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Kovess-Masfety V, Rabaté L, Caby D, Nicaise P. French mental health care system: Analysis of care utilisation patterns and the case for a stepped care approach. Health Policy 2023; 138:104945. [PMID: 37984095 DOI: 10.1016/j.healthpol.2023.104945] [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: 06/15/2023] [Revised: 11/08/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
CONTEXT In France, spending on mental health and psychiatric care, in proportion to GDP, is close to the EU average. However, there are complaints that the French system is overwhelmed and potentially underfunded. OBJECTIVE To describe the utilisation of psychiatric and mental health care in different settings to consider the appropriateness of care provision and resource allocation. METHODS For the year 2018, several national databases on the use of all type of psychiatric care provision (full and part-time hospitalisations, private and public, public ambulatory care, private office-based psychiatrists) were cross-tabulated with diagnosis categories for different age groups and illness severity in order to assess the use of resources and evaluate the appropriateness of resource allocation. RESULTS A sizable proportion of patients with mild and moderate mental disorders are treated in psychiatric care whilst there is insufficient continuity of care for patients with severe disorders, who are not adequately followed up after discharge from hospitals. This contributes to increase the rate of re-hospitalisations, the use of emergency departments, and longer stays in hospitals. CONCLUSION The several components of the French mental health care system are used inappropriately, not only in geographical terms but also in terms of service use. We argue that strengthening the access to affordable psychotherapy and the implementation of a stepped-care approach could contribute to solve this issue.
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Affiliation(s)
- V Kovess-Masfety
- LPPS, Paris Cité University, Paris, France; Cour des comptes, Paris, France.
| | | | - D Caby
- Cour des comptes, Paris, France
| | - P Nicaise
- Institute of Health and Society (IRSS), Université Catholique de Louvain, Bruxelles, Belgium
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Battesti G, El Khalifa J, Abdelhedi N, Ferre V, Bouscarat F, Picard-Dahan C, Brunet-Possenti F, Collin G, Lavaud J, Le Bozec P, Rousselot M, Tournier A, Lheure C, Couvelard A, Hacein-Bey-Abina S, Abina AM, Charpentier C, Mignot S, Nicaise P, Descamps D, Deschamps L, Descamps V. New insights in COVID-19-associated chilblains: A comparative study with chilblain lupus erythematosus. J Am Acad Dermatol 2020; 83:1219-1222. [PMID: 32622895 PMCID: PMC7332433 DOI: 10.1016/j.jaad.2020.06.1018] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Nour Abdelhedi
- Department of Dermatology, Bichat Hospital, Paris, France
| | | | | | | | | | - Gilles Collin
- Department of Virology, Bichat Hospital, Paris, France
| | - Justine Lavaud
- Department of Dermatology, Bichat Hospital, Paris, France
| | | | | | | | - Coralie Lheure
- Department of Dermatology, Bichat Hospital, Paris, France
| | | | - Salima Hacein-Bey-Abina
- Unité des Technologies Chimiques et Biologiques Pour la Santé, Centre National de la Recherche Scientifique, Unité Mixte de Recherche (UTCBS CNRS UMR) 8258, Institut National de la Santé et de la Recherche Médicale (INSERM) U1267, Faculté de Pharmacie de Paris, Université de Paris, Paris, France; Clinical Immunology Laboratory, Groupe Hospitalier Universitaire Paris-Sud, Hôpital Kremlin-Bicêtre, Assistance Publique-Hôpitaux de Paris, Le-Kremlin-Bicêtre, France
| | - Amine M Abina
- Unité des Technologies Chimiques et Biologiques Pour la Santé, Centre National de la Recherche Scientifique, Unité Mixte de Recherche (UTCBS CNRS UMR) 8258, Institut National de la Santé et de la Recherche Médicale (INSERM) U1267, Faculté de Pharmacie de Paris, Université de Paris, Paris, France; Cerba Healthcare, Cerballiance-Ile-de-France Ouest, Hôpital Privé de l'Ouest Parisien, Trappes, France
| | | | - Sabine Mignot
- Department of Immunology, Bichat Hospital, Paris, France
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Nicaise P, Giacco D, Priebe S, Lorant V. Healthcare system performance on care continuity for severe mentally ill patients in five countries. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P Nicaise
