellier, Montpellier University, 34090 Montpellier, France
| | - Grégoire Mercier
- Department of Statistics, Montpellier University Hospital, CEDEX 5, 34090 Montpellier, France;
| | - Jean-Paul Cristol
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, CEDEX 5, 34090 Montpellier, France
- Laboratory of Biochemistry, Montpellier University Hospital, CEDEX 5, 34090 Montpellier, France
| | - François Roubille
- Cardiology Department, Montpellier University Hospital, Inserm U1046, CNRS UMR 9214, PhyMedExp, 34295 Montpellier, France (J.-L.P.)
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, CEDEX 5, 34090 Montpellier, France
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Bessis D, Devoye C, Molinari N, Quéré I, de La Villéon G, Jeziorski É. BASCULE syndrome: Additional evidence for the association with autonomic dysfunction. Pediatr Dermatol 2024; 41:377-378. [PMID: 38494782 DOI: 10.1111/pde.15522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/16/2023] [Indexed: 03/19/2024]
Affiliation(s)
- Didier Bessis
- Department of Dermatology, Saint-Eloi University Hospital of Montpellier, Montpellier, France
| | - Céline Devoye
- Department of Pediatric Infectious Diseases and Immunology, Arnaud de Villeneuve University Hospital of Montpellier, Montpellier, France
| | - Nicolas Molinari
- Medical and Informatic Department, Lapeyronie University Hospital of Montpellier, Montpellier, France
| | - Isabelle Quéré
- Department of Vascular Medicine, Saint-Eloi University Hospital of Montpellier, Montpellier, France
| | - Grégoire de La Villéon
- Department of Pediatric and Congenital Cardiology, M3C Regional Reference Center, University Hospital, Montpellier, France
- Department of Pediatric Cardiology and Rehabilitation Unit, Saint-Pierre Institute, Palavas-Les-Flots, France
| | - Éric Jeziorski
- Department of Pediatric Infectious Diseases and Immunology, Arnaud de Villeneuve University Hospital of Montpellier, Montpellier, France
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Ughetto A, Aouinti S, Molinari N, Roubille F, Delmas C. Early left ventricular unloading via active transseptal left atrial venting in case of cardiogenic shock under veno-arterial extracorporeal membrane oxygenation: A meta-analysis. Eur J Heart Fail 2024. [PMID: 38374544 DOI: 10.1002/ejhf.3178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/06/2024] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open
Affiliation(s)
- Aurore Ughetto
- Anesthesia and Intensive Cardiac Care Unit, Montpellier University Hospital, Montpellier, France
| | - Safa Aouinti
- Clinical Research and Epidemiology Unit, Montpellier University Hospital, Montpellier, France
| | - Nicolas Molinari
- Clinical Research and Epidemiology Unit, Montpellier University Hospital, Montpellier, France
| | - François Roubille
- Intensive Cardiac Care Unit, Cardiology Department, Montpellier University Hospital, Montpellier, France
| | - Clément Delmas
- Intensive Cardiac Care Unit, Cardiology Department, Rangueil University Hospital, Toulouse, France
- Recherche et Enseignement en Insuffisance Cardiaque Avancée, Assistance et Transplantation (REICATRA), Institut Saint Jacques, CHU de Toulouse, Toulouse, France
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Depuydt P, Molinari N, Sonneville R. Selective decontamination of the digestive tract: it's all in your mind! Intensive Care Med 2024; 50:128-130. [PMID: 38127144 DOI: 10.1007/s00134-023-07286-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Pieter Depuydt
- Department of Intensive Care, Ghent University Hospital, Ghent, Belgium
| | - Nicolas Molinari
- Department of Statistics, IDESP, INSERM, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Romain Sonneville
- Université Paris Cité, INSERM UMR 1137, 75018, Paris, France.
- APHP.Nord, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 75018, Paris, France.
- Service de Médecine Intensive-Réanimation, Hôpital Bichat, Claude Bernard, 46 rue Henri Huchard, 75877, Paris Cedex, France.
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Charbit J, Courvalin E, Dagod G, Laumon T, Hammani S, Molinari N, Capdevila X. PCO2 Gradient Between Inlet and Outlet Blood of Extracorporeal Respiratory Support is a Reliable Marker of CO2 Elimination. ASAIO J 2023:00002480-990000000-00375. [PMID: 38127592 DOI: 10.1097/mat.0000000000002122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Our objective was to assess the relationship between the pre-/post-oxygenator gradient of the partial pressure of carbon dioxide (∆EC PCO2; dissolved form) and CO2 elimination under extracorporeal respiratory support. All patients who were treated with veno-venous extracorporeal membrane oxygenation and high-flow extracorporeal CO2 removal in our intensive care unit over 18 months were included. Pre-/post-oxygenator blood gases were collected every 12 h and CO2 elimination was calculated for each pair of samples (pre-/post-oxygenator total carbon dioxide content in blood [ctCO2] × pump flow [extracorporeal pump flow {QEC}]). The relationship between ∆EC PCO2 and CO2 elimination, as well as the origin of CO2 removed. Eighteen patients were analyzed (24 oxygenators and 293 datasets). Each additional unit of ∆EC PCO2 × QEC was associated with an increase in CO2 elimination of 5.2 ml (95% confidence interval [CI], 4.7-5.6 ml; p < 0.001). Each reduction of 1 ml STPD/dl of CO2 across the oxygenator was associated with a reduction of 0.63 ml STPD/dl (95% CI, 0.60-0.66) of CO2 combined with water, 0.08 ml STPD/dl (95% CI, 0.07-0.09) of dissolved CO2, and 0.29 ml STPD/dl (95% CI, 0.27-0.31) of CO2 in erythrocytes. The pre-/post-oxygenator PCO2 gradient under extracorporeal respiratory support is thus linearly associated with CO2 elimination; however, most of the CO2 removed comes from combined CO2 in plasma, generating bicarbonate.
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Affiliation(s)
- Jonathan Charbit
- From the Trauma and Polyvalent Critical Care Unit, Montpellier University Hospital, Montpellier, France
- institut Desbrest d'épidémiologie et de santé publique, institut national de la santé et de la recherche médicale, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | - Elie Courvalin
- From the Trauma and Polyvalent Critical Care Unit, Montpellier University Hospital, Montpellier, France
| | - Geoffrey Dagod
- From the Trauma and Polyvalent Critical Care Unit, Montpellier University Hospital, Montpellier, France
| | - Thomas Laumon
- From the Trauma and Polyvalent Critical Care Unit, Montpellier University Hospital, Montpellier, France
| | - Samy Hammani
- From the Trauma and Polyvalent Critical Care Unit, Montpellier University Hospital, Montpellier, France
| | - Nicolas Molinari
- institut Desbrest d'épidémiologie et de santé publique, institut national de la santé et de la recherche médicale, University of Montpellier, Montpellier University Hospital, Montpellier, France
| | - Xavier Capdevila
- From the Trauma and Polyvalent Critical Care Unit, Montpellier University Hospital, Montpellier, France
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Daniel J, Dumortier J, Del Bello A, Gamon L, Molinari N, Faure S, Meszaros M, Ursic-Bedoya J, Meunier L, Monet C, Navarro F, Boillot O, Pageaux GP, Donnadieu-Rigole H. Integrating an addiction team into the management of patients transplanted for alcohol-associated liver disease reduces the risk of severe relapse. JHEP Rep 2023; 5:100832. [PMID: 37681206 PMCID: PMC10480527 DOI: 10.1016/j.jhepr.2023.100832] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 09/09/2023] Open
Abstract
Background & Aims Liver transplantation (LT) is a last resort treatment for patients at high risk of mortality from end-stage liver disease. Over the past years, alcohol-associated liver disease has become the most frequent indication for LT in the world. The outcomes of LT for alcohol-associated liver disease are good, but return to alcohol use is detrimental for medium-term survival because of cancer development, cardiovascular events, and recurrent alcohol-associated cirrhosis. Several strategies have been developed to prevent return to alcohol use during the pre- or post-LT period, but there are no specific recommendations. Therefore, the main objective of this study was to investigate if the integration of an addiction team in a LT unit affected the rate of severe alcohol relapse after LT. The secondary objectives were to assess the effects of addiction follow up on cardiovascular events, cancer, and overall survival. Methods This study was a retrospective comparison between centres with or without addiction monitoring. Results The study included 611 patients of which 79.4% were male with a mean age of 55.4 years at the time of LT, 190 were managed by an integrated addiction team. The overall alcohol relapse rate was 28.9% and the rate of severe relapse was 13.0%. Patients with addiction follow-up had significantly less frequent severe alcohol relapse than those in the control group (p = 0.0218). Addiction follow up (odds ratio = 0.19; p = 0.001) and age at LT (odds ratio = 1.23; p = 0.02) remained significantly associated with post-LT cardiovascular events. Conclusions Our study confirms the benefits of integrating an addiction team to reduce return to alcohol use after LT. Clinical Trials registration This study is registered at ClinicalTrials.gov (NCT04964687). Impact and implications The main indication for liver transplantation is alcohol-associated cirrhosis. There are currently no specific recommendations on the addiction monitoring of transplant candidates, although severe return to alcohol use after liver transplantation has a negative impact on long-term survival of patients. In this study, we explored the impact of a systematic addiction intervention on the return to alcohol use rates. In our transplantation centre, we demonstrated the interest of an addiction follow up to limit the severe alcohol relapses rate. This information should be further investigated in prospective studies to validate these data.
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Affiliation(s)
- Jules Daniel
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Jérôme Dumortier
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon et Université Claude Bernard, Lyon, France
| | - Arnaud Del Bello
- Nephrology and Organ Transplant Department, CHU de Toulouse, Toulouse, France
| | - Lucie Gamon
- Medical Information Department, La Colombière Hospital, University Hospital of Montpellier, Montpellier, France
| | - Nicolas Molinari
- Medical Information Department, La Colombière Hospital, University Hospital of Montpellier, Montpellier, France
- Medical University of Montpellier (UM1), Montpellier, France
| | - Stéphanie Faure
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Magdalena Meszaros
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - José Ursic-Bedoya
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Lucy Meunier
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Clément Monet
- Department of Anesthesia and Intensive Care Unit, University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, Montpellier, France
| | - Francis Navarro
- Medical University of Montpellier (UM1), Montpellier, France
- Department of Digestive Surgery, University Hospital of Montpellier, St-Eloi Hospital, Montpellier, France
| | - Olivier Boillot
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils de Lyon et Université Claude Bernard, Lyon, France
| | - Georges-Philippe Pageaux
- Hepatology and Liver Transplantation Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
- Medical University of Montpellier (UM1), Montpellier, France
| | - Hélène Donnadieu-Rigole
- Medical University of Montpellier (UM1), Montpellier, France
- Addictions Department, Saint Eloi Hospital, University Hospital of Montpellier, Montpellier, France
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Pensier J, De Jong A, Monet C, Aarab Y, Le Bihan C, Capdevila M, Lakbar I, Stock L, Belafia F, Chanques G, Molinari N, Jaber S. Outcomes and time trends of acute respiratory distress syndrome patients with and without liver cirrhosis: an observational cohort. Ann Intensive Care 2023; 13:96. [PMID: 37773241 PMCID: PMC10541379 DOI: 10.1186/s13613-023-01190-1] [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: 07/14/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND In studies prior to lung-protective ventilation, liver cirrhosis in acute respiratory distress syndrome (ARDS) was associated with high mortality rates. Since patients with cirrhosis have been excluded from many trials on ARDS, their outcome when treated with lung-protective ventilation is unclear. The objectives were to assess whether cirrhosis is associated with mortality in ARDS and trends over time in mortality and severity. METHODS We conducted a retrospective analysis of a prospective observational cohort conducted in a 20-bed tertiary ICU from October 2003 to December 2021. All consecutive adult critically ill patients with ARDS were included. ARDS was defined by the Berlin criteria. The primary outcome was 90 day mortality, assessed with Kaplan-Meier curves and multivariate Cox analysis. Time trends were assessed on 90 day mortality, Sequential Organ-Function Assessment score (SOFA) and non-hepatic SOFA. Ventilation settings were compared between patients with and without cirrhosis. RESULTS Of the 7155 patients screened, 863 had a diagnosis of ARDS. Among these ARDS patients, 157(18%) had cirrhosis. The overall 90 day mortality was of 43% (378/863), 57% (90/157) in patients with cirrhosis and 41% (288/706) in patients without cirrhosis (p < 0.001). On survival curves, cirrhosis was associated with 90 day mortality (p < 0.001). Cirrhosis was independently associated with 90 day mortality in multivariate analysis (hazard ratio = 1.56, 95% confidence interval 1.20-2.02). There was no change in mortality over time in ARDS patients with and without cirrhosis. SOFA (p = 0.04) and non-hepatic SOFA (p = 0.02) increased over time in ARDS patients without cirrhosis, and remained stable in ARDS patients with cirrhosis. Tidal volume, positive end-expiratory pressure, plateau pressure and driving pressure were not different between ARDS patients with and without cirrhosis. CONCLUSIONS Although ARDS management improved over the last decades, the 90 day mortality remained high and stable over time for both ARDS patients with (57%) and without cirrhosis (41%). Nevertheless, the severity of patients without cirrhosis has increased over time, while the severity of patients with cirrhosis has remained stable.
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Affiliation(s)
- Joris Pensier
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France
- Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, France
| | - Audrey De Jong
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France
- Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, France
| | - Clément Monet
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France
- Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, France
| | - Yassir Aarab
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France
| | - Clément Le Bihan
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France
| | - Mathieu Capdevila
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France
- Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, France
| | - Inès Lakbar
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France
- CEReSS, Health Service Research and Quality of Life Centre, School of Medicine, Aix-Marseille University, La Timone, Marseille, France
| | - Lucas Stock
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France
| | - Fouad Belafia
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France
| | - Gerald Chanques
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France
- Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, France
| | - Nicolas Molinari
- Medical Information, IMAG; CNRS, Univ Montpellier, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
- Institut Desbrest de Santé Publique (IDESP), INSERM-Université de Montpellier. Département d'informatique Médicale, CHRU Montpellier, Montpellier, France
| | - Samir Jaber
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, 80 Avenue Augustin Fliche, Montpellier Cedex 5, Montpellier, France.
- Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, France.
- Samir JABER, Département d'Anesthésie Réanimation B (DAR B), 80 Avenue Augustin Fliche, 34295, Montpellier, France.
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9
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Tessier B, Annesi-Maesano I, Cambonie G, Molinari N, Kalfa N. COVID-19 lockdown related to decrease in premature birth rate and increase in birth weight in metropolitan France. Front Pediatr 2023; 11:1223692. [PMID: 37744451 PMCID: PMC10513386 DOI: 10.3389/fped.2023.1223692] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction The worldwide rate of preterm birth (PTB) has been increasing over the last two decades. COVID-19 lockdowns provide a unique opportunity to assess the effects of socioenvironmental and lifestyle factors on premature birth and birth weight. We explored the effects of COVID-19 lockdowns on the PTB rate and birth weight at a nationwide scale in France until one year after their occurrence. Material and Methods This national retrospective observational study evaluated the rate of PTB and birth weight in France from January 2016 to December 2020. Data were obtained from the national Programme Médicalisé des Systèmes d'Information database. The rates of global and sub-categories of PTB were tested. The birth weight was studied before and after lockdown for all live births, for term and premature neonates, and for each category of low birth weight (LBW) by a stratified analysis. Results Data from 2,949,372 births from January 2016 to December 2019, including 228,857 PTB, were compared to those of 699,344 births and 51,886 PTB from January to December 2020. The national rate of PTB decreased significantly from 7.7% to 7.3%, when compared with the 2016-2019 period. This decrease was persistent up to 9 months later. It was observed only for moderate PTB, whereas very PTB and extremely PTB remained stable. The national mean birth weight for full-term babies increased after the lockdown and was still observable up to 8 months later (+0.16%, p < 0.0001). The proportion of children with LBW also decreased 2 months after lockdown (-0.15%; p = 0.02). For VLBW, the difference only appeared over the 6-month post-lockdown period (-0.06%; p = 0.006). Conclusion This nationwide study shows a significant reduction in prematurity and a significant increase in birth weight in France after the lockdown for a period of time not limited to the lockdown itself. A more in-depth study of the factors determining these variations may help to drive PTB prevention policies.
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Affiliation(s)
- Benoit Tessier
- Department of Pediatric Surgery and Urology, Lapeyronie Hospital, CHU Montpellier—University of Montpellier, Montpellier, France
- Debrest Institute of Epidemiology and Public Health IDESP, UMR INSERM—University of Montpellier, Montpellier, France
| | - Isabella Annesi-Maesano
- Debrest Institute of Epidemiology and Public Health IDESP, UMR INSERM—University of Montpellier, Montpellier, France
| | - Gilles Cambonie
- Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, CHU Montpellier–University of Montpellier, Montpellier, France
| | - Nicolas Molinari
- Debrest Institute of Epidemiology and Public Health IDESP, UMR INSERM—University of Montpellier, Montpellier, France
- Department of Biostatistics and Medical Information, CHU Montpellier—University of Montpellier, Montpellier, France
| | - Nicolas Kalfa
- Department of Pediatric Surgery and Urology, Lapeyronie Hospital, CHU Montpellier—University of Montpellier, Montpellier, France
- Debrest Institute of Epidemiology and Public Health IDESP, UMR INSERM—University of Montpellier, Montpellier, France
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10
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Jung B, Huguet H, Molinari N, Jaber S. Sodium bicarbonate for the treatment of severe metabolic acidosis with moderate or severe acute kidney injury in the critically ill: protocol for a randomised clinical trial (BICARICU-2). BMJ Open 2023; 13:e073487. [PMID: 37591655 PMCID: PMC10441043 DOI: 10.1136/bmjopen-2023-073487] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/21/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION When both severe metabolic acidemia (pH equal or less than 7.20; PaCO2 equal or less than 45 mm Hg and bicarbonate concentration equal or less than of 20 mmol/L) and moderate-to-severe acute kidney injury are observed, day 28 mortality is approximately 55%-60%. A multiple centre randomised clinical trial (BICARICU-1) has suggested that sodium bicarbonate infusion titrated to maintain the pH equal or more than 7.30 is associated with a higher survival rate (secondary endpoint) in a prespecified stratum of patients with both severe metabolic acidemia and acute kidney injury patients. Whether sodium bicarbonate infusion may improve survival at day 90 (primary outcome) in these severe acute kidney injury patients is currently unknown. METHODS AND ANALYSIS The sodium bicarbonate for the treatment of severe metabolic acidosis with moderate or severe acute kidney injury in the critically ill: a randomised clinical trial (BICARICU-2) trial is an investigator-initiated, multiple centre, stratified, parallel-group, unblinded trial with a computer-generated allocation sequence and an electronic system-based randomisation. After randomisation, the intervention group will receive 4.2% sodium bicarbonate infusion to target a plasma pH equal or more than 7.30 while the control group will not receive sodium bicarbonate. The primary outcome is the day 90 mortality. Main secondary outcomes are organ support dependences. ETHICS AND DISSEMINATION The trial has been approved by the appropriate ethics committee (CPP Nord Ouest, Rouen, France, 25 April 2019, number: 19.03.15.72446). Informed consent is required. If sodium bicarbonate improves day 90 mortality, it will become part of the routine care. TRIAL REGISTRATION NUMBER NCT04010630.
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Affiliation(s)
- Boris Jung
- Department of Medical Intensive Care, Montpellier University Hospital, Montpellier, France
- PhyMedExp Laboratory, University of Montpellier, Montpellier, France
| | - Helena Huguet
- Department of Statistics, Montpellier Université d'Excellence, Montpellier, France
| | - Nicolas Molinari
- Department of Statistics, Montpellier Université d'Excellence, Montpellier, France
| | - Samir Jaber
- PhyMedExp Laboratory, University of Montpellier, Montpellier, France
- Saint Eloi Department of Anesthesiology and Critical Care Medicine, Montpellier University Hospital, Montpellier, France
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11
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Capdevila M, De Jong A, Aarab Y, Vonarb A, Carr J, Molinari N, Capdevila X, Brochard L, Jaber S. Which spontaneous breathing trial to predict effort to breathe after extubation according to five critical illnesses: the cross-over GLOBAL WEAN study protocol. BMJ Open 2023; 13:e070931. [PMID: 37438068 DOI: 10.1136/bmjopen-2022-070931] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Readiness to be freed from ventilatory support can be evaluated by spontaneous breathing trial (SBT) assessing the patient's ability to sustain respiratory effort after extubation. Current SBT practices are heterogenous and there are few physiological studies on the topic. The objective of this study is to assess which SBT best reproduces inspiratory effort to breathe after extubation depending on the patient's illness. METHODS AND ANALYSIS This will be a multicentre randomised cross-over physiological study, in a large population, in the era of modern intensive care units using last generation modern ventilators. Each included patient will perform three 15-minute SBTs in a random order: pressure support ventilation (PSV) level of 7 cmH2O with positive end expiratory pressure (PEEP) level of 0 cmH2O, PSV 0 cmH2O with PEEP 0 cmH2O and T-piece trial. A rest period of baseline state ventilation will be observed between the SBTs (10 min) and before extubation (30 min). Primary outcome will be the inspiratory muscle effort, reflected by pressure time product per minute (PTPmin). This will be calculated from oesophageal pressure measurements at baseline state, before and after each SBT and 20 min after extubation. Secondary outcomes will be PTPmin at 24 hours and 48 hours after extubation, changes in physiological variables and respiratory parameters at each step, postextubation respiratory management and the rate of successful extubation. One hundred patients with at least 24 hours of invasive mechanical ventilation will be analysed, divided into five categories of critical illness: abdominal surgery, brain injury, chest trauma, chronic obstructive pulmonary disease and miscellaneous (pneumonia, sepsis, heart disease). ETHICS AND DISSEMINATION The study project was approved by the appropriate ethics committee (2019-A01063-54, Comité de Protection des Personnes TOURS - Région Centre - Ouest 1, France). Informed consent is required, for all patients or surrogate in case of inability to give consent. TRIAL REGISTRATION NUMBER NCT04222569.
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Affiliation(s)
- Mathieu Capdevila
- Department of Anaesthesiology and Critical Care Medicine B, University Hospital Centre Montpellier, Montpellier, France
- Department of critical care patient acquired muscle weakness, INSERM U1046, Montpellier, France
| | - Audrey De Jong
- Department of Anaesthesiology and Critical Care Medicine B, University Hospital Centre Montpellier, Montpellier, France
- Department of critical care patient acquired muscle weakness, INSERM U1046, Montpellier, France
| | - Yassir Aarab
- Department of Anaesthesiology and Critical Care Medicine B, University Hospital Centre Montpellier, Montpellier, France
| | - Aurelie Vonarb
- Department of Anaesthesiology and Critical Care Medicine B, University Hospital Centre Montpellier, Montpellier, France
| | - Julie Carr
- Department of Anaesthesiology and Critical Care Medicine B, University Hospital Centre Montpellier, Montpellier, France
| | - Nicolas Molinari
- Department of Statistics, University Hospital Centre Montpellier, Montpellier, France
| | - Xavier Capdevila
- Department of Anaesthesiology and Critical Care Medicine A, University Hospital Centre Montpellier, Montpellier, France
- Montpellier NeuroSciences Institute, INSERM U1051, Montpellier, France
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St.Michael's Hospital, Toronto, Ontario, Canada
| | - Samir Jaber
- Department of Anaesthesiology and Critical Care Medicine B, University Hospital Centre Montpellier, Montpellier, France
- Department of critical care patient acquired muscle weakness, INSERM U1046, Montpellier, France
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12
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Suehs CM, Molinari N, Bourdin A, Solovei L. Change in cardiorespiratory parameters following surgical correction of pectus excavatum: protocol for the historical-prospective HeartSoar cohort. BMJ Open 2023; 13:e070891. [PMID: 37321811 PMCID: PMC10277089 DOI: 10.1136/bmjopen-2022-070891] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 05/23/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION How cardiorespiratory function changes following the surgical correction of pectus excavatum (PE) often gives mixed results, with meta-analyses demonstrating no benefit in terms of pulmonary function but improvement in cardiac function. Functional responses may depend on type of surgery, follow-up time and/or the patient's presurgical functional status, and debate persists on the purely aesthetic nature of such surgery. The aim of this protocol is to analyse data describing lung function and incremental exercise testing before vs after the surgical correction of PE. METHODS AND ANALYSIS A historical-prospective before-after surgical correction of PE cohort will be constituted. Historical inclusions are recruited during follow-up visits at approximately 12, 24, 36 or 48 months following a prior surgery (with presurgical data mined from patient records). Prospective inclusions are recruited during presurgical work-ups and followed for 1 year following surgery. The data collected include spirometry, incremental exercise testing, body mass index, body composition, questionnaires targeting general health status, self-esteem and body image. Any complications due to surgery are also described.The primary outcome is oxygen pulse during incremental exercise testing, and 44 data points are required to demonstrate a moderate postsurgical change (ie, a Cohen's effect of d=0.5). Wilcoxon signed-rank tests or t-tests for paired data will be used for before-after comparisons (with false discovery rate corrections for secondary analyses). ETHICS AND DISSEMINATION This study will be conducted according to the principles of the Declaration of Helsinki (as revised in 2013) and was approved by a randomly assigned, independent, ethics committee (Comité de Protection des Personnes Sud-Méditerranée II, reference number: 218 B21) as per French law on 6 July 2018. Informed, written consent for study participation is required of all study candidates prior to enrolment. Results will be published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03770390; Clinicaltrials.gov.
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Affiliation(s)
- Carey Meredith Suehs
- Respiratory Diseases, Medical Information, Univ Montpellier, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Nicolas Molinari
- Medical Information, IMAG; CNRS, Univ Montpellier, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - A Bourdin
- Respiratory Diseases, PhyMedExp, CNRS, INSERM, Univ Montpellier, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
| | - Laurence Solovei
- Thoracic Surgery, Univ Montpellier, Centre Hospitalier Regional Universitaire de Montpellier, Montpellier, France
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13
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Marouf A, Molinari N, Sibon D, Cottereau AS, Kanoun S, Antoine C, Debureaux PE, Cavalieri D, Fornecker LM, Casasnovas RO, Herbaux C, Amorim S, Rossi C, Bouscary D, Brice P, Ghesquieres H, Tamburini J, Deau B. Tandem haematopoietic stem cell transplantation versus single cell transplant and BV maintenance in relapsed/refractory Hodgkin lymphoma: A matched cohort analysis from the LYSA. Br J Haematol 2023. [PMID: 37192755 DOI: 10.1111/bjh.18859] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/05/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023]
Abstract
Autologous hematopoietic stem cell transplant (ASCT) is the standard curative treatment for patients with high-risk relapsed/refractory Hodgkin lymphoma (R/R HL). The AETHERA study showed survival gain with Brentuximab Vedotin (BV) maintenance after ASCT in BV-naive patients, which was recently confirmed in the retrospective AMAHRELIS cohort, including a majority of BV-exposed patients. However, this approach has not been compared to intensive tandem auto/auto or auto/allo transplant strategies, which were used before BV approval. Here, we matched BV maintenance (AMAHRELIS) and tandem SCT (HR2009) cohorts, and observed that BV maintenance was associated with better survival outcome in patients with HR R/R HL.
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Affiliation(s)
- A Marouf
- Laboratoire U1163, Institut Imagine, Université Paris Cité, Inserm, Paris, France
- Service Hématologie, AP-HP, Hôpital Cochin, Paris, France
- Groupe Hospitalier privé Ambroise Paré-Hartmann, Département Recherche Innovation, Neuilly-Sur-Seine, France
| | - N Molinari
- IDESP, INSERM, PreMEdical INRIA, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - D Sibon
- Paris Est University, Créteil, France
- Service Hémopathies Lymphoïdes, AP-HP, Hôpital Henri Mondor, Créteil, France
| | - A S Cottereau
- Laboratoire U1163, Institut Imagine, Université Paris Cité, Inserm, Paris, France
- Service de Médecine Nucléaire, AP-HP, Hôpital Cochin, Paris, France
| | - S Kanoun
- Centre de Recherche Clinique de Toulouse, Team 9, Toulouse, France
| | - C Antoine
- Lymphoma Academic Research Organization (LYSARC) Lymphoma Study Association Imaging, Hôpital Henri Mondor, Créteil, France
| | - P E Debureaux
- Saint Louis Research Institute, INSERM U1160, Paris, France
| | - D Cavalieri
- Service Hématologie, CHRU Lille, Lille, France
| | - L M Fornecker
- Université de Strasbourg, INSERM S-1113, Strasbourg, France
- Service Hématologie, Cancéropôle Est, Strasbourg, France
| | - R O Casasnovas
- UFR des Sciences de Santé, INSERM UMR 1231 CHU Dijon, Dijon, France
- Service Hématologie, CHU Dijon, Dijon, France
| | - C Herbaux
- Service Hématologie, CHU Montpellier, Montpellier, France
| | - S Amorim
- Service Hématologie, Hôpital Saint-Louis, Paris, France
| | - C Rossi
- Department of Hematology, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM Unit 1231, University of Burgundy Franche-Comté, Besancon, France
- Department of Medicine, Divisions of Oncology and Hematology, Stanford University, Stanford, California, USA
| | - D Bouscary
- Laboratoire U1163, Institut Imagine, Université Paris Cité, Inserm, Paris, France
- Service Hématologie, AP-HP, Hôpital Cochin, Paris, France
- Centre de Recherche des Cordeliers, INSERM U1016, Université Paris Cité, Inserm, Paris, France
| | - P Brice
- Service Hématologie, Hôpital Saint-Louis, Paris, France
| | - H Ghesquieres
- Service Hématologie, Hôpital Lyon Sud, Pierre-Bénite, France
| | - J Tamburini
- Laboratoire U1163, Institut Imagine, Université Paris Cité, Inserm, Paris, France
- Service Hématologie, AP-HP, Hôpital Cochin, Paris, France
- Translational Research Centre in Onco-Hematology, Faculty of Medicine, University of Geneva, Geneva 4, Switzerland
| | - B Deau
- Laboratoire U1163, Institut Imagine, Université Paris Cité, Inserm, Paris, France
- Service Hématologie, AP-HP, Hôpital Cochin, Paris, France
- Groupe Hospitalier privé Ambroise Paré-Hartmann, Département Recherche Innovation, Neuilly-Sur-Seine, France
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14
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Rolland R, Loubet A, Bommart S, Monnin-Bares V, Zarqane H, Vanoverschelde J, Herman F, Molinari N, Kovacsik H. Safety, Efficacy and Mid-Term Outcome for Transarterial Embolization (TAE) of Renal Angiomyolipoma (AML) Using Ethylene Vinyl Alcohol Copolymer Liquid Embolic Agent (EVOH). J Clin Med 2023; 12:jcm12103385. [PMID: 37240490 DOI: 10.3390/jcm12103385] [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: 03/28/2023] [Revised: 05/06/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Transarterial embolization (TAE) of renal angiomyolipoma (AML) is effective in treating and preventing hemorrhage. We report our experience using EVOH with a single-center retrospective study of all AML embolized with EVOH between June 2013 and March 2022 at the Montpellier University Hospital. A total of 29 embolizations were carried out in 24 consecutive patients (mean age: 53.86 years; 21 women and 3 men) with 25 AMLs for severe bleeding, symptomatic AML, tumor size > 4 cm, or presence of aneurysm(s) > 5 mm. Data collected included imaging and clinical outcomes, tuberous sclerosis complex status, change in AML volume, rebleeding, renal function, volume and concentration of EVOH used, and complications. Out of 29 embolizations performed for 25 AMLs, four were performed in an emergency. Technical success was achieved for 24/25 AMLs. Mean AML volume reduction was 53.59% after a mean follow-up time of 446 days using MRI or CT scan. Aneurysms on angiogram and the symptomatological nature of AML, as well as secondary TAE and multiple arterial pedicles, were statistically associated (p < 0.05). Two patients (8%) underwent nephrectomy after TAE. Four patients had a second embolization. Minor and major complication rates were 12% and 8%, respectively. Neither rebleeding nor renal function impairment was noticed. TAE of AML using EVOH is, thus, highly effective and safe.
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Affiliation(s)
- Rémi Rolland
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Antoine Loubet
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Sébastien Bommart
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Valérie Monnin-Bares
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Hamid Zarqane
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Juliette Vanoverschelde
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Fanchon Herman
- Department of Medical Statistics and Epidemiology, Centre Hospitalier Universitaire Montpellier, University of Montpellier, 34090 Montpellier, France
| | - Nicolas Molinari
- Department of Medical Statistics and Epidemiology, Centre Hospitalier Universitaire Montpellier, University of Montpellier, 34090 Montpellier, France
| | - Hélène Kovacsik
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
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Jaffuel D, Bouchaut Y, Mallet JP, Vidal C, Molinari N, Bourdin A, Roubille F. Dapagliflozin initiation in chronic heart failure patients improves central sleep apnoea. ERJ Open Res 2023; 9:00123-2023. [PMID: 37377653 PMCID: PMC10291304 DOI: 10.1183/23120541.00123-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/30/2023] [Indexed: 06/29/2023] Open
Abstract
Dapagliflozin decreases central sleep apnoea in central sleep apnoea patients, thereby sparing the initiation of ventilatory therapy https://bit.ly/41e2fm0.