- Université catholique de Louvain, Brussels, Belgium
| | - D Giacco
- Queen Mary University of London, London, UK
| | - S Priebe
- Queen Mary University of London, London, UK
| | - V Lorant
- Université catholique de Louvain, Brussels, Belgium
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Bird VJ, Giacco D, Nicaise P, Pfennig A, Lasalvia A, Welbel M, Priebe S. In-patient treatment in functional and sectorised care: patient satisfaction and length of stay. Br J Psychiatry 2018; 212:81-87. [PMID: 29436328 DOI: 10.1192/bjp.2017.20] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Debate exists as to whether functional care, in which different psychiatrists are responsible for in- and out-patient care, leads to better in-patient treatment as compared with sectorised care, in which the same psychiatrist is responsible for care across settings. Aims To compare patient satisfaction with in-patient treatment and length of stay in functional and sectorised care. METHOD Patients with an ICD-10 diagnosis of psychotic, affective or anxiety/somatoform disorders consecutively admitted to an adult acute psychiatric ward in 23 hospitals across 11 National Health Service trusts in England were recruited. Patient satisfaction with in-patient care and length of stay (LoS) were compared (trial registration ISRCTN40256812). RESULTS In total, 2709 patients were included, of which 1612 received functional and 1097 sectorised care. Patient satisfaction was significantly higher in sectorised care (β = 0.54, 95% CI 0.35-0.73, P<0.001). This difference remained significant when adjusting for locality and patient characteristics. LoS was 6.9 days shorter for patients in sectorised care (β = -6.89, 95% CI -11.76 to -2.02, P<0.001), but this difference did not remain significant when adjusting for clustering by hospital (β = -4.89, 95% CI -13.34 to 3.56, P = 0.26). CONCLUSIONS This is the first robust evidence that patient satisfaction with in-patient treatment is higher in sectorised care, whereas findings for LoS are less conclusive. If patient satisfaction is seen as a key criterion, sectorised care seems preferable. Declarations of interest None.
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Affiliation(s)
- V J Bird
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development),Queen Mary University of London,London,UK
| | - D Giacco
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development),Queen Mary University of London,London,UK
| | - P Nicaise
- Institute of Health and Society IRSS,Université Catholique de Louvain,Bruxelles,Belgium
| | - A Pfennig
- Department of Psychiatry and Psychotherapy,Carl Gustav Carus University Hospital, Technische Universität Dresden,Dresden,Germany
| | - A Lasalvia
- Section of Psychiatry,Department of Public Health and Community Medicine,University of Verona,Verona,Italy
| | - M Welbel
- Institute of Psychiatry and Neurology,Warsaw,Poland
| | - S Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development),Queen Mary University of London,London,UK
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5
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Beltramo G, Thabut G, Peron N, Nicaise P, Cazes A, Debray MP, Joannes A, Castier Y, Mailleux AA, Frija J, Pradère P, Justet A, Borie R, Dombret MC, Taille C, Aubier M, Crestani B. Anti-parietal cell autoimmunity is associated with an accelerated decline of lung function in IPF patients. Respir Med 2018; 135:15-21. [PMID: 29414448 DOI: 10.1016/j.rmed.2017.12.011] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/26/2017] [Accepted: 12/26/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Autoantibodies against lung epithelial antigens are often detected in patients with Idiopathic Pulmonary Fibrosis (IPF). Anti-Parietal Cell Antibodies (APCA) target the H+/K+ATPase (proton pump). APCA prevalence and lung H+/K+ATPase expression was never studied in IPF patients. METHODS We retrospectively collected clinical, lung function and imaging data from APCA positive patients (APCA+IPF) and compared them with APCA negative IPF patients matched on the date of diagnostic assessment. H+/K+ATPase expression was assessed with immunohistochemistry and PCR. RESULTS Among 138 IPF patients diagnosed between 2007 and 2014 and tested for APCA, 19 (13.7%) APCA+ patients were identified. APCA+IPF patients were 