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Affiliation(s)
- Dany Jaffuel
- Department of Pneumology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Yannick Bouchaut
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
- Department of Cardiology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France
| | - Jean-Pierre Mallet
- Department of Pneumology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Célia Vidal
- IDESP, INSERM, PreMEdical INRIA, Univ Montpellier, CHU Montpellier, Montpellier, France
- Groupe Adène, Montpellier, France
| | - Nicolas Molinari
- IDESP, INSERM, PreMEdical INRIA, Univ Montpellier, CHU Montpellier, Montpellier, France
- Groupe Adène, Montpellier, France
| | - Arnaud Bourdin
- Department of Pneumology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - François Roubille
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
- Department of Cardiology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France
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16
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Salsano A, Nenna A, Molinari N, Avtaar Singh SS, Spadaccio C, Santini F, Chello M, Fiore A, Nappi F. Impact of Mitral Regurgitation Recurrence on Mitral Valve Repair for Secondary Ischemic Mitral Regurgitation. J Cardiovasc Dev Dis 2023; 10:124. [PMID: 36975888 PMCID: PMC10053850 DOI: 10.3390/jcdd10030124] [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: 02/26/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES The current guidelines still do not include specific recommendations on the use of subvalvular repair (SV-r) for treatment of ischemic mitral regurgitation (IMR). Therefore, the objective of our study was to evaluate the clinical impact of mitral regurgitation (MR) recurrence and ventricular remodeling on long-term outcomes after SV-r combined with restrictive annuloplasty (RA-r). METHODS We performed a subanalysis of the papillary muscle approximation trial, studying 96 patients with severe IMR and coronary artery disease undergoing restrictive annuloplasty alongside subvalvular repair (SV-r + RA-r group) or restrictive annuloplasty alone (RA-r group). We analyzed treatment failure differences, the influence of residual MR, left ventricular remodeling, and clinical outcomes. The primary endpoint was treatment failure (composite of death; reoperation; or recurrence of moderate, moderate-to-severe, or severe MR) within 5 years of follow-up after the procedure. RESULTS A total of 45 patients showed failure of the treatment within 5 years, of which 16 patients underwent SV-r + RA-r (35.6%) and 29 underwent RA-r (64.4%, p = 0.006). Patients with significant residual MR presented with a higher rate of all-cause mortality at 5 years compared with trivial MR (HR 9.09, 95% CI 2.08-33.33, p = 0.003). MR progression occurred earlier in the RA-r group, as 20 patients in the RA-r group vs. 6 in SV-r + RA-r group had a significant MR 2 years after surgery (p = 0.002). CONCLUSIONS RA-r remains a surgical mitral repair technique with an increased risk of failure and mortality at 5 years compared with SV-r. The rates of recurrent MR are higher, and recurrence occurs earlier, with RA-r alone compared to SV-r. The addition of the subvalvular repair increases the durability of the repair, thus extending all of the benefits of preventing MR recurrence.
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Affiliation(s)
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Nicolas Molinari
- IDESP, INSERM, PreMEdical INRIA, University of Montpellier, CHU Montpellier, 34295 Montpellier, France
| | | | | | | | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor APHP, 94000 Creteil, France
- Advanced Surgical Technologies, Sapienza University of Rome, 00128 Roma, Italy
| | - Francesco Nappi
- Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, 93200 Paris, France
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17
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Martrille L, Papadodima S, Venegoni C, Molinari N, Gibelli D, Baccino E, Cattaneo C. Age Estimation in 0-8-Year-Old Children in France: Comparison of One Skeletal and Five Dental Methods. Diagnostics (Basel) 2023; 13:diagnostics13061042. [PMID: 36980350 PMCID: PMC10047510 DOI: 10.3390/diagnostics13061042] [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: 02/13/2023] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Age estimation in juveniles is a critical procedure in judicial cases for verification of imputability or for civil reasons when adopting children. Several methods based both on skeletal and dental growth have been performed and applied on different populations; nevertheless, few articles have compared different methods in order to test their reliability in different conditions and age ranges, and this is a clear obstacle in the creation of common guidelines for age estimation in the living. A comparison of five dental methods (Anderson, Ubelaker, Schour and Massler, Gustafson and Koch, Demirjian) and one skeletal method (Greulich a Pyle atlas) was performed on a population of 94 children aged between 0 and 8 years. Results showed that, whereas under 2 years all the methods have the same inaccuracy, over 2 years the diagram methods, such as Schour and Massler and Ubelaker's revised one, have a lower error range than the most frequently used Greulich and Pyle atlas and Demirjian method. Schour and Massler, Gustafson and Koch, and Ubelaker methods showed, respectively, a mean error amounting to 0.40, 0.53, and 0.56 years versus the 0.74 and 0.88 years given by Demirjian and the Greulich and Pyle atlas. An in-depth analysis of the potential of several methods is necessary in order to reach a higher adherence of age estimation with the complexity of growth dynamics.
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Affiliation(s)
- Laurent Martrille
- EDPFM, University of Montpellier, Department of Legal Medicine, CHU Montpellier, F-34000 Montpellier, France
| | - Stavroula Papadodima
- Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, M. Asias 75, 115 27 Athens, Greece
| | - Cristina Venegoni
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Sezione di Medicina Legale, DMU-Dipartimento di Morfologia Umana e Scienze Biomediche, Università degli Studi di Milano, Via Mangiagalli 37, 20133 Milano, Italy
| | - Nicolas Molinari
- IDESP, INSERM, PreMEdical INRIA, University of Montpellier, CHU Montpellier, F-34000 Montpellier, France
| | - Daniele Gibelli
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Sezione di Medicina Legale, DMU-Dipartimento di Morfologia Umana e Scienze Biomediche, Università degli Studi di Milano, Via Mangiagalli 37, 20133 Milano, Italy
| | - Eric Baccino
- EDPFM, University of Montpellier, Department of Legal Medicine, CHU Montpellier, F-34000 Montpellier, France
| | - Cristina Cattaneo
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Sezione di Medicina Legale, DMU-Dipartimento di Morfologia Umana e Scienze Biomediche, Università degli Studi di Milano, Via Mangiagalli 37, 20133 Milano, Italy
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18
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Bourdin A, Bommart S, Marin G, Vachier I, Gamez AS, Ahmed E, Suehs CM, Molinari N. Obesity in women with asthma: Baseline disadvantage plus greater small-airway responsiveness. Allergy 2023; 78:780-790. [PMID: 36070075 DOI: 10.1111/all.15509] [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: 03/04/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Obesity is known to diminish lung volumes and worsen asthma. However, mechanistic understanding is lacking, especially as concerns small-airway responsiveness. The objective of this study was therefore to compare small-airway responsiveness, as represented by the change in expiratory:inspiratory mean lung density ratios (MLDe/i , as determined by computed tomography [CT]) throughout methacholine testing in obese versus non-obese women with asthma. METHODS Thoracic CT was performed during methacholine bronchoconstriction challenges to produce standardized response curves (SRC: response parameter versus ln[1 + % PD20], where PD20 is the cumulative methacholine dose) for 31 asthma patients (n = 18 non-obese and n = 13 obese patients). Mixed models evaluated obesity effects and interactions on SRCs while adjusting for age and bronchial morphology. Small airway responsiveness as represented by SRC slope was calculated for each third of the MLDe/i response and compared between groups. RESULTS Obesity-associated effects observed during experimental bronchoconstriction included: (i) a significant baseline effect for forced expiratory volume in 1 second with lower values for the obese (73.11 ± 13.44) versus non-obese (82.19 ± 8.78; p = 0.002) groups prior to methacholine testing and (ii) significantly higher responsiveness in small airways as estimated via differences in MLDe/i slopes (group×ln(1 + % PD20 interaction; p = 0.023). The latter were pinpointed to higher slopes in the obese group at the beginning 2/3 of SRCs (p = 0.004 and p = 0.021). Significant obesity effects (p = 0.035 and p = 0.008) indicating lower forced vital capacity and greater % change in MLDe/I (respectively) throughout methacholine testing, were also observed. CONCLUSION In addition to baseline differences, small-airway responsiveness (as represented by the change in MLDe/i ) during methacholine challenge is greater in obese women with asthma as compared to the non-obese.
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Affiliation(s)
- Arnaud Bourdin
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France.,PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Sébastien Bommart
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France.,Department of Medical Imaging, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Gregory Marin
- Department of Medical Information, Univ Montpellier, CHU Montpellier, Montpellier, France.,IDESP, INSERM, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Isabelle Vachier
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France.,Department of Respiratory Diseases and Addictology, Medicine Biology Mediterranee, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - Anne Sophie Gamez
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Engi Ahmed
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Carey M Suehs
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France.,Department of Medical Information, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France.,Department of Medical Information, Univ Montpellier, CHU Montpellier, Montpellier, France.,IDESP, INSERM, Univ Montpellier, CHU Montpellier, Montpellier, France
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19
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Suehs CM, Vachier I, Galeazzi D, Vaast F, Cardon F, Molinari N, Bourdin A. Standard patient training versus Vik-Asthme chatbot-guided training: 'AsthmaTrain' - a protocol for a randomised controlled trial for patients with asthma. BMJ Open 2023; 13:e067039. [PMID: 36810168 PMCID: PMC9945055 DOI: 10.1136/bmjopen-2022-067039] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Therapeutic education for patients with asthma has been shown to reduce asthma morbidity. The high availability of smart phones provides the opportunity to furnish patient training via specifically designed chatbot applications. The goal of this protocol is to perform a first pilot comparison of traditional face to face versus chatbot-guided patient therapeutic education programmes for patients with asthma. METHODS AND ANALYSIS Eighty adult patients with a physician-confirmed diagnosis of asthma will be enrolled in a two-parallel-arm, randomised (1:1) controlled pilot trial. A single-Zelen consent procedure is deployed to first enrol all participants in the comparator arm, that is, the standard patient therapeutic education programme at the University Hospitals of Montpellier, France. This means of patient therapeutic education is based on reoccurring interviews and discussion with qualified nursing staff as per usual care. Following baseline data acquisition, randomisation will be performed. Those patients randomised to the comparator arm will not be informed of the second arm. Those patients randomised to the experimental arm will be proposed access to a specifically designed chatbot (Vik-Asthme) as the second tested means of patient training (refusals continue with standard training, though analysed as intention to treat). The primary outcome is change in the total Asthma Quality of Life Questionnaire score at the end of follow-up (6 months). Secondary outcomes cover asthma control, spirometry, general health status, programme adherence and burden for medical staff, exacerbations and medical resource use (medications, consults, emergency visits, hospitalisation and intensive care). ETHICS AND DISSEMINATION This study ('AsthmaTrain' protocol version 4-20220330) has been approved by the Committee for the Protection of Persons Ile-de-France VII on 28 March 2022 (reference number 21.03617.000059). Enrolment began on 24 May 2022. Results will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05248126.
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Affiliation(s)
- Carey Meredith Suehs
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- Department of Medical Information, Univ Montpellier, CHU Montpellier, Montpelier, France
| | - Isabelle Vachier
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- Medicine Biology Mediterranee, Department of Respiratory Diseases and Addictology, Arnaud de Villeneuve Hospital, CHRU Montpellier, Montpellier, France
| | - David Galeazzi
- Department of Medical Information, Univ Montpellier, CHU Montpellier, Montpelier, France
| | - François Vaast
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Fanny Cardon
- Department of Research and Innovation, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- Department of Medical Information, Univ Montpellier, CHU Montpellier, Montpelier, France
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- PhyMedExp, CNRS, INSERM, Univ Montpellier, CHU Montpellier, Montpellier, France
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20
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Gouzi F, Dubois-Gamez AS, Lacoude P, Abdellaoui A, Hédon C, Charriot J, Boissin C, Vachier I, Hayot M, Molinari N, Bourdin A. Feasibility of a nasal breathing training during pulmonary rehabilitation. A pilot randomized controlled study. Respir Physiol Neurobiol 2023; 308:103987. [PMID: 36372120 DOI: 10.1016/j.resp.2022.103987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Hyperventilation syndrome (HVS) is a common source of dyspnea and disability. While pulmonary rehabilitation (PR) including breathing exercises is indicated, randomized controlled trial are warranted to recommend one type of breathing exercise than another. We aimed to compare during PR, the effect of 5 sessions of nasal ventilation exercise (NV+PR) versus voluntary hypoventilation (vHV+PR) on exercise dyspnea (primary outcome) and capacity and health-related quality of life in patients. In this open label randomized controlled trial, 19 HVS patients (age=48.3 ± 15.2 y.o, female/male=18/1, Nijmegen score=33 ± 7.7) were randomized in a NV+PR (n = 9) or vHV+PR (n = 10) group. Modified Medical Research Council (mMRC) dyspnea, 6-minute walking distance (6MWD) with nasal/oral ventilation were assessed before and after 3 months of PR, and questionnaires (Nijmegen, VQ-11). There was a significant effect of PR of but no significant difference between groups in the improvements of dyspnea@max exercise (time effect (T): p < 0.01; group (G): p = 0.63; group*time interaction (G*T): p = 0.49), mMRC dyspnea (T: p < 0.01; G: p = 0.45; G*T: p = 0.62), 6MWD (T: p < 0.05; G: p = 0.36; G*T: p = 0.31), VQ-11 (T: p < 0.001; G: p = 0.16; G*T: p = 0.09) and plasma HCO3- (T: p < 0.05; G: p = 0.93; G*T; p = 0.36), Yet, Nijmegen score (T: p < 0.01; G: p = 0.32; G*T: p < 0.05) improvement was larger in NV+PR group. The exercise oronasal breathing shift during the 6MWT was significantly delayed in all patients (T: p < 0.05; G: p = 0.30; G*T: p = 0.32) and positively correlated with plasma HCO3-(r = 0.42; p < 0.05). Nasal exercise was not superior versus voluntary hypoventilation during PR in HVS patients. Yet, nasal exercise appeared feasible, leading to acquisition of a nasal breathing pattern during walking, improvement of PR outcomes and ventilatory alkalosis. The link between nasal breathing and hyperventilation is discussed in the light of the nasal ventilation rhythm in the limbic system and its role on the limbic emotional and ventilatory functions.
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Affiliation(s)
- F Gouzi
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France.
| | - A S Dubois-Gamez
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - P Lacoude
- Institut de Formation en Masso-Kinésithérapie de Montpellier (IFMK), France
| | - A Abdellaoui
- Institut de Formation en Masso-Kinésithérapie de Montpellier (IFMK), France
| | - C Hédon
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - J Charriot
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - C Boissin
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - I Vachier
- Institut Desbrest de Santé Publique (IDESP) INSERM - Université de Montpellier. Département d'informatique Médicale, CHRU Montpellier, France
| | - M Hayot
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
| | - N Molinari
- Institut Desbrest de Santé Publique (IDESP) INSERM - Université de Montpellier. Département d'informatique Médicale, CHRU Montpellier, France
| | - A Bourdin
- PhyMedExp, INSERM - CNRS - Montpellier University, CHRU Montpellier, Montpellier, France
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21
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Cassinotto C, Nogue E, Durand Q, Panaro F, Assenat E, Dohan A, Malafaye N, Guiu B, Molinari N. Life expectancy of patients with hepatocellular carcinoma according to the upfront treatment: A nationwide analysis. Diagn Interv Imaging 2023; 104:192-199. [PMID: 36682959 DOI: 10.1016/j.diii.2023.01.002] [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: 10/04/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to update the life expectancy of patients with hepatocellular carcinoma (HCC) in an exhaustive nationwide population according to the upfront treatment performed. MATERIALS AND METHODS From the French Program for the Medicalization of Information System database, all patients older than 18 years diagnosed with a de novo HCC from January 2011 to December 2018 were retrospectively selected. Five-year survival rates (95% confidence intervals [CI]) were computed according to the first surgical or interventional radiology procedures performed. RESULTS A total of 63,996 patients (80% men) with a median age of 68 years (Q1, Q3: 61, 77) were selected, including 24,007 patients who underwent at least one procedure (5-year survival of 45.5%; (95% CI: 44.8-46.2), and 39,989 with none (5-year survival, 9.6%; (95% CI: 9.3-10.0). Only 20.5% (13,101/63,996) of patients could undergo an upfront curative procedure. Liver transplantation achieved the best outcome, whether performed upfront (n = 791; 5-year survival, 79.0% [95% CI: 76.1-82.1]) or during subsequent steps (n = 2217; 5-year survival 80.9% [95% CI: 79.2-82.7]). Tumor ablation (n = 5306), open resection (n = 5171), and minimally-invasive resection (n = 1833) achieved 5-year survival rates of 53.8% (95% CI: 52.3-55.4), 54.1% (95% CI: 52.6-55.6), and 66.2% (95% CI: 63.7-68.7), respectively, with more patients with cirrhosis and subsequent procedures in the tumor ablation group. Patients with upfront transarterial (chemo)embolization (n = 10,247) and selective internal radiation therapy (n = 659) had 5-year survival rates of 31.3% (95% CI: 30.3-32.4) and 18.5% (95% CI: 15.2-22.5). CONCLUSION While HCC remains mostly diagnosed at an advanced stage associated with a poor prognosis, all the curative options provide 5-year survival rates above 50%.