16 men and 3 women, mean age 71 years. The median titer of APCA was 1:160. A pernicious anemia was present in 5 patients and preceded the fibrosis in 3 cases. With a mean follow up of 31 months, 2 patients had an exacerbation and 7 patients died. As compared with 19 APCA- IPF patients, APCA+IPF patients had a less severe disease with better DLCO (57% vs 43% predicted), preserved PaO2 (85 ± 8 mmHg vs 74 ± 11 mmHg), a lower rate of honeycombing on HRCT (58% vs 89%), but they experienced an accelerated decline of FVC (difference 61.4 ml/year; p = .0002). The H+/K+ATPase was strongly expressed by hyperplastic alveolar epithelial cells in the fibrotic lung. CONCLUSION Anti-parietal cell autoimmunity is detected in some IPF patients and is associated with an accelerated decline of lung function. Anti-parietal cell autoimmunity may promote lung fibrosis progression.
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Affiliation(s)
- Guillaume Beltramo
- Assistance Publique-Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation and Remodeling), Hôpital Bichat, Service de Pneumologie A, 75018 Paris, France
| | - Gabriel Thabut
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Pneumologie et Transplantation, 75018 Paris, France; INSERM UMR 1152, Labex Inflamex, Paris, France; Université Paris Diderot, Paris, France
| | - Nicolas Peron
- Assistance Publique-Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation and Remodeling), Hôpital Bichat, Service de Pneumologie A, 75018 Paris, France
| | - Pascale Nicaise
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Département d'Hématologie et Immunologie UF Autoimmunité et Hypersensibilités, 75018 Paris, France
| | - Aurélie Cazes
- INSERM UMR 1152, Labex Inflamex, Paris, France; Université Paris Diderot, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Département d'Anatomie Pathologique, 75018 Paris, France
| | - Marie-Pierre Debray
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Radiologie, Paris, France
| | - Audrey Joannes
- INSERM UMR 1152, Labex Inflamex, Paris, France; Université Paris Diderot, Paris, France
| | - Yves Castier
- INSERM UMR 1152, Labex Inflamex, Paris, France; Université Paris Diderot, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service de Chirurgie Vasculaire et Thoracique 75018 Paris, France
| | - Arnaud A Mailleux
- INSERM UMR 1152, Labex Inflamex, Paris, France; Université Paris Diderot, Paris, France
| | - Justine Frija
- Université Paris Diderot, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Service d'Explorations Fonctionnelles Multidisciplinaires, 75018 Paris, France
| | - Pauline Pradère
- Assistance Publique-Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation and Remodeling), Hôpital Bichat, Service de Pneumologie A, 75018 Paris, France
| | - Aurélien Justet
- Assistance Publique-Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation and Remodeling), Hôpital Bichat, Service de Pneumologie A, 75018 Paris, France; INSERM UMR 1152, Labex Inflamex, Paris, France; Université Paris Diderot, Paris, France
| | - Raphaël Borie
- Assistance Publique-Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation and Remodeling), Hôpital Bichat, Service de Pneumologie A, 75018 Paris, France; INSERM UMR 1152, Labex Inflamex, Paris, France; Université Paris Diderot, Paris, France
| | - Marie-Christine Dombret
- Assistance Publique-Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation and Remodeling), Hôpital Bichat, Service de Pneumologie A, 75018 Paris, France; INSERM UMR 1152, Labex Inflamex, Paris, France; Université Paris Diderot, Paris, France
| | - Camille Taille
- Assistance Publique-Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation and Remodeling), Hôpital Bichat, Service de Pneumologie A, 75018 Paris, France; INSERM UMR 1152, Labex Inflamex, Paris, France; Université Paris Diderot, Paris, France
| | - Michel Aubier
- Assistance Publique-Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation and Remodeling), Hôpital Bichat, Service de Pneumologie A, 75018 Paris, France; INSERM UMR 1152, Labex Inflamex, Paris, France; Université Paris Diderot, Paris, France
| | - Bruno Crestani
- Assistance Publique-Hôpitaux de Paris, DHU FIRE (Fibrosis, Inflammation and Remodeling), Hôpital Bichat, Service de Pneumologie A, 75018 Paris, France; INSERM UMR 1152, Labex Inflamex, Paris, France; Université Paris Diderot, Paris, France.