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Affiliation(s)
- Christophe Cassinotto
- Department of Diagnostic and Interventional Radiology, Saint-Eloi Hospital, University Hospital of Montpellier, 34090 Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, University Hospital of Montpellier, 34090 Montpellier, France.
| | - Erika Nogue
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier University, 34090 Montpellier, France
| | - Quentin Durand
- Department of Diagnostic and Interventional Radiology, Saint-Eloi Hospital, University Hospital of Montpellier, 34090 Montpellier, France
| | - Fabrizio Panaro
- Department of Surgery/ Division of HBP Surgery and Transplantation, Saint-Eloi Hospital, University Hospital of Montpellier, 34090 Montpellier, France
| | - Eric Assenat
- Department of Oncology, Saint-Eloi Hospital, University Hospital of Montpellier, 34090 Montpellier, France
| | - Anthony Dohan
- Department of Radiology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, 75014 Paris, France; Université Paris Cité, Faculté de Médecine, 75006 Paris, France
| | - Nicolas Malafaye
- Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier University, 34090 Montpellier, France
| | - Boris Guiu
- Department of Diagnostic and Interventional Radiology, Saint-Eloi Hospital, University Hospital of Montpellier, 34090 Montpellier, France; Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, University Hospital of Montpellier, 34090 Montpellier, France
| | - Nicolas Molinari
- Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM, University Hospital of Montpellier, 34090 Montpellier, France; Clinical Research and Epidemiology Unit, University Hospital of Montpellier, Montpellier University, 34090 Montpellier, France
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22
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De Jong A, Bignon A, Stephan F, Godet T, Constantin JM, Asehnoune K, Sylvestre A, Sautillet J, Blondonnet R, Ferrandière M, Seguin P, Lasocki S, Rollé A, Fayolle PM, Muller L, Pardo E, Terzi N, Ramin S, Jung B, Abback PS, Guerci P, Sarton B, Rozé H, Dupuis C, Cousson J, Faucher M, Lemiale V, Cholley B, Chanques G, Belafia F, Huguet H, Futier E, Azoulay E, Molinari N, Jaber S, BIGNON ANNE, STEPHAN FRANÇOIS, GODET THOMAS, CONSTANTIN JEANMICHEL, ASEHNOUNE KARIM, SYLVESTRE AUDE, SAUTILLET JULIETTE, BLONDONNET RAIKO, FERRANDIERE MARTINE, SEGUIN PHILIPPE, LASOCKI SIGISMOND, ROLLE AMELIE, FAYOLLE PIERREMARIE, MULLER LAURENT, PARDO EMMANUEL, TERZI NICOLAS, RAMIN SEVERIN, JUNG BORIS, ABBACK PAERSELIM, GUERCI PHILIPPE, SARTON BENJAMINE, ROZE HADRIEN, DUPUIS CLAIRE, COUSSON JOEL, FAUCHER MARION, LEMIALE VIRGINIE, CHOLLEY BERNARD, CHANQUES GERALD, BELAFIA FOUAD, HUGUET HELENA, FUTIER EMMANUEL, GNIADEK CLAUDINE, VONARB AURELIE, PRADES ALBERT, JAILLET CARINE, CAPDEVILA XAVIER, CHARBIT JONATHAN, GENTY THIBAUT, REZAIGUIA-DELCLAUX SAIDA, IMBERT AUDREY, PILORGE CATHERINE, CALYPSO ROMAN, BOUTEAU-DURAND ASTRID, CARLES MICHEL, MEHDAOUI HOSSEN, SOUWEINE BERTRAND, CALVET LAURE, JABAUDON MATTHIEU, RIEU BENJAMIN, CANDILLE CLARA, SIGAUD FLORIAN, RIU BEATRICE, PAPAZIAN LAURENT, VALERA SABINE, MOKART DJAMEL, CHOW CHINE LAURENT, BISBAL MAGALI, POULIQUEN CAMILLE, DE GUIBERT JEANMANUEL, TOURRET MAXIME, MALLET DAMIEN, LEONE MARC, ZIELESKIEWICZ LAURENT, COSSIC JEANNE, ASSEFI MONA, BARON ELODIE, QUEMENEUR CYRIL, MONSEL ANTOINE, BIAIS MATTHIEU, OUATTARA ALEXANDRE, BONNARDEL ELINE, MONZIOLS SIMON, MAHUL MARTIN, LEFRANT JEANYVES, ROGER CLAIRE, BARBAR SABER, LAMBIOTTE FABIEN, SAINT-LEGER PIEHR, PAUGAM CATHERINE, POTTECHER JULIEN, LUDES PIERREOLIVIER, DARRIVERE LUCIE, GARNIER MARC, KIPNIS ERIC, LEBUFFE GILLES, GAROT MATTHIAS, FALCONE JEREMY, CHOUSTERMAN BENJAMIN, COLLET MAGALI, GAYAT ETIENNE, DELLAMONICA JEAN, MFAM WILLYSERGE, OCHIN EVELINA, NEBLI MOHAMED, TILOUCHE NEJLA, MADEUX BENJAMIN, BOUGON DAVID, AARAB YASSIR, GARNIER FANNY, AZOULAY ELIE, MOLINARI NICOLAS, JABER SAMIR. Effect of non-invasive ventilation after extubation in critically ill patients with obesity in France: a multicentre, unblinded, pragmatic randomised clinical trial. Lancet Respir Med 2023:S2213-2600(22)00529-X. [PMID: 36693403 DOI: 10.1016/s2213-2600(22)00529-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Non-invasive ventilation (NIV) and oxygen therapy (high-flow nasal oxygen [HFNO] or standard oxygen) following extubation have never been compared in critically ill patients with obesity. We aimed to compare NIV (alternating with HFNO or standard oxygen) and oxygen therapy (HFNO or standard oxygen) following extubation of critically ill patients with obesity. METHODS In this multicentre, parallel group, pragmatic randomised controlled trial, conducted in 39 intensive care units in France, critically ill patients with obesity undergoing extubation were randomly assigned (1:1) to either the NIV group or the oxygen therapy group. Two randomisations were performed: first, randomisation to either NIV or oxygen therapy, and second, randomisation to either HFNO or standard oxygen (also 1:1), which was nested within the first randomisation. Blinding of the randomisation was not possible, but the statistician was masked to group assignment. The primary outcome was treatment failure within 3 days after extubation, a composite of reintubation for mechanical ventilation, switch to the other study treatment, or premature discontinuation of study treatment. The primary outcome was analysed by intention to treat. Effect of medical and surgical status was assessed. The reintubation within 3 days was analysed by intention to treat and after a post-hoc crossover analysis. This study is registered with ClinicalTrials.gov, number NCT04014920. FINDINGS From Oct 2, 2019, to July 17, 2021, of the 1650 screened patients, 981 were enrolled. Treatment failure occurred in 66 (13·5%) of 490 patients in the NIV group and in 130 (26·5%) of 491 patients in the oxygen-therapy group (relative risk 0·43; 95% CI 0·31-0·60, p<0·0001). Medical or surgical status did not modify the effect of NIV group on the treatment-failure rate. Reintubation within 3 days after extubation was similar in the non-invasive ventilation group and in the oxygen therapy group in the intention-to-treat analysis (48 (10%) of 490 patients and 59 (12%) of 491 patients, p=0·26) and lower in the NIV group than in the oxygen-therapy group in the post-hoc cross-over (51 (9%) of 560 patients and 56 (13%) of 421 patients, p=0·037) analysis. No severe adverse events were reported. INTERPRETATION Among critically ill adults with obesity undergoing extubation, the use of NIV was effective to reduce treatment-failure within 3 days. Our results are relevant to clinical practice, supporting the use of NIV after extubation of critically ill patients with obesity. However, most of the difference in the primary outcome was due to patients in the oxygen therapy group switching to NIV, and more evidence is needed to conclude that an NIV strategy leads to improved patient-centred outcomes. FUNDING French Ministry of Health.
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Affiliation(s)
- Audrey De Jong
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier, CEDEX 5, France
| | - Anne Bignon
- CHU Lille, Réanimation Chirurgicale, F-59000, France
| | - François Stephan
- Surgical Intensive Care unit, Le Plessis Robinson Marie Lannelongue Hospital; Saclay University, school of Medicine, INSERM U999, France
| | - Thomas Godet
- CHU Clermont-Ferrand, Department of Peri-Operative Medicine, 63000 Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and critical care, Pitié-Salpêtrière Hospital, Paris, France
| | - Karim Asehnoune
- Department of Anaesthesia and Critical Care, Hôtel Dieu, University Hospital of Nantes, Nantes, France
| | - Aude Sylvestre
- Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation, 13015 Marseille, France; Aix-Marseille Université, Faculté de médecine, Centre d'Études et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13005 Marseille, France
| | | | - Raiko Blondonnet
- CHU Clermont-Ferrand, Department of Peri-Operative Medicine, 63000 Clermont-Ferrand, France
| | - Martine Ferrandière
- Département Anesthésie Réanimation, Université de Tours, CHU de Tours, Tours, France
| | - Philippe Seguin
- Département Anesthésie Réanimation, Université de Rennes, CHU de Rennes, Rennes, France
| | - Sigismond Lasocki
- Département Anesthésie Réanimation, Université d'Angers, CHU d'Angers, Angers, France
| | - Amélie Rollé
- Department of intensive care, Guadeloupe University Hospital, French Caribbean, France
| | - Pierre-Marie Fayolle
- Department of intensive care, Fort de France Hospital, Martinique, French Caribbean, France
| | - Laurent Muller
- Department of Intensive Care, Nîmes University Hospital, Nîmes, France
| | - Emmanuel Pardo
- Sorbonne University, GRC 29, AP-HP, DMU DREAM, Department of Anaesthesiology and Critical Care, Saint-Antoine Hospital, 75012 Paris, France
| | - Nicolas Terzi
- Department of Medical Intensive Care, CHU de Rennes, Rennes, France
| | - Séverin Ramin
- Anaesthesiology and Intensive Care, Anaesthesia and Critical Care Department A, Lapeyronie Teaching Hospital, Montpellier Cedex 5, France
| | - Boris Jung
- Département de Médecine Intensive-Réanimation, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Paer-Selim Abback
- Département d'Anesthésie-Réanimation, Hôpital Beaujon, APHP, Paris, France
| | - Philippe Guerci
- Département d'Anesthésie-Réanimation, Hôpital de Nancy, Nancy, France
| | - Benjamine Sarton
- Critical Care Unit. University Teaching Hospital of Purpan, Place du Dr Baylac, F-31059, Toulouse Cedex 9, France
| | - Hadrien Rozé
- CHU Bordeaux, Department of Anaesthesia and Critical Care, Magellan Medico-Surgical Centre, F-33000 Bordeaux, France; Biology of Cardiovascular Diseases, Bordeaux University, INSERM, UMR 1034, F-33600 Pessac, France
| | - Claire Dupuis
- Service de médecine intensive et réanimation, CHU Gabriel-Montpied, Clermont-Ferrand, France
| | - Joel Cousson
- Pole Anesthésie Réanimation Hopital R Debré CHU de Reims, France
| | - Marion Faucher
- Département d'Anesthésie-Réanimation, Institut Paoli-Calmettes, Hôpital de Marseille, Marseille, France
| | - Virginie Lemiale
- Médecine Intensive et Réanimation, Groupe GRRROH, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Bernard Cholley
- Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Gerald Chanques
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier, CEDEX 5, France
| | - Fouad Belafia
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier, CEDEX 5, France
| | - Helena Huguet
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France; Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Emmanuel Futier
- CHU Clermont-Ferrand, Department of Peri-Operative Medicine, 63000 Clermont-Ferrand, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Groupe GRRROH, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Nicolas Molinari
- IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France; Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Samir Jaber
- Department of Anaesthesia and Intensive Care unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214, Montpellier, CEDEX 5, France.
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Bughin F, Mendelson M, Jaffuel D, Pépin JL, Gagnadoux F, Goutorbe F, Abril B, Ayoub B, Aranda A, Alagha K, Pomiès P, Roubille F, Mercier J, Molinari N, Dauvilliers Y, Héraud N, Hayot M. Impact of a telerehabilitation programme combined with continuous positive airway pressure on symptoms and cardiometabolic risk factors in obstructive sleep apnea patients. Digit Health 2023; 9:20552076231167009. [PMID: 37051564 PMCID: PMC10084579 DOI: 10.1177/20552076231167009] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 03/15/2023] [Indexed: 04/14/2023] Open
Abstract
Background Obstructive sleep apnea syndrome is a common sleep-breathing disorder associated with adverse health outcomes including excessive daytime sleepiness, impaired quality of life and is well-established as a cardiovascular risk factor. Continuous positive airway pressure is the reference treatment, but its cardiovascular and metabolic benefits are still debated. Combined interventions aiming at improving patient's lifestyle behaviours are recommended in guidelines management of obstructive sleep apnea syndrome but adherence decreases over time and access to rehabilitation programmes is limited. Telerehabilitation is a promising approach to address these issues, but data are scarce on obstructive sleep apnea syndrome. Methods The aim of this study is to assess the potential benefits of a telerehabilitation programme implemented at continuous positive airway pressure initiation, compared to continuous positive airway pressure alone and usual care, on symptoms and cardiometabolic risk factors of obstructive sleep apnea syndrome. This study is a 6-months multicentre randomized, parallel controlled trial during which 180 obese patients with severe obstructive sleep apnea syndrome will be included. We will use a sequential hierarchical criterion for major endpoints including sleepiness, quality of life, nocturnal systolic blood pressure and inflammation biological parameters. Discussion m-Rehab obstructive sleep apnea syndrome is the first multicentre randomized controlled trial to examine the effectiveness of a telerehabilitation lifestyle programme in obstructive sleep apnea syndrome. We hypothesize that a telerehabilitation lifestyle intervention associated with continuous positive airway pressure for 6 months will be more efficient than continuous positive airway pressure alone on symptoms, quality of life and cardiometabolic risk profile. Main secondary outcomes include continuous positive airway pressure adherence, usability and satisfaction with the telerehabilitation platform and medico-economic evaluation. Trial registration Clinicaltrials.gov Identifier: NCT05049928. Registration data: 20 September 2021.