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Lorant V, Nicaise P. Effectiveness of networks of mental health services on continuity of care and social integration. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V Lorant
- Université Catholique de Louvain, Brussels, Belgium
| | - P Nicaise
- Université Catholique de Louvain, Brussels, Belgium
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Azghay M, Bouchaud O, Mechaï F, Nicaise P, Fain O, Stirnemann J. Utility of QuantiFERON-TB Gold In-Tube assay in adult, pulmonary and extrapulmonary, active tuberculosis diagnosis. Int J Infect Dis 2016; 44:25-30. [PMID: 26780268 DOI: 10.1016/j.ijid.2016.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Tuberculosis remains a public health problem in France and the diagnosis of tuberculosis disease (TB) is sometimes difficult. The aim of this study was to analyse the contribution of the QuantiFERON-TB Gold In-Tube assay (QFT-GIT) to TB diagnosis. METHODS Sixty patients hospitalized with TB, for whom a QFT-GIT assay had been performed between June 2008 and June 2011 at the University Hospital of Bondy in the north-east of Paris, were identified retrospectively. Clinical and laboratory data were collected. The sensitivity, specificity, predictive values, and likelihood ratios of the QFT-GIT were all calculated. Furthermore, the characteristics of patients testing positive were compared to those of patients testing negative, as well as the QFT-GIT values according to several different factors. RESULTS The sensitivity of the QFT-GIT was 85% (95% confidence interval (CI) 0.73-0.92) and specificity was 73.3% (95% CI 0.68-0.78). The positive predictive value was 39.5% and the negative predictive value was 97.3%. The positive and negative likelihood ratios were 3.2 and 0.20, respectively. The prevalence of TB in this population was 15% (pre-test probability). After a positive test result, the probability of TB increased to 40% (post-positive probability test); after a negative test result, it decreased to 4.5% (post-negative probability test). The combination of the QFT-GIT test with the tuberculin skin test brought no significant improvement in sensitivity. Factors significantly associated with a negative QFT-GIT result included older age, high C-reactive protein, a low lymphocyte count, and immunosuppressant intake. The test value in quantitative terms was significantly higher in those with lymph node TB than in those with pulmonary TB, and in younger patients (<40 years) than in older patients (>40 years old). CONCLUSION On its own, QFT-GIT is an insufficient tool to confirm the diagnosis of TB disease. However, it may form part of an ensemble of tools in combination with clinical, biological, and radiological assessments.
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Affiliation(s)
- Mohammed Azghay
- Service des Maladies Infectieuses et Tropicales, Hôpital Avicenne - Université Paris 13 Paris Cité Sorbonne, 125 route de Stalingrad, 93000 Bobigny, France.