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Affiliation(s)
- François Bughin
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU, Montpellier, France
- Clinique du Millénaire, Montpellier, France
- François Bughin, Clinique du Millénaire, Montpellier, France.
| | - Monique Mendelson
- Grenoble Alpes University, INSERM, University hospital Grenoble Alpes, HP2, Grenoble, France
| | - Dany Jaffuel
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU, Montpellier, France
- Department of Pneumology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France
| | - Jean-Louis Pépin
- Grenoble Alpes University, INSERM, University hospital Grenoble Alpes, HP2, Grenoble, France
| | - Frédéric Gagnadoux
- Department of Respiratory, University of Angers, Sleep Medicine, University Hospital of Angers, Angers, France
| | | | - Beatriz Abril
- Service des troubles du sommeil, CHU Nîmes, Nimes, France
| | - Bronia Ayoub
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU, Montpellier, France
| | | | | | - Pascal Pomiès
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU, Montpellier, France
| | - François Roubille
- Cardiology Department, INI-CRT, CHU Montpellier, PhyMedExp,, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Jacques Mercier
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU, Montpellier, France
| | - Nicolas Molinari
- IDESP, INRIA, INSERM, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Yves Dauvilliers
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Nelly Héraud
- Direction de La Recherche Clinique et de L'innovation en Santé - Korian, Lodève, France; GCS CIPS, Lodève, France
| | - M Hayot
- PhyMedExp, University of Montpellier, INSERM, CNRS, CHU, Montpellier, France
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Martinez D, Huet F, Dupasquier V, Aguilhon S, Soltani S, Leclercq F, Molinari N, Chapet N, Delbaere Q, Roubille F. Clinical and ethical implications of withdrawal treatment at the end of heart failure clinical trials. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.080] [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: 12/31/2022]
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Fillard A, Licari A, Molinari N, Marseglia G, Demoly P, Caimmi D. Sensitivity of FEV 1 and Clinical Parameters in Children With a Suspected Asthma Diagnosis. J Allergy Clin Immunol Pract 2023; 11:238-247. [PMID: 36280139 DOI: 10.1016/j.jaip.2022.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asthma is the most common chronic disease in children and a robust diagnosis is crucial to optimize patient care and reduce its burden. To diagnose asthma in children, the Global Initiative for Asthma (GINA) recommendations propose a 12% improvement in forced expiratory volume in 1 second (FEV1) after a bronchodilation test. Nevertheless, such a criterion is rarely confirmed in these patients in clinical practice. OBJECTIVE The objective of this study was to evaluate the sensitivity of spirometric and clinical parameters in identifying children with possible asthma. METHODS The VERI-VEMS Study is a multicenter international retrospective cohort study. Data were collected, from January 2008 until January 2019, for all consecutive children (aged 5-18 years), with a diagnosis of asthma, who performed a spirometry at the time of the diagnosis. We compared the sensitivity of the reversibility criterion proposed by GINA guidelines, with other spirometric and clinical variables, using physician-diagnosed asthma and response to treatment as the standard. RESULTS The study included 871 children. The reversibility criterion of 12% of FEV1 showed a sensitivity of 30.4%. The 3 best spirometric or clinical criteria were the presence of dry cough, or wheezing or atopy and dry cough, or wheezing or exercise-induced dyspnea, with a sensitivity reaching 99.5%, with no added value of the spirometric parameters in the calculation of the cumulated sensitivity for the diagnosis of pediatric asthma. CONCLUSIONS Postbronchodilator reversibility of 12%, although essential for patients' follow-up, has an insufficient low sensitivity in reaching a diagnosis of asthma in pediatric patients, compared with a combination of clinical symptoms, that show a better sensitivity. Further studies on specificity will help clarify the role of this change in the diagnostic paradigm in formally diagnosing children with asthma.
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Affiliation(s)
- Anouchka Fillard
- Allergy Unit, Département de Pneumologie et Addictology, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Amelia Licari
- Pediatric Unit, University of Pavia, San Matteo Hospital, Pavia, Italy
| | - Nicolas Molinari
- Department of Statistics, IMAG UMR5149 S, University Hospital of Montpellier, Montpellier, France; Debrest Institute of Epidemiology and Public Health (IDESP), UMR UA11, University of Montpellier - INSERM, Montpellier, France
| | | | - Pascal Demoly
- Allergy Unit, Département de Pneumologie et Addictology, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France; Debrest Institute of Epidemiology and Public Health (IDESP), UMR UA11, University of Montpellier - INSERM, Montpellier, France
| | - Davide Caimmi
- Allergy Unit, Département de Pneumologie et Addictology, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France; Debrest Institute of Epidemiology and Public Health (IDESP), UMR UA11, University of Montpellier - INSERM, Montpellier, France.
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Rolle A, De Jong A, Vidal E, Molinari N, Azoulay E, Jaber S. Cardiac arrest and complications during non-invasive ventilation: a systematic review and meta-analysis with meta-regression. Intensive Care Med 2022; 48:1513-1524. [PMID: 36112157 PMCID: PMC9483519 DOI: 10.1007/s00134-022-06821-y] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/06/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this study was to perform a systematic review and meta-analysis to investigate the incidence rate of cardiac arrest and severe complications occurring under non-invasive ventilation (NIV). METHODS We performed a systematic review and meta-analysis of studies between 1981 and 2020 that enrolled adults in whom NIV was used to treat acute respiratory failure (ARF). We generated the pooled incidence and confidence interval (95% CI) of NIV-related cardiac arrest per patient (primary outcome) and performed a meta-regression to assess the association with study characteristics. We also generated the pooled incidences of NIV failure and hospital mortality. RESULTS Three hundred and eight studies included a total of 7,601,148 participants with 36,326 patients under NIV (8187 in 138 randomized controlled trials, 9783 in 99 prospective observational studies, and 18,356 in 71 retrospective studies). Only 19 (6%) of the analyzed studies reported the rate of NIV-related cardiac arrest. Forty-nine cardiac arrests were reported. The pooled incidence was 0.01% (95% CI 0.00-0.02, I2 = 0% (0-15)). NIV failure was reported in 4371 patients, with a pooled incidence of 11.1% (95% CI 9.0-13.3). After meta-regression, NIV failure and the study period (before 2010) were significantly associated with NIV-related cardiac arrest. The hospital mortality pooled incidence was 6.0% (95% CI 4.4-7.9). CONCLUSION Cardiac arrest related to NIV occurred in one per 10,000 patients under NIV for ARF treatment. NIV-related cardiac arrest was associated with NIV failure.
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Affiliation(s)
- Amélie Rolle
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University of Montpellier 1, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France.,Anesthesiology and Intensive Care Department, University of La Guadeloupe, 97159, Pointe A Pitre, Guadeloupe
| | - Audrey De Jong
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University of Montpellier 1, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France.,Phymed Exp INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Elsa Vidal
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University of Montpellier 1, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France.,Anesthesiology and Intensive Care Department, University of La Guadeloupe, 97159, Pointe A Pitre, Guadeloupe
| | - Nicolas Molinari
- IDESP, INSERM, Université de Montpellier, CHU Montpellier, Languedoc‑Roussillon, Montpellier, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Groupe FAMIREA, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Samir Jaber
- Anesthesia and Critical Care Department, Saint Eloi Teaching Hospital, University of Montpellier 1, 80 Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France. .,Phymed Exp INSERM U1046, CNRS UMR 9214, Montpellier, France.
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Merliot‑Gailhoustet L, Raimbert C, Garnier O, Carr J, De Jong A, Molinari N, Jaber S, Chanques G. Publisher Correction to: Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross‑over randomized controlled trial E‑CHOISIR (Electronic‑CHOIce of a System for Intensive care Relaxation). Crit Care 2022; 26:291. [PMID: 36163028 PMCID: PMC9513888 DOI: 10.1186/s13054-022-04169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Roubille F, Matzner‐Lober E, Aguilhon S, Rene M, Lecourt L, Galinier M, Ricci J, Molinari N. Impact of global warming on weight in patients with heart failure during the 2019 heatwave in France. ESC Heart Fail 2022; 10:727-731. [PMID: 36130614 PMCID: PMC9871725 DOI: 10.1002/ehf2.14129] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/24/2022] [Accepted: 08/16/2022] [Indexed: 01/29/2023] Open
Abstract
Heatwaves affect human health and should be more and more frequent because of global warming and could lead to increase mortality in general population, especially regarding cardiovascular mortality. During the summer 2019, Europe experienced a strong episode of heatwave. Telemonitoring of patients with heart failure (HF) provide an elegant tool to monitor closely the weights, and we assumed to be able to assess our hypothesis through a nationwide telemonitoring system. Here, we hypothesize that (i) there will be a change in patients' weight during the heatwave and (ii) that the telemonitoring would enable us to follow these changes. The change in weight would be a surrogate for clinical worsening (with or without decompensated HF). Briefly, 1420 patients with a median age of 73.0 years and mean weight of 78.1 kg have been included in this analysis. The relationship between temperature and weight is very strong (P < 10-7 ). The magnitude of the effect seems clinically relevant with a variation of 1.5 kg during a short period. This could expose patients to increased symptoms, HF decompensations, and poor outcomes. These results suggest a new way to implement weight telemonitoring in HF. This suggests also a direct impact of global warming on Human health, with acute episodes that are expected to occur more often, threatening patients with chronic diseases, especially patients with heart failure. In clinical practice, this urges to take into consideration the episodes of extreme heatwave and suggest that we have already useful tools including telemonitoring available in frail patients.
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Affiliation(s)
- François Roubille
- PhyMedExp, Cardiology Department, University of Montpellier, INSERM U1046, CNRS UMR, 9214; INI‐CRTMontpellierFrance
| | - Eric Matzner‐Lober
- UMR CNRS CREST 9194, ENSAEParisFrance,IDESP UA11, INSERM, Univ Montpellier, Department of Statistics, CHU MontpellierMontpellierFrance
| | | | - Max Rene
- CDM e‐Health rue Albert Calmette78350Jouy‐en‐JosasFrance
| | | | - Michel Galinier
- Fédération des Services de Cardiologie, CHU Toulouse‐Rangueil, Faculté de Médecine, ToulouseUniversité Paul Sabatier‐Toulouse III31400ToulouseFrance
| | | | - Nicolas Molinari
- IDESP UA11, INSERM, Univ Montpellier, Department of Statistics, CHU MontpellierMontpellierFrance
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Merliot-Gailhoustet L, Raimbert C, Garnier O, Carr J, De Jong A, Molinari N, Jaber S, Chanques G. Discomfort improvement for critically ill patients using electronic relaxation devices: results of the cross-over randomized controlled trial E-CHOISIR (Electronic-CHOIce of a System for Intensive care Relaxation). Crit Care 2022; 26:263. [PMID: 36057612 PMCID: PMC9440448 DOI: 10.1186/s13054-022-04136-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/21/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose To assess the impact of different electronic relaxation devices on common stressful patient symptoms experienced in intensive care unit (ICU).
Methods Sixty critically ill patients were enrolled in four relaxation sessions using a randomized cross-over design: standard relaxation (TV/radio), music therapy (MUSIC-CARE©), and two virtual reality systems using either real motion pictures (DEEPSEN©) or synthetic motion pictures (HEALTHY-MIND©). The goal was to determine which device was the best to reduce overall patient discomfort intensity (0–10 Numeric Rating Scale (NRS); primary endpoint). Secondary endpoints were specific stressful symptoms (pain, anxiety, dyspnea, thirst, and lack of rest feeling) and stress response measured by Analgesia/Nociception Index (ANI). Multivariate mixed-effect analysis was used, taking into account patient characteristics and multiple measurements. Results Fifty patients followed the full research protocol, and ten patients did at least one research planned session of relaxation. HEALTHY-MIND© was associated with a significant decrease in overall discomfort, the primary endpoint (median NRS = 4[2–6] vs. 2[0–5]; p = 0.01, mixed-effect model), accompanied by a significant decrease in stress response (increase in ANI, secondary endpoint; p < 0.01). Regarding other secondary endpoints, each of the two virtual reality systems was associated with a decrease in anxiety (p < 0.01), while HEALTHY-MIND© was associated also with a decrease in pain (p = 0.001) and DEEPSEN© with a decrease in lack of rest (p = 0.01). Three incidents (claustrophobia/dyspnea/agitation) were reported among 109 virtual reality sessions. Cybersickness was rare (NRS = 0[0–0]). Conclusion Electronic relaxation therapy is a promising, safe, and effective non-pharmacological solution that can be used to improve overall discomfort in alert and non-delirious ICU patients. Its effectiveness depends on technical characteristics (virtual reality using a synthetic imagined world versus a real world or music therapy alone without virtual reality), as well as the type of symptoms. Electronic relaxation therapies are effective supportive care tools for improving stressful symptoms in ICU patients. Effectiveness depends on the type of symptom and the characteristics of the devices. Overall discomfort and adrenergic stress response are more significantly improved by virtual reality using a synthetic imagined world than using a real world or music therapy alone.
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Bessis D, Trouillet‐Assant S, Secco L, Bardin N, Blanc B, Blatière V, Chable‐Bessia C, Delfour C, Girard C, Richard J, Gros N, Le Moing V, Molinari N, Pallure V, Pisoni A, Raison‐Peyron N, Reynaud E, Schwob É, Pescarmona R, Samaran Q, Willems M, Vincent T, Sofonea MT, Belot A, Tuaillon É. COVID-19 pandemic-associated chilblains: more links for SARS-CoV-2 and less evidence for high interferon type I systemic response. Br J Dermatol 2022; 187:1032-1035. [PMID: 35971922 PMCID: PMC9538550 DOI: 10.1111/bjd.21820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/08/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Didier Bessis
- Department of Dermatology, Saint‐Eloi HospitalCompetence Centre for Rare Skin Diseases and University of MontpellierMontpellierFrance,INSERM U1058MontpellierFrance
| | | | - Léo‐Paul Secco
- Department of Dermatology, Saint‐Eloi HospitalCompetence Centre for Rare Skin Diseases and University of MontpellierMontpellierFrance
| | | | | | - Véronique Blatière
- Department of Dermatology, Saint‐Eloi HospitalCompetence Centre for Rare Skin Diseases and University of MontpellierMontpellierFrance
| | | | | | - Céline Girard
- Department of Dermatology, Saint‐Eloi HospitalCompetence Centre for Rare Skin Diseases and University of MontpellierMontpellierFrance,INSERM U1058MontpellierFrance
| | | | | | | | | | | | | | - Nadia Raison‐Peyron
- Department of Dermatology, Saint‐Eloi HospitalCompetence Centre for Rare Skin Diseases and University of MontpellierMontpellierFrance
| | | | - Émilie Schwob
- Department of Dermatology, Saint‐Eloi HospitalCompetence Centre for Rare Skin Diseases and University of MontpellierMontpellierFrance
| | | | - Quentin Samaran
- Department of Dermatology, Saint‐Eloi HospitalCompetence Centre for Rare Skin Diseases and University of MontpellierMontpellierFrance
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Hédon C, Schnell F, Sosner P, Chagué F, Schuster I, Julia M, Duparc A, Guy JM, Molinari N, Michaux L, Cransac F, Cade S. Cardiac screening before returning to elite sport after SARS-CoV-2 infection. Arch Cardiovasc Dis 2022; 115:562-570. [PMID: 36207245 PMCID: PMC9530801 DOI: 10.1016/j.acvd.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/19/2022]
Abstract
Background Aim Methods Results Conclusion
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Affiliation(s)
- Christophe Hédon
- PhyMedExp, University Montpellier, Inserm, CNRS; Cardiology and Physiology departments, University hospital Montpellier, Montpellier, France.
| | - Frédéric Schnell
- Department of Sport Medicine, University hospital Pontchaillou; University Rennes 1, Inserm, LTSI-UMR 1099, Rennes, France
| | - Philippe Sosner
- Sport Medicine Center "Mon Stade", Paris, France; AP-HP Hôtel-Dieu University Hospital, Diagnosis and Therapeutic Center, Paris, France; INSEP, medical center, Paris, France; MOVE laboratory (UR 20296), Poitiers University of sciences and technology of physical activity and sports, Poitiers, France
| | - Frédéric Chagué
- Cardiology Department, University Hospital of Dijon, Physiopathology and brain cardiovascular epidemiology (PEC2), EA7460, University of Bourgogne Franche-Comté, Dijon, France
| | - Iris Schuster
- PhyMedExp, University Montpellier, Inserm, CNRS, University hospital Nîmes, Nîmes, France
| | - Marc Julia
- Department of Sport medicine, Hospital of Perpignan, Perpignan, France
| | - Alexandre Duparc
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Jean-Michel Guy
- Cardio-respiratory rehabilitation center of Loire, St Priest en Jarez, France
| | - Nicolas Molinari
- IDESP, Inserm, University Montpellier, University hospital Montpellier, Montpellier, France
| | | | - Frédéric Cransac
- Cardiology Department, Clinique du Millénaire, Montpellier, France
| | - Stéphane Cade
- Cardiology Department, Clinique du Millénaire, Montpellier, France
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Srisuwatchari W, Vo T, Gauthier A, Molinari N, Schrijvers R, Demoly P, Chiriac AM. Hypersensitivity reactions to iodinated radiocontrast media: Cluster analysis reveals distinct clinical phenotypes. World Allergy Organ J 2022; 15:100680. [PMID: 36092950 PMCID: PMC9440439 DOI: 10.1016/j.waojou.2022.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/07/2022] [Accepted: 07/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background Drug hypersensitivity reaction (DHR) to iodinated radiocontrast media (iRCM) is reported in 1%–3% of injections. Risk assessment of patients with suspicion of DHR to iRCM relies solely on clinical phenotyping and drug allergy workup. Using a novel unsupervised TwoStep cluster analysis, we aimed to identify prototypic patterns within a large cohort of patients evaluated for a potential iRCM DHR. Methods A retrospective study was conducted using data from the Drug Allergy and Hypersensitivity Database of the Allergy Unit, University Hospital of Montpellier, Montpellier, France. All referred patients during February 2001 to December 2019 with suspicion of iRCM DHR with either confirmed positive or confirmed negative skin tests were included in the analysis. Results A total of 1439 patients were evaluated. The chronology of the index reaction was immediate and nonimmediate in 77.1% and 22.4%, respectively. Cluster analysis categorized the total study population in 5 clusters. Cluster 1 compiled all nonimmediate and cluster 2–5 almost all immediate reactors. Cluster 1 and 2 had recent reactions (<1 y) with mostly known iRCMs and the highest iRCM allergy prevalence (16–17%). In the other clusters, more remote reactions, unknown iRCMs and a lower allergy prevalence (3–8%) was observed. Chronology and semiology of the index reaction were the factors most strongly differentiated among clusters. History of anaphylactic shock and chronology of immediate hypersensitivity reactions were shown to be independent predictors of allergy with adjusted OR (aOR) of 4.68 (95%CI: 3.01–7.27, p < 0.001) and 2.51 (95%CI: 1.67–3.78, p < 0.001), respectively. Conclusions Unsupervised cluster analysis identified 5 prototypic patterns within patients with a suspected DHR to iRCMs. Well-phenotyped patients cluster together in 2 groups in which the prevalence of allergy is approximately 1 in 6. However, this value decreases for patients with reactions dating back to more than a decade.
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Godet T, De Jong A, Garin C, Guérin R, Rieu B, Borao L, Pereira B, Molinari N, Bazin JE, Jabaudon M, Chanques G, Futier E, Jaber S. Impact of Macintosh blade size on endotracheal intubation success in intensive care units: a retrospective multicenter observational MacSize-ICU study. Intensive Care Med 2022; 48:1176-1184. [PMID: 35974189 PMCID: PMC9463307 DOI: 10.1007/s00134-022-06832-9] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/18/2022] [Indexed: 12/19/2022]
Abstract
Purpose To investigate the impact of Macintosh blade size used during direct laryngoscopy (DL) on first-attempt intubation success of orotracheal intubation in French intensive care units (ICUs). We hypothesized that success rate would be higher with Macintosh blade size No3 than with No4. Methods Multicenter retrospective observational study based on data from prospective trials conducted in 48 French ICUs of university, and general and private hospitals. After each intubation using Macintosh DL, patients’ and operators’ characteristics, Macintosh blade size, results of first DL and alternative techniques used, as well as the need of a second operator were collected. Complications rates associated with intubation were investigated. Primary outcome was success rate of first DL using Macintosh blade. Results A total of 2139 intubations were collected, 629 with a Macintosh blade No3 and 1510 with a No4. Incidence of first-pass intubation after first DL was significantly higher with Macintosh blade No3 (79.5 vs 73.3%, p = 0.0025), despite equivalent Cormack–Lehane scores (p = 0.48). Complications rates were equivalent between groups. Multivariate analysis concluded to a significant impact of Macintosh blade size on first DL success in favor of blade No3 (OR 1.44 [95% CI 1.14–1.84]; p = 0.0025) without any significant center effect on the primary outcome (p = 0.18). Propensity scores and adjustment analyses concluded to equivalent results. Conclusion In the present study, Macintosh blade No3 was associated with improved first-passed DL in French ICUs. However, study design requires the conduct of a nationwide prospective multicenter randomized trial in different settings to confirm these results. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06832-9.
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Affiliation(s)
- Thomas Godet
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63000, Clermont-Ferrand, France. .,Département Anesthésie Réanimation B (DAR B), Hôpital Saint-Eloi, and Inserm U-1046, Centre Hospitalier Universitaire (CHU) Montpellier, 34295, Montpellier, France. .,Département Anesthésie Réanimation, Pôle de Médecine Périopératoire (MPO), Hôpital Estaing, Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, 1 place Lucie et Raymond Aubrac, 63001, Clermont-Ferrand cedex 1, France.
| | - Audrey De Jong
- Département Anesthésie Réanimation B (DAR B), Hôpital Saint-Eloi, and Inserm U-1046, Centre Hospitalier Universitaire (CHU) Montpellier, 34295, Montpellier, France
| | - Côme Garin
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Renaud Guérin
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Benjamin Rieu
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Lucile Borao
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- Délégation à la Recherche Clinique et à l'Innovation (DRCI), Centre Hospitalier Universitaire (CHU) de Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Nicolas Molinari
- Clinical Research Department, Centre Hospitalier Universitaire (CHU) Montpellier, 34295, Montpellier, France
| | - Jean-Etienne Bazin
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Matthieu Jabaudon
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63000, Clermont-Ferrand, France.,iGReD, Université Clermont Auvergne, CNRS, INSERM, 63003, Clermont-Ferrand, France
| | - Gérald Chanques
- Département Anesthésie Réanimation B (DAR B), Hôpital Saint-Eloi, and Inserm U-1046, Centre Hospitalier Universitaire (CHU) Montpellier, 34295, Montpellier, France
| | - Emmanuel Futier
- Département Anesthésie Réanimation, Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, 63000, Clermont-Ferrand, France.,iGReD, Université Clermont Auvergne, CNRS, INSERM, 63003, Clermont-Ferrand, France
| | - Samir Jaber
- Département Anesthésie Réanimation B (DAR B), Hôpital Saint-Eloi, and Inserm U-1046, Centre Hospitalier Universitaire (CHU) Montpellier, 34295, Montpellier, France
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Samaran Q, Samaran R, Ferreira E, Haddad N, Fottorino A, Maillard H, Dreno B, Meyer N, Azria D, Maubec E, Gaudy-Marqueste C, Molinari N, Stoebner PE, Dereure O. Anti-PD-1 for the treatment of advanced cutaneous squamous cell carcinoma in elderly patients: a French multicenter retrospective survey. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04246-0. [PMID: 35962286 PMCID: PMC9374288 DOI: 10.1007/s00432-022-04246-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/01/2022] [Indexed: 11/08/2022]
Abstract
Background Anti-PD1 agents are currently recommended as first-line treatment in advanced cutaneous squamous cell carcinoma (acSCC) by updated European guidelines. Although acSCC frequently affects elderly patients with multiple comorbidities, this subset of patients is often excluded of registration clinical trials. Purpose To assess anti-PD-1 efficacy and safety in elderly acSCC patients in real-life conditions and describe this specific population with oncogeriatric evaluation tools. Methods A multicenter retrospective study including acSCC patients at least 70 years old treated with PD-1 inhibitors was conducted in French referral centers. The primary endpoint was the overall response rate (ORR). Secondary endpoints included safety data, time to response (TTR), duration of response (DOR), overall survival (OS), and progression-free survival (PFS). Results 63 patients were included. ORR was 57.1% (95% CI 44.0–69.5), median TTR and DOR were 3 and 5.5 months respectively. Median OS was not reached (95% CI 12.5 months-not reached) at data cut-off after a median follow-up of 8 months while median PFS was 8 months. (95% CI 5 months-not reached). Grade 3–5 adverse effects occurred in 47.6% of patients. 41.3% of patients experienced degradation of ECOG performance status during anti-PD-1 treatment. Nutritional state worsened in 27% of patients and 57.1% lost weight during treatment. Conclusion In this particular subset of acSCC patients PD-1 inhibitors obtain results similar to those obtained in younger populations included in pivotal clinical trials, with acceptable safety. A specific oncogeriatric evaluation at treatment initiation and during follow-up appears important in this setting most notably to help manage toxicity. Supplementary Information The online version contains supplementary material available at 10.1007/s00432-022-04246-0.
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Affiliation(s)
- Quentin Samaran
- Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France. .,Department of Dermatology, Nîmes University Hospital and Montpellier University, Nîmes, France. .,Chru de Montpellier-Hôpital St Eloi-Service de Dermatologie, 80, Avenue Augustin Fliche, 34295, Montpellier Cedex 5, France.
| | - Romain Samaran
- Department of Dermatology, Le Mans Hospital, Le Mans, France.,Department of Dermatology, Nantes University Hospital and Nantes University, Nantes, France
| | - Ernestine Ferreira
- Department of Geriatrics, Montpellier University Hospital and Montpellier University, Montpellier, France
| | - Naeda Haddad
- Department of Dermatology, Avicenne Hospital (AP-HP) and Paris 13 University, Bobigny, France
| | - Antoine Fottorino
- Department of Oncodermatology, La Timone Hospital (AP-HM) and Aix-Marseille University, Marseille, France
| | - Hervé Maillard
- Department of Dermatology, Le Mans Hospital, Le Mans, France
| | - Brigitte Dreno
- Department of Dermatology, Nantes University Hospital and Nantes University, Nantes, France
| | - Nicolas Meyer
- Institut Universitaire Du Cancer de Toulouse, Toulouse University Hospital, Toulouse, France
| | - David Azria
- Fédération Universitaire d'Oncologie Radiothérapie, ICM-Institut Régional du Cancer Montpellier, Montpellier, France
| | - Eve Maubec
- Department of Dermatology, Avicenne Hospital (AP-HP) and Paris 13 University, Bobigny, France
| | - Caroline Gaudy-Marqueste
- Department of Oncodermatology, La Timone Hospital (AP-HM) and Aix-Marseille University, Marseille, France
| | - Nicolas Molinari
- IDESP, INSERM, Department of Statistics, Univ Montpellier, CHU Montpellier, Montpellier, France
| | | | - Olivier Dereure
- Department of Dermatology, Montpellier University Hospital and Montpellier University, Montpellier, France
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Hireche K, Canaud L, Lounes Y, Aouinti S, Molinari N, Alric P. Thoracoscopic Versus Open Lobectomy After Induction Therapy for Nonsmall Cell Lung Cancer: New Study Results and Meta-analysis. J Surg Res 2022; 276:416-432. [PMID: 35465975 DOI: 10.1016/j.jss.2022.04.002] [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: 09/17/2021] [Revised: 02/23/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The use of video-assisted thoracoscopic surgery (VATS) lobectomy has become a mainstay of modern thoracic surgery practice and the technique of choice for resection of early-stage lung cancers. However, the benefits of VATS following induction therapy are yet to be clarified. This study aims to assess whether VATS lobectomy achieves similar perioperative and oncologic outcomes compared to thoracotomy for nonsmall cell lung cancer after induction therapy. METHODS We retrospectively reviewed the outcomes of 72 patients who underwent lung lobectomy after induction therapy in our institution from January 2017 to January 2020. Subsequently, we carried out a comprehensive literature search and pooled our results with available data from previously published studies to perform a meta-analysis. RESULTS VATS was associated with reduced intraoperative blood loss (P = 0.05) and less perioperative complications (P = 0.04) in our local institution. The meta-analysis comprised nine studies. A total of 943 patients underwent VATS and 2827 patients underwent open lobectomy. VATS was associated with significant shorter surgery duration (P < 0.0001), shorter chest-tube drainage duration (P < 0.0001), and shorter hospital stays (P < 0.0001). Furthermore, there was significantly less perioperative complications (P = 0.006) and less intraoperative blood loss (P = 0.036) in the VATS group. However, there were no significant differences in 3-y overall survival and 3-y disease-free survival rates. CONCLUSIONS In some selected patients undergoing induction therapy, VATS lobectomy could achieve equivalent perioperative outcomes to thoracotomy but evidence is lacking on oncologic outcomes. Further trials with a focus on oncologic outcomes and longer follow-up are required.
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Affiliation(s)
- Kheira Hireche
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France.
| | - Ludovic Canaud
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Youcef Lounes
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Safa Aouinti
- IDESP, INSERM, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- IDESP, INSERM, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Pierre Alric
- Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve University Hospital, Montpellier, France; PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
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Tanno LK, Molinari N, Annesi-Maesano I, Demoly P, Bierrenbach AL. Anaphylaxis in Brazil between 2011 and 2019. Clin Exp Allergy 2022; 52:1071-1078. [PMID: 35856139 PMCID: PMC9541456 DOI: 10.1111/cea.14193] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a lack of population-based studies of anaphylaxis from low- and middle-income countries. This hampers public health planning and investments and may influence availability of adrenaline auto-injectors. OBJECTIVE We conducted the first national population-based study of anaphylaxis hospitalization in Brazil. METHODS Descriptive study using routinely reported data to the Brazilian Hospital Information System for the years 2011-2019. Information available is coded based on the International Classification of Diseases (ICD)-10 and covers main cause of hospitalization (primary cause) and any conditions contributing to it (secondary cause). RESULTS Over 9 years, we identified 5716 admissions due to anaphylaxis for all causes. The average hospitalization rate related to anaphylaxis was 0.71/100,000 population per year, with a 2.4% (95% CI 1.9%, 2.9%) increase per annum over the study period. Admissions were more frequent among females (52.8%), except for cases due to insect sting. Most admissions occurred in adulthood, from 30 to 59 years (36.3%) but 13.8% in preschool children (0-4 years). There were more young children admitted for food-related anaphylaxis, and more adults admitted for drug/iatrogenic-related anaphylaxis. There were 334 cases (5.8% of admissions) of fatal anaphylaxis over the study period, with increased case fatality rate over time. CONCLUSIONS AND CLINICAL RELEVANCE This is the first study of anaphylaxis hospital admissions using nation-wide data from a low- or middle-income country. Hospital admissions and fatalities from anaphylaxis in Brazil appear to be increasing.
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Affiliation(s)
- Luciana Kase Tanno
- Hospital Sírio-Libanês Sao Paulo, Sa˜o Paulo, Brazil.,University Hospital of Montpellier, Montpellier, France.,Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier - INSERM, Paris, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Nicolas Molinari
- University Hospital of Montpellier, Montpellier, France.,Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier - INSERM, Paris, France
| | - Isabella Annesi-Maesano
- Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier - INSERM, Paris, France
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier - INSERM, Paris, France.,WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Ana Luiza Bierrenbach
- Hospital Sírio-Libanês Sao Paulo, Sa˜o Paulo, Brazil.,Sanas Epidemiology and Research, Sa˜o Paulo, Brazil
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Volpato M, Vialaret J, Hirtz C, Petit A, Suehs C, Patarin J, Matzner-Lober E, Vachier I, Molinari N, Bourdin A, Charriot J. Rheology predicts sputum eosinophilia in patients with muco-obstructive lung diseases. Biochem Biophys Res Commun 2022; 622:64-71. [PMID: 35843096 DOI: 10.1016/j.bbrc.2022.07.025] [Citation(s) in RCA: 2] [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: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Mucus is known to play a pathogenic role in muco-obstructive lung diseases, but little is known about the determinants of mucus rheology. The purpose of this study is to determine which sputum components influence sputum rheology in patients with muco-obstructive lung diseases. METHODS We performed a cross sectional prospective cohort study. Spontaneous sputum was collected from consecutive patients with muco-obstructive lung diseases. Sputum rheology was assessed using the Rheomuco® rheometer (Rheonova, Grenoble); the elastic modulus G', viscous modulus G″, and the critical stress threshold σc were recorded. Key quantitative and qualitative biological sputum components were determined by cytology, nucleic acid amplification tests and mass spectrometry. RESULTS 48 patients were included from January to August 2019. Among them, 10 had asthma, 14 COPD and 24 non-CF bronchiectasis (NCFB). The critical stress threshold σc predicted a sputum eosinophilia superior to 1.25% with 89.19% accuracy (AUC = 0.8762). G' and G″ are positively correlated with MUC5AC protein concentration ((rho = 0.361; P = .013) and (rho = 0.335; P = .021), respectively). σc was positively correlated with sputum eosinophilia (rho = 0.394; P = .012), MUC5B (rho = 0.552; P < .001) and total protein (rho = 0.490; P < .001) concentrations. G' and G″ were significantly higher in asthma patients (G' = 14.49[7.18-25.26]Pa, G'' = 3.0[2.16-5.38]Pa) compared to COPD (G' = 5.01[2.94-6.48]Pa, P = .010; G'' = 1.45[1.16-1.94]Pa, P = .006) and to NCFB (G' = 4.99[1.49-10.49]Pa, P = .003; G'' = 1.46[0.71-2.47]Pa, P = .002). CONCLUSION In muco-obstructive lung diseases, rheology predicts sputum eosinophilia and is correlated with mucin concentrations, regardless of the underlying disease. CLINICAL TRIAL REGISTRATION (registrar, website, and registration number), where applicable NCT04081740.
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Affiliation(s)
- Mathilde Volpato
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France.
| | - Jerome Vialaret
- Clinical Proteomics Platform, LBPC, IRMB, CHU Montpellier, Montpellier University, Montpellier, France.
| | - Christophe Hirtz
- Clinical Proteomics Platform, LBPC, IRMB, CHU Montpellier, Montpellier University, Montpellier, France.
| | - Aurélie Petit
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France; Medecine Biologie Meditérrannée, France.
| | - Carey Suehs
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France; Department of Medical Information, Montpellier University Hospitals, La Colombière Hospital, Montpellier Cedex, France.
| | - Jérémy Patarin
- Rheonova, domaine universitaire, 1270 rue de la piscine, 38400 Saint Martin d'Hères, France.
| | - Eric Matzner-Lober
- Continuing Education ENSAE-ENSAI (CEPE), Rennes University 2, Rennes, France.
| | | | - Nicolas Molinari
- Department of Medical Information, Montpellier University Hospitals, La Colombière Hospital, Montpellier Cedex, France; IMAG, CNRS, Univ Montpellier, CHU Montpellier, Montpellier, France.