| | - Olivier Bouchaud
- Service des Maladies Infectieuses et Tropicales, Hôpital Avicenne - Université Paris 13 Paris Cité Sorbonne, 125 route de Stalingrad, 93000 Bobigny, France
| | - Frederic Mechaï
- Service des Maladies Infectieuses et Tropicales, Hôpital Avicenne - Université Paris 13 Paris Cité Sorbonne, 125 route de Stalingrad, 93000 Bobigny, France
| | - Pascale Nicaise
- Département d'Hématologie et Immunologie UF Autoimmunité et Hypersensibilités Hôpital Bichat Claude Bernard, Paris, France
| | - Olivier Fain
- Service de Médecine Interne, Hôpital Saint Antoine, Paris, France
| | - Jérôme Stirnemann
- Division of General Internal Medicine, Geneva University Hospital, Geneva, Switzerland
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Beltramo G, Peron N, Nicaise P, Danel C, Debray M, Pradère P, Justet A, Borie R, Dombret M, Taille C, Aubier M, Crestani B. Pneumopathie interstitielle idiopathique et auto-immunité muqueuse anti-cellules pariétales gastriques. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.037] [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: 10/22/2022]
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Gouel-Chéron A, Neukirch C, Aubier B, Montravers P, Nicaise P, Chollet-Martin S, Mertes PM, Aubier M, Longrois D. Anaphylactic bronchospasm during general anesthesia is not related to asthma. Allergy 2015; 70:453-6. [PMID: 25556961 DOI: 10.1111/all.12565] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2014] [Indexed: 10/24/2022]
Abstract
In the general population, a history of asthma (HA) is associated with a higher risk of mortality of anaphylactic shock (AS), but it is unknown whether this association remains valid for intra-operative AS. The goal of this retrospective study was to investigate whether a HA was associated with a higher risk of bronchospasm during intra-operative AS. We analyzed 106 patients (January 2009-December 2012) with intra-operative AS: 57% of them had a confirmed IgE-mediated reaction and 27% had a HA. On logistic regression, the only factor statistically associated with bronchospasm was a neuromuscular blocking drug, with both IgE- or non-IgE-mediated reactions. These results suggest that the mechanisms of bronchospasm in AS may be different from those of asthma and that, in the presence of bronchospasm during anesthesia, AS should be considered to be the most likely cause.
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Affiliation(s)
- A. Gouel-Chéron
- Département d'Anesthésie-Réanimation; Hôpital Bichat-Claude Bernard; Paris France
| | - C. Neukirch
- Service de Pneumologie; Hôpital Bichat-Claude Bernard; Paris France
| | - B. Aubier
- Département d'Anesthésie-Réanimation; Hôpital Bichat-Claude Bernard; Paris France
| | - P. Montravers
- Département d'Anesthésie-Réanimation; Hôpital Bichat-Claude Bernard; Paris France
| | - P. Nicaise
- Laboratoire d'Immunologie “Auto-Immunité et Hypersensibilités”; Hôpital Bichat-Claude Bernard; Paris France
| | - S. Chollet-Martin
- Laboratoire d'Immunologie “Auto-Immunité et Hypersensibilités”; Hôpital Bichat-Claude Bernard; Paris France
| | - P.-M. Mertes
- Service d'Anesthésie-Réanimation; Nouvel Hôpital Civil, CHU de Strasbourg; Strasbourg France
| | - M. Aubier
- Service de Pneumologie; Hôpital Bichat-Claude Bernard; Paris France
| | - D. Longrois
- Département d'Anesthésie-Réanimation; Hôpital Bichat-Claude Bernard; Paris France
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Revaux A, Mekinian A, Nicaise P, Bucourt M, Cornelis F, Lachassinne E, Chollet-Martin S, Fain O, Carbillon L. Antiphospholipid syndrome and other autoimmune diseases associated with chronic intervillositis. Arch Gynecol Obstet 2014; 291:1229-36. [DOI: 10.1007/s00404-014-3536-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/29/2014] [Indexed: 11/25/2022]
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Nicaise P, Lorant V. Networks of psychiatric services to foster care integration: Social Network Analysis of partnerships within the Belgian mental health care delivery reform. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku166.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lorant V, Grard A, Nicaise P. Patients’ inclusion into networks of mental health services: a nation-wide mixed Methods study of a mental health reform. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku166.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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13
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Mekinian A, Costedoat-Chalumeau N, Masseau A, Botta A, Chudzinski A, Theulin A, Emmanuelli V, Hachulla E, De Carolis S, Revaux A, Nicaise P, Cornelis F, Subtil D, Montestruc F, Bucourt M, Chollet-Martin S, Carbillon L, Fain O. Chronic histiocytic intervillositis: outcome, associated diseases and treatment in a multicenter prospective study. Autoimmunity 2014; 48:40-5. [PMID: 25028066 DOI: 10.3109/08916934.2014.939267] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