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France; PhyMedExp INSERM U1046, Montpellier, France.
| | - Jeremy Charriot
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France; PhyMedExp INSERM U1046, Montpellier, France.
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Chiriac AM, Zhu R, Izquierdo L, Molinari N, Demoly P. The minimal important difference of the allergic rhinitis control test. J Allergy Clin Immunol Pract 2022; 10:1924-1926.e2. [PMID: 35413474 DOI: 10.1016/j.jaip.2022.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/29/2022] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Anca Mirela Chiriac
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, University of Montpellier, Montpellier, France; IDESP, UMR UA11, University of Montpellier, INSERM, Montpellier, France.
| | - Rongfei Zhu
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lisa Izquierdo
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, University of Montpellier, Montpellier, France
| | - Nicolas Molinari
- IDESP, UMR UA11, University of Montpellier, INSERM, Montpellier, France; Clinical Research Unit, Department of Clinical Information, University Hospital of Montpellier, Montpellier, France
| | - Pascal Demoly
- Department of Pulmonology, Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, University of Montpellier, Montpellier, France; IDESP, UMR UA11, University of Montpellier, INSERM, Montpellier, France
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Dagneaux L, Nogue E, Mathieu J, Demoulin D, Canovas F, Molinari N. Survivorship of 4,748 Contemporary Total Ankle Replacements from the French Discharge Records Database. J Bone Joint Surg Am 2022; 104:684-692. [PMID: 35030113 DOI: 10.2106/jbjs.21.00746] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Studies of survivorship of primary total ankle replacements (TARs) beyond 5 years have shown varying results among early and modern designs. National cohorts give valuable insights about TAR outcomes, revision risk factors, and specific designs. The purpose of this study was to investigate implant survivorship and risk factors for revision of contemporary TARs using our national database. METHODS This observational study included patients identified in the national PMSI (Programme médicalisé des systèmes d'information) database as having undergone TAR from 2010 to 2019. Demographics, discharge data, concomitant procedures, and type of implant were extracted. Kaplan-Meier estimations were performed to determine time to revision using metal component revision for implant failure and revision for deep infection as end points. Weighted Cox models were used for risk factor analysis, including risks of early revision (within the first 2 years). The adjusted hazard ratios (HRadj) were reported with 95% confidence intervals. RESULTS A cohort of 4,748 patients was extracted. The mean age at surgery was 63 years; 43% of the patients were female. The mean follow-up was 5 years (range, 1 to 10 years). Revisions were noted in 817 cases (17%), including 734 with metal component revision and 83 with revision due to deep infection. The 1-year, 2-year, 5-year, and 10-year survivorship free of metal component revision was 95%, 90%, 84%, and 78%, respectively. Younger age, implants derived from second-generation designs, and an institutional volume of ≤10 TARs per year were found to be independent predictors of revision for any cause. In addition to the above factors (except for implant generation), male sex and concomitant osteotomies and/or fusion were found to be significant predictors for any early revision. CONCLUSIONS The 10-year survivorship free of metal component revision after TAR was 78%, which was consistent with other national registries. Revisions were associated with young age, associated arthritis or deformities requiring concomitant fusion or osteotomy, and implants derived from second-generation designs. Institutions where >10 procedures were performed per year were associated with better TAR survivorship. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Louis Dagneaux
- Lower Limb Surgery Unit, Department of Orthopedic Surgery, University of Montpellier, Montpellier, France
| | - Erika Nogue
- Clinical Research and Epidemiology Unit, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Julie Mathieu
- Lower Limb Surgery Unit, Department of Orthopedic Surgery, University of Montpellier, Montpellier, France
| | - David Demoulin
- Clinical Research and Epidemiology Unit, CHU Montpellier, University of Montpellier, Montpellier, France
| | - François Canovas
- Lower Limb Surgery Unit, Department of Orthopedic Surgery, University of Montpellier, Montpellier, France
| | - Nicolas Molinari
- UA11 Institute of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France
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Lecronier M, Jung B, Molinari N, Pinot J, Similowski T, Jaber S, Demoule A, Dres M. Severe but reversible impaired diaphragm function in septic mechanically ventilated patients. Ann Intensive Care 2022; 12:34. [PMID: 35403916 PMCID: PMC9001790 DOI: 10.1186/s13613-022-01005-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Whether sepsis-associated diaphragm dysfunction may improve despite the exposure of mechanical ventilation in critically ill patients is unclear. This study aims at describing the diaphragm function time course of septic and non-septic mechanically ventilated patients. Methods Secondary analysis of two prospective observational studies of mechanically ventilated patients in whom diaphragm function was assessed twice: within the 24 h after intubation and when patients were switched to pressure support mode, by measuring the endotracheal pressure in response to bilateral anterior magnetic phrenic nerve stimulation (Ptr,stim). Change in diaphragm function was expressed as the difference between Ptr,stim measured under pressure support mode and Ptr,stim measured within the 24 h after intubation. Sepsis was defined according to the Sepsis-3 international guidelines upon inclusion. In a sub-group of patients, the right hemidiaphragm thickness was measured by ultrasound. Results Ninety-two patients were enrolled in the study. Sepsis upon intubation was present in 51 (55%) patients. In septic patients, primary reason for ventilation was acute respiratory failure related to pneumonia (37/51; 73%). In non-septic patients, main reasons for ventilation were acute respiratory failure not related to pneumonia (16/41; 39%), coma (13/41; 32%) and cardiac arrest (6/41; 15%). Ptr,stim within 24 h after intubation was lower in septic patients as compared to non-septic patients: 6.3 (4.9–8.7) cmH2O vs. 9.8 (7.0–14.2) cmH2O (p = 0.004), respectively. The median (interquartile) duration of mechanical ventilation between first and second diaphragm evaluation was 4 (2–6) days in septic patients and 3 (2–4) days in non-septic patients (p = 0.073). Between first and second measurements, the change in Ptr,stim was + 19% (− 13–61) in septic patients and − 7% (− 40–12) in non-septic patients (p = 0.005). In the sub-group of patients with ultrasound measurements, end-expiratory diaphragm thickness decreased in both, septic and non-septic patients. The 28-day mortality was higher in patients with decrease or no change in diaphragm function. Conclusion Septic patients were associated with a more severe but reversible impaired diaphragm function as compared to non-septic patients. Increase in diaphragm function was associated with a better survival. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-022-01005-9.
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Affiliation(s)
- Marie Lecronier
- Médecine Intensive - Réanimation (Département "R3S"), APHP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France. .,Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM-UMR S 1158, Sorbonne Université, Paris, France.
| | - Boris Jung
- Département de Médecine Intensive - Réanimation, CHU Montpellier, Montpellier, France.,Laboratoire de Physiologie et Médecine Expérimentale du cœur et des Muscles, INSERM U1046-CNRS UMR 9214, Université de Montpellier, Montpellier, France
| | - Nicolas Molinari
- Department of Medical Information, Hôpital Arnaud de Villeneuve, IMAG U5149, Université de Montpellier, Montpellier, France
| | - Jérôme Pinot
- Médecine Intensive - Réanimation (Département "R3S"), APHP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Thomas Similowski
- Médecine Intensive - Réanimation (Département "R3S"), APHP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM-UMR S 1158, Sorbonne Université, Paris, France
| | - Samir Jaber
- Département de Médecine Intensive - Réanimation, CHU Montpellier, Montpellier, France.,Laboratoire de Physiologie et Médecine Expérimentale du cœur et des Muscles, INSERM U1046-CNRS UMR 9214, Université de Montpellier, Montpellier, France
| | - Alexandre Demoule
- Médecine Intensive - Réanimation (Département "R3S"), APHP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM-UMR S 1158, Sorbonne Université, Paris, France
| | - Martin Dres
- Médecine Intensive - Réanimation (Département "R3S"), APHP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France.,Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM-UMR S 1158, Sorbonne Université, Paris, France
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Fillias Q, Millet I, Guiu B, Orliac C, Curros Doyon F, Gamon L, Molinari N, Taourel P. Development and validation of a composite score to predict severe forms of ischemic colitis. Eur Radiol 2022; 32:6355-6366. [PMID: 35353197 DOI: 10.1007/s00330-022-08726-2] [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: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop a simple scoring system in order to predict the risk of severe (death and/or surgery) ischemic colitis METHODS: In this retrospective study, 205 patients diagnosed with ischemic colitis in a tertiary hospital were consecutively included over a 6-year period. The study sample was sequentially divided into a training cohort (n = 103) and a validation cohort (n = 102). In the training cohort, multivariable analysis was used to identify clinical, biological, and CT variables associated with poor outcome and to build a risk scoring system. The discriminative ability of the score (sensitivity, specificity, positive predictive value, negative predictive value) was estimated in the two cohorts to externally validate the score, and a receiver operating characteristic curve was established to estimate the area under the curve of the score. Bootstrapping was used to validate the score internally. RESULTS In the training cohort, four independent variables were associated with unfavorable outcome: hemodynamic instability (2 pts), involvement of the small bowel (1 pt), paper-thin wall pattern (3 pts), no stratified enhancement pattern (1 pt). The score was used to categorize patients into low risk (score: 0, 1), high risk (score: 2-3), and very high risk (score: 4-7) groups with sensitivity and specificity of 97% and 67%, respectively, and a good discriminating capability, with a C-statistic of 0.94. Internal and external validation showed good discrimination capability (C-statistics of 0.9 and 0.84, respectively). CONCLUSION A simple risk score can stratify patients into three distinct prognosis groups, which can optimize patient management. CLINICAL TRIAL NUMBER NCT04662268 KEY POINTS: • Simple scoring system predicting the risk of severe ischemic colitis • First study to include CT findings to the clinical and biological data used to determine a severity score.
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Affiliation(s)
- Quentin Fillias
- Department of Imaging, Hospital Lapeyronie, CHU Montpellier, Montpellier, France
| | - Ingrid Millet
- Department of Imaging, Hospital Lapeyronie, CHU Montpellier, Montpellier, France
- UMR 1302 Institute Desbrest of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France
| | - Boris Guiu
- Department of Imaging, Hospital Saint Eloi, CHU Montpellier, Montpellier, France
| | - Celine Orliac
- Department of Imaging, Hospital Lapeyronie, CHU Montpellier, Montpellier, France
| | | | - Lucie Gamon
- Department of Biostatistics, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- UMR 1302 Institute Desbrest of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France
- Department of Biostatistics, CHU Montpellier, Montpellier, France
| | - Patrice Taourel
- Department of Imaging, Hospital Lapeyronie, CHU Montpellier, Montpellier, France.
- UMR 1302 Institute Desbrest of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France.
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Sandie AB, Molinari N, Wanjoya A, Kouanfack C, Laurent C, Tchatchueng-Mbougua JB. Non-inferiority test for a continuous variable with a flexible margin in an active controlled trial: an application to the “Stratall ANRS 12110 / ESTHER” trial. Trials 2022; 23:202. [PMID: 35248123 PMCID: PMC8898539 DOI: 10.1186/s13063-022-06118-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Non-inferiority trials are becoming increasingly popular in public health and clinical research. The choice of the non-inferiority margin is the cornerstone of such trials. Most of the time, the non-inferiority margin is fixed and constant, determined from historical trials as a fraction of the effect of the reference intervention. But in some circumstances, there may some uncertainty around the reference treatment that one would like to account for when performing the hypothesis testing. In this case, the non-inferiority margin is not fixed in advance and depends on the reference intervention estimate. Hence, the uncertainty surrounding the non-inferiority margin should be accounted for in statistical tests. In this work, we explore how to perform the non-inferiority test for a continuous variable with a flexible margin. Methods We have proposed in this study, two procedures for the non-inferiority test with a flexible margin for continuous endpoints. The proposed test procedures are based on a test statistic and confidence interval approaches respectively. Simulations have been used to assess the performances and properties of the proposed test procedures. An application was done on a real-world clinical data, to assess the efficacy of clinical monitoring alone versus laboratory and clinical monitoring in HIV-infected adult patients. Results Basically, for both proposed methods, the type I error estimate was not dependent on the values of the reference treatment. In the test statistic approach, the type 1 error rate estimate was approximatively equal to the nominal value. It has been found that the confidence interval level determined approximatively the level of significance. For a given nominal type I error α, the appropriate one- and two-sided confidence intervals should be with levels 1−α and 1−2α, respectively. Conclusions Based on the type I error rate and power estimates, the proposed non-inferiority hypothesis test procedures had good performances and were applicable in practice. Trial registration ClinicalTrials.gov NCT00301561. Registered on March 13, 2006, url: https://clinicaltrials.gov/ct2/show/NCT00301561.
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Bertelli F, Suehs CM, Mallet JP, Court-Fortune I, Gagnadoux F, Borel JC, Gaubert O, Molinari N, Bourdin A, Jaffuel D. Did COVID-19 impact Positive Airway Pressure adherence in 2020? A cross-sectional study of 8477 patients with sleep apnea. Respir Res 2022; 23:46. [PMID: 35246109 PMCID: PMC8894547 DOI: 10.1186/s12931-022-01969-z] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background Whether the COVID-19 pandemic impacts Positive Airway Pressure (PAP) adherence over the long-term is unknown and only preliminary short-term data have been reported. Methods With the aim of describing the impact of the first and second waves of COVID-19 on PAP adherence during 2020 in France, we designed a cross-sectional study of Sleep-Apnea (SA)-patients under PAP telemonitoring. To examine PAP adherence in adult SA patients, we assessed de-identified data from a non-profit healthcare provider database during the period January 1, 2019 to December 31, 2020. Included patients met the following criteria: (i) PAP-treated for at least 4 months before January 1, 2019 and with continuous PAP during both 2019 and 2020; (ii) ≥ 360 daily PAP telemonitored data per year. For PAP adherence, data were collected using the PAP-software. Results 8477/10482 patients were finally included in the analysis [72.4% male, median age 70 years (IQ25–75: 61–77], 25.6% < 62 years old, initial Apnea–Hypopnea Index (AHI) of 41 (31–59)/h. Median PAP adherence was 7.21 (6.12–8.10) h/day in 2020 versus 7.12 (6.05–8.02) h/day in 2019, p < 0.001. The median difference in PAP adherence between the first 2020 lockdown and the corresponding 2019 weeks was 9.75 (CI95% 8.75–10.75) min/day, p < 0.001. The median difference in PAP adherence between the second 2020 lockdown and the corresponding 2019 weeks was 5.00 (CI95% 4.00–6.00) min/day, p < 0.001. If we consider the minimal clinically important difference of 30 min for PAP adherence, 30.4% and 26% of the patients increased their PAP adherence by at least 30 min during the first and second lockdowns respectively; 17.6% and 19.3% of the patients lowered their PAP adherence by at least 30 min in the first and second lockdowns, respectively. Conclusion During the first and second lockdowns, the COVID-19 pandemic had a clinically irrelevant effect on PAP adherence for the study population. Future studies are needed to describe COVID-19 pandemic impact on PAP adherence not only for long-term PAP-treated SA patients but also for incident cases. Trial registration The COVADENE study was registered on March 1st, 2021 on ClinicalTrials.gov (Identifier: NCT04775966)
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Affiliation(s)
- Fanny Bertelli
- Department of Medical Information, Montpellier University Hospital, IDESP, UMR 5149, Montpellier University, 34090, Montpellier, France.,Groupe Adène, rue de Chambert, 34080, Montpellier, France
| | - Carey M Suehs
- Department of Medical Information, Montpellier University Hospital, IDESP, UMR 5149, Montpellier University, 34090, Montpellier, France.,Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France
| | - Jean-Pierre Mallet
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France.,PhyMedExp, CNRS, INSERM, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Isabelle Court-Fortune
- Department of Respiratory Diseases, CHU Saint Etienne, 25, boulevard Pasteur, 42055, Saint-Étienne Cedex 2, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University Hospital, INSERM U1063, SOPAM, Angers University, Angers, France
| | - Jean Christian Borel
- Inserm U1042, HP2 (Hypoxia PhysioPathology), Laboratory Centre Hospitalier Universitaire Grenoble Alpes, Grenoble Alps, University, Grenoble, France
| | | | - Nicolas Molinari
- Department of Medical Information, Montpellier University Hospital, IDESP, UMR 5149, Montpellier University, 34090, Montpellier, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France.,PhyMedExp, CNRS, INSERM, Univ Montpellier, CHU Montpellier, Montpellier, France
| | - Dany Jaffuel
- Groupe Adène, rue de Chambert, 34080, Montpellier, France. .,Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, 371, Avenue Doyen Giraud, 34295, Montpellier Cedex 5, France. .,PhyMedExp, CNRS, INSERM, Univ Montpellier, CHU Montpellier, Montpellier, France.