UNLABELLED Introduction: In this prospective multicenter study, we aimed to describe (1) the outcome of pregnancy in the case of previous chronic histiocytic intervillositis (CHI), (2) the immunological findings and associated diseases, (3) the treatments, and (4) the factors associated with pregnancy loss. METHODS We prospectively included all patients with a prior CHI with ongoing pregnancy between 2011 and 2013. RESULTS Twenty-four women (age 34±5 years) were included in this study. An autoimmune disease was present in seven (29%) cases. Twenty-one prospective pregnancies were treated. The number of live births was more frequent comparatively to the previous obstetrical issues (16/24 versus 24/76; p=0.003). Most of the pregnancies were treated (88%), whereas only 13% of previous pregnancies were treated (p<0.05). No difference was found with respect to the pregnancy outcome in the different treatment regimens. In univariate analyses, a prior history of intrauterine death and intrauterine growth restriction and the presence of CHI in prospective placentas were associated with failure to have a live birth. DISCUSSION In this multicenter study, we show the frequency of the associated autoimmune diseases in CHI, as well as the presence of autoantibodies without characterized autoimmune disease. The number of live births increased from 32% to 67% in the treated pregnancies. Despite the treatment intervention, the risk of preterm delivery remained at 30%. Last, we show that the recurrence rate of an adverse pregnancy outcome persisted at 30% despite treatment intervention. CONCLUSION CHI is associated with high recurrence rate and the combined regimen seems to be necessary, in particular, in the presence of previous intrauterine death.
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Affiliation(s)
- Arsène Mekinian
- Université Paris 13 , Bondy, France; AP-HP, Service de médecine interne, Hôpital Jean Verdier, Bondy , France
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Francuz B, Demange V, Mousel ML, Grzebyk M, Nicaise P, Chollet-Martin S, Choudat D. Manifestations allergiques ou irritatives chez le personnel des laboratoires de préparation et des animaleries d’un institut de recherche. ARCH MAL PROF ENVIRO 2014. [DOI: 10.1016/j.admp.2013.08.006] [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: 10/25/2022]
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Gazal S, Sacre K, Allanore Y, Teruel M, Goodall AH, Tohma S, Alfredsson L, Okada Y, Xie G, Constantin A, Balsa A, Kawasaki A, Nicaise P, Amos C, Rodriguez-Rodriguez L, Chiocchia G, Boileau C, Zhang J, Vittecoq O, Barnetche T, Gonzalez Gay MA, Furukawa H, Cantagrel A, Le Loët X, Sumida T, Hurtado-Nedelec M, Richez C, Chollet-Martin S, Schaeverbeke T, Combe B, Khoryati L, Coustet B, El-Benna J, Siminovitch K, Plenge R, Padyukov L, Martin J, Tsuchiya N, Dieudé P. Identification of secreted phosphoprotein 1 gene as a new rheumatoid arthritis susceptibility gene. Ann Rheum Dis 2014; 74:e19. [PMID: 24448344 DOI: 10.1136/annrheumdis-2013-204581] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the contribution of the SPP1 rs11439060 and rs9138 polymorphisms, previously reported as autoimmune risk variants, in the rheumatoid arthritis (RA) genetic background according to anti-citrullinated protein antibodies (ACPAs) status of RA individuals. METHODS We analysed a total of 11,715 RA cases and 26,493 controls from nine independent cohorts; all individuals were genotyped or had imputed genotypes for SPP1 rs11439060 and rs9138. The effect of the SPP1 rs11439060 and rs9138 risk-allele combination on osteopontin (OPN) expression in macrophages and OPN serum levels was investigated. RESULTS We provide evidence for a distinct contribution of SPP1 to RA susceptibility according to ACPA status: the combination of ≥3 SPP1 rs11439060 and rs9138 common alleles was associated mainly with ACPA negativity (p=1.29×10(-5), ORACPA-negative 1.257 (1.135 to 1.394)) and less with ACPA positivity (p=0.0148, ORACPA-positive 1.072 (1.014 to 1.134)). The ORs between these subgroups (ie, ACPA-positive and ACPA-negative) significantly differed (p=7.33×10(-3)). Expression quantitative trait locus analysis revealed an association of the SPP1 risk-allele combination with decreased SPP1 expression in peripheral macrophages from 599 individuals. To corroborate these findings, we found an association of the SPP1 risk-allele combination and low serum level of secreted OPN (p=0.0157), as well as serum level of secreted OPN correlated positively with ACPA production (p=0.005; r=0.483). CONCLUSIONS We demonstrate a significant contribution of the combination of SPP1 rs11439060 and rs9138 frequent alleles to risk of RA, the magnitude of the association being greater in patients negative for ACPAs.
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Affiliation(s)
- Steven Gazal
- Plateforme de Génomique Constitutionnelle Assistance Publique Hôpitaux de Paris, Bichat Hospital, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France
| | - Karim Sacre
- Department of Internal Medicine, DHU FIRE, Assistance Publique Hôpitaux de Paris, Bichat Hospital, INSERM U699, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France
| | - Yannick Allanore
- Department A of Rheumatology, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, University of Paris Descartes Paris, France INSERM U1016, University of Paris Descartes, Cochin Hospital, Paris, France
| | - Maria Teruel
- Instituto de Parasitologia y Biomedicina Lopez-Neyra, CSIC, Granada, Spain
| | - Alison H Goodall
- Department of Cardiovascular Sciences, University of Leicester & Leicester National Institute for Health Research Biomedical Research Unit in Cardiovascular Disease, Clinical Sciences Wing, Glenfield Hospital, Leicester, UK
| | | | - Shigeto Tohma
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Yukinori Okada
- Department of Human Genetics and Disease Diversity, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan Program in Medical and Population Genetics, Broad Institute, Cambridge, Massachusetts, USA
| | - Gang Xie
- Samuel Lunenfeld and Toronto General Research Institutes and the Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arnaud Constantin
- Department of Rheumatology, UMR 1027, INSERM, Toulouse III University, Purpan Hospital, CHU Toulouse, Toulouse, France
| | | | - Aya Kawasaki
- Faculty of Medicine, Molecular and Genetic Epidemiology Laboratory, University of Tsukuba, Tsukuba, Japan
| | - Pascale Nicaise
- Department of Immunology, Assistance Publique Hôpitaux de Paris, Bichat Hospital, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France
| | - Christopher Amos
- Genomic Medicine Department of Community, Family Medicine Geisel School of Medicine, Dartmouth College, USA
| | | | - Gilles Chiocchia
- INSERM U1016, University of Paris Descartes, Cochin Hospital, Paris, France
| | - Catherine Boileau
- INSERM U698, Assistance Publique Hôpitaux de Paris, Bichat Hospital, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France
| | - Jinyi Zhang
- Samuel Lunenfeld and Toronto General Research Institutes and the Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Olivier Vittecoq
- Department of Rheumatology, CHU de Rouen-Hopitaux de Rouen and INSERM U905, Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, Normandy, France
| | - Thomas Barnetche
- Department of Rheumatology, Pellegrin Hospital, Bordeaux Selagen University, Bordeaux, France
| | - Miguel A Gonzalez Gay
- Department of Rheumatology, Hospital Marques de Valdecilla, IFIMAV, Santander, Spain
| | - Hiroshi Furukawa
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Alain Cantagrel
- Department of Rheumatology, UMR 1027, INSERM, Toulouse III University, Purpan Hospital, CHU Toulouse, Toulouse, France
| | - Xavier Le Loët
- Department of Rheumatology, CHU de Rouen-