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Lahmar M, Ahmed E, Vachier I, Fort A, Marin G, Molinari N, Bergougnoux A, Bourdin A. Hedgehog Interacting Protein (HHIP) polymorphisms involved in early chronic obstructive pulmonary disease (COPD). Rev Mal Respir 2022. [DOI: 10.1016/j.rmr.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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De Jong A, Huguet H, Molinari N, Jaber S. Non-invasive ventilation versus oxygen therapy after extubation in patients with obesity in intensive care units: the multicentre randomised EXTUB-OBESE study protocol. BMJ Open 2022; 12:e052712. [PMID: 35045999 PMCID: PMC8772410 DOI: 10.1136/bmjopen-2021-052712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Patients with obesity are considered to be at high risk of acute respiratory failure (ARF) after extubation in intensive care unit (ICU). Compared with oxygen therapy, non-invasive ventilation (NIV) may prevent ARF in high-risk patients. However, these strategies have never been compared following extubation of critically ill patients with obesity. Our hypothesis is that NIV is associated with less treatment failure compared with oxygen therapy in patients with obesity after extubation in ICU. METHODS AND ANALYSIS The NIV versus oxygen therapy after extubation in patients with obesity in ICUs protocol (EXTUB-obese) trial is an investigator-initiated, multicentre, stratified, parallel-group unblinded trial with an electronic system-based randomisation. Patients with obesity defined as a body mass index ≥30 kg/m² will be randomly assigned in the 'NIV-group' to receive prophylactic NIV applied immediately after extubation combined with high-flow nasal oxygen (HFNO) or standard oxygen between NIV sessions versus in the 'oxygen therapy group' to receive oxygen therapy alone (HFNO or standard oxygen,). The primary outcome is treatment failure within the 72 hours, defined as reintubation for mechanical ventilation, switch to the other study treatment, or premature study-treatment discontinuation (at the request of the patient or for medical reasons such as gastric distention). The single, prespecified, secondary outcome is the incidence of ARF until day 7. Other outcomes analysed will include tracheal intubation rate at day 7 and day 28, length of ICU and hospital stay, ICU mortality, day 28 and day 90 mortality. ETHICS AND DISSEMINATION The study project has been approved by the appropriate ethics committee 'Comité-de-Protection-des-Personnes Ile de FranceV-19.04.05.70025 Cat2 2019-A00956-51'. Informed consent is required. The results will be submitted for publication in a peer-reviewed journal and presented at one or more scientific conferences. If use of NIV shows positive effects, teams (medical and surgical) will use NIV following extubation of critically ill patients with obesity. TRIAL REGISTRATION NUMBER NCT04014920.
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Affiliation(s)
- Audrey De Jong
- Département d'Anesthésie Réanimation B PhyMedExp, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Helena Huguet
- Clinical research department of Montpellier university hospital, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Nicolas Molinari
- IMAG, CNRS, Univ Montpellier, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Samir Jaber
- Département d'Anesthésie Réanimation B PhyMedExp, University Hospital Centre Montpellier, Montpellier, Languedoc-Roussillon, France
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Gris JC, Cochery-Nouvellon É, Bourguignon C, Mercier É, Bouvier S, Quéré I, Perez-Martin A, Molinari N, Matzner-Lober É. Reference values of coagulation assays performed for thrombophilia screening after a first venous thrombosis and their intra-patient associations. Thromb Res 2022; 210:94-103. [PMID: 35042062 DOI: 10.1016/j.thromres.2022.01.005] [Citation(s) in RCA: 1] [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: 09/22/2021] [Revised: 12/03/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION No reference values are currently available for coagulation assays performed for thrombophilia screening prescribed according to guidelines, after a first venous thromboembolic (VTE) event, and we have no idea of the intra-patient associations between results. METHODS We performed a retrospective study of consecutive prescriptions fulfilling guidelines in a French university hospital from 2010 to 2019 (n = 3842) from the Glims® laboratory information system. We collected results of 12 parameters: aPTT, PT, fibrinogen (Fg), one-stage clotting methods for factors VIII, IX, XI and II (FVIII, FIX, FXI, FII), antithrombin (using an amidolytic assay: AT), protein C and S (using clotting assays: PC and PS) and mixing tests of a lupus-anticoagulant sensitive aPTT and of DRVVT. RESULTS We show the results of the 12 parameters from 3603 individual files with less than 6 missing values, then describe these distributions and correlations between results from 2930 files with no missing value. We give the frequency of results described as indicating a risk of first VTE or of VTE recurrence. We propose 2 quantitative scores linking the 12 parameters at the individual level and reflecting their degree of dispersion with respect to their mean, describe the values of these scores and their associations with thrombophilic results. CONCLUSIONS These normal values should help laboratory workers to validate process results and to assess their degree of originality. Our 2 scores should help to determine the intra-patient plausibility of associations of results. The usefulness of these laboratory scores for predicting clinically-relevant outcomes deserves to be investigated.
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Affiliation(s)
- Jean-Christophe Gris
- Department of Haematology, CHU Nîmes, Univ Montpellier, Nîmes, France; Faculty of Pharmaceutical and Biological Sciences, Montpellier University, France; UMR UA11 INSERM Institut Desbrest d'Epidémiologie et de Santé Publique, Montpellier University, France; I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
| | - Éva Cochery-Nouvellon
- Department of Haematology, CHU Nîmes, Univ Montpellier, Nîmes, France; UMR UA11 INSERM Institut Desbrest d'Epidémiologie et de Santé Publique, Montpellier University, France
| | - Chloé Bourguignon
- Department of Haematology, CHU Nîmes, Univ Montpellier, Nîmes, France; UMR UA11 INSERM Institut Desbrest d'Epidémiologie et de Santé Publique, Montpellier University, France
| | - Éric Mercier
- Department of Haematology, CHU Nîmes, Univ Montpellier, Nîmes, France; Faculty of Pharmaceutical and Biological Sciences, Montpellier University, France; UMR UA11 INSERM Institut Desbrest d'Epidémiologie et de Santé Publique, Montpellier University, France
| | - Sylvie Bouvier
- Department of Haematology, CHU Nîmes, Univ Montpellier, Nîmes, France; UMR UA11 INSERM Institut Desbrest d'Epidémiologie et de Santé Publique, Montpellier University, France
| | - Isabelle Quéré
- UMR UA11 INSERM Institut Desbrest d'Epidémiologie et de Santé Publique, Montpellier University, France; Department of Vascular Medicine, University Hospital, Montpellier, France
| | - Antonia Perez-Martin
- UMR UA11 INSERM Institut Desbrest d'Epidémiologie et de Santé Publique, Montpellier University, France; Department of Vascular Medicine, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Nicolas Molinari
- Faculty of Pharmaceutical and Biological Sciences, Montpellier University, France; UMR UA11 INSERM Institut Desbrest d'Epidémiologie et de Santé Publique, Montpellier University, France
| | - Éric Matzner-Lober
- UMR UA11 INSERM Institut Desbrest d'Epidémiologie et de Santé Publique, Montpellier University, France; CREST UMR 9194, ENSAE Formation Continue, 91120 Palaiseau, France
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Guinault D, Bernier M, Delarche A, Neuville S, Milioto O, Molinari N, Dahan P. Immunogenicity of the BNT162b2 Vaccine in Patients Undergoing Maintenance Hemodialysis Is Associated with Medical Conditions. Nephron Clin Pract 2022; 146:553-558. [PMID: 35477156 DOI: 10.1159/000524292] [Citation(s) in RCA: 1] [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: 07/24/2021] [Accepted: 03/14/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Patients undergoing maintenance hemodialysis have an attenuated immune response to vaccination. The aim of our study was to determine the predictive factors for humoral response to vaccination with the BNT162b2 mRNA vaccine (Pfizer-BioNTech) in patients on maintenance hemodialysis. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS In this retrospective, single-center study, we included patients on maintenance hemodialysis already vaccinated with two doses of the BNT162b2 vaccine (Pfizer-BioNTech) and with a post-vaccination serological follow-up. RESULTS 252 patients were included for study with a mean age of 71.9 (±14.4) years. Twelve patients (4.7%) were under immunosuppressive therapy (calcineurin inhibitors: n = 4; chemotherapy for myeloma: n = 3; last infusion of rituximab over the previous 4 years: n = 2; abatacept: n = 2; adalimumab n = 1). Three of these patients were under immunosuppressive therapy for nonrenal solid organ transplantation. Multivariate analysis identified immunosuppressive therapy (OR 4.73 [1.38-16.17], p = 0.013) and lower baseline albumin levels (OR 1.23 [1.09-1.38], p < 0.001) as independent predictive factors of nonresponse to vaccination. Older age (β = -0.59 ± 0.21, p = 0.006) and immunosuppressive therapy (β = 40.33 ± 13.33, p = 0.003) were significantly associated with lower humoral response to vaccination. CONCLUSIONS Approximately 90% of patients under maintenance hemodialysis developed specific antibodies to the BNT162b2 mRNA vaccine. Immunosuppressive therapy, malnutrition, and older age were associated with a higher risk of nonseroconversion or lower humoral response to mRNA-based vaccination against SARS-CoV-2. We strongly recommend serological monitoring after vaccination to determine booster timing, especially for patients with malnutrition or on immunosuppressive therapy.
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Affiliation(s)
- Damien Guinault
- Nephrology Department, Clinique Saint-Exupéry, Toulouse, France
| | | | | | - Sylvie Neuville
- Nephrology Department, Clinique Saint-Exupéry, Toulouse, France
| | - Olivier Milioto
- Nephrology Department, Clinique Saint-Exupéry, Toulouse, France
| | - Nicolas Molinari
- Department of Statistics, Montpellier University Hospital, Montpellier University, Montpellier, France
| | - Philippe Dahan
- Nephrology Department, Clinique Saint-Exupéry, Toulouse, France
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Bourdin A, Molinari N. Non-optimal methodology questions indirect treatment comparison of dupilumab vs. other biologics in severe asthma. Respir Med 2022; 191:105999. [DOI: 10.1016/j.rmed.2020.105999] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/16/2022]
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Bughin F, Bui G, Ayoub B, Blervaque L, Saey D, Avignon A, Brun JF, Molinari N, Pomies P, Mercier J, Gouzi F, Hayot M. Impact of a Mobile Telerehabilitation Solution on Metabolic Health Outcomes and Rehabilitation Adherence in Patients With Obesity: Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e28242. [PMID: 34874887 PMCID: PMC8691412 DOI: 10.2196/28242] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/10/2021] [Accepted: 09/17/2021] [Indexed: 02/06/2023] Open
Abstract
Background Obesity is a major public health issue. Combining exercise training, nutrition, and therapeutic education in metabolic rehabilitation (MR) is recommended for obesity management. However, evidence from randomized controlled studies is lacking. In addition, MR is associated with poor patient adherence. Mobile health devices improve access to MR components. Objective The aim of this study is to compare the changes in body composition, anthropometric parameters, exercise capacity, and quality of life (QOL) within 12 weeks of patients in the telerehabilitation (TR) program to those of usual care patients with obesity. Methods This was a parallel-design randomized controlled study. In total, 50 patients with obesity (BMI>30 kg/m²) were included in a TR group (TRG) or a usual care group (UCG) for 12 weeks. Patients underwent biometric impedance analyses, metabolic exercise tests, actimetry, and QOL and satisfaction questionnaires. The primary outcome was the change in fat mass at 12 weeks from baseline. Secondary outcomes were changes in body weight, metabolic parameters, exercise capacity, QOL, patients’ adhesion, and satisfaction. Results A total of 49 patients completed the study. No significant group × time interaction was found for fat mass (TRG: mean 1.7 kg, SD 2.6 kg; UCG: mean 1.2 kg, SD 2.4 kg; P=.48). Compared with the UCG, TRG patients tended to significantly improve their waist to hip ratios (TRG: −0.01 kg, SD 0.04; UCG: +0.01 kg, SD 0.06; P=.07) and improved QOL physical impact (TRG: +21.8, SD 43.6; UCG: −1.2, SD 15.4; P=.005). Significant time effects were observed for body composition, 6-minute walk test distance, exercise metabolism, sedentary time, and QOL. Adherence (95%) and satisfaction in the TRG were good. Conclusions In adults with obesity, the TR program was not superior to usual care for improving body composition. However, TR was able to deliver full multidisciplinary rehabilitation to patients with obesity and improve some health outcomes. Given the patients’ adherence and satisfaction, pragmatic programs should consider mobile health devices to improve access to MR. Further studies are warranted to further establish the benefits that TR has over usual care. Trial Registration ClinicalTrials.gov NCT03396666; http://clinicaltrials.gov/ct2/show/NCT03396666
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Affiliation(s)
- François Bughin
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Gaspard Bui
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Bronia Ayoub
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Leo Blervaque
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Didier Saey
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Antoine Avignon
- Institut Desbrest de Santé Publique, University of Montpellier, Institut national de la santé et de la recherche médicale, Montpellier, France.,Endocrinologie-Diabétologie-Nutrition, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Montpellier, France
| | - Jean Frédéric Brun
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Nicolas Molinari
- Institut Montpelliérain Alexander Grothendieck, University of Montpellier, Centre national de la recherche scientifique, Montpellier, France.,Department of Medical Statistics and Epidemiology, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Montpellier, France
| | - Pascal Pomies
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Jacques Mercier
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Fares Gouzi
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
| | - Maurice Hayot
- PhyMedExp, Centre Hospitalier Universitaire Montpellier, University of Montpellier, Institut national de la santé et de la recherche médicale, Centre national de la recherche scientifique, Montpellier, France
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Pensier J, De Jong A, Chanques G, Futier E, Azoulay E, Molinari N, Jaber S. A multivariate model for successful publication of intensive care medicine randomized controlled trials in the highest impact factor journals: the SCOTI score. Ann Intensive Care 2021; 11:165. [PMID: 34837580 PMCID: PMC8626742 DOI: 10.1186/s13613-021-00954-x] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background Critical care randomized controlled trials (RCTs) are often published in high-impact journals, whether general journals [the New England Journal of Medicine (NEJM), The Lancet, the Journal of the American Medical Association (JAMA)] or critical care journals [Intensive Care Medicine (ICM), the American Journal of Respiratory and Critical Care Medicine (AJRCCM), Critical Care Medicine (CCM)]. As rejection occurs in up to 97% of cases, it might be appropriate to assess pre-submission probability of being published. The objective of this study was to develop and internally validate a simplified score predicting whether an ongoing trial stands a chance of being published in high-impact general journals. Methods A cohort of critical care RCTs published between 1999 and 2018 in the three highest impact medical journals (NEJM, The Lancet, JAMA) or the three highest impact critical care journals (ICM, AJRCCM, CCM) was split into two samples (derivation cohort, validation cohort) to develop and internally validate the simplified score. Primary outcome was journal of publication assessed as high-impact general journal (NEJM, The Lancet, JAMA) or critical care journal (ICM, AJRCCM, CCM). Results A total of 968 critical care RCTs were included in the predictive cohort and split into a derivation cohort (n = 510) and a validation cohort (n = 458). In the derivation cohort, the sample size (P value < 0.001), the number of centers involved (P value = 0.01), mortality as primary outcome (P value = 0.002) or a composite item including mortality as primary outcome (P value = 0.004), and topic [ventilation (P value < 0.001) or miscellaneous (P value < 0.001)] were independent factors predictive of publication in high-impact general journals, compared to high-impact critical care journals. The SCOTI score (Sample size, Centers, Outcome, Topic, and International score) was developed with an area under the ROC curve of 0.84 (95% Confidence Interval, 0.80–0.88) in validation by split sample. Conclusions The SCOTI score, developed and validated by split sample, accurately predicts the chances of a critical care RCT being published in high-impact general journals, compared to high-impact critical care journals. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00954-x.
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Affiliation(s)
- Joris Pensier
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214 CEDEX 5, Montpellier, France
| | - Audrey De Jong
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214 CEDEX 5, Montpellier, France
| | - Gerald Chanques
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214 CEDEX 5, Montpellier, France
| | - Emmanuel Futier
- Department of Peri-Operative Medicine, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, Groupe FAMIREA, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - Nicolas Molinari
- IDESP, INSERM, Univ Montpellier, CHU Montpellier, Montpellier, France.,Universite de Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Samir Jaber
- Department of Anesthesia and Intensive Care Unit, Regional University Hospital of Montpellier, St-Eloi Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR, 9214 CEDEX 5, Montpellier, France. .,Département d'Anesthésie Réanimation B (DAR B), 80 Avenue Augustin Fliche, 34295, Montpellier, France.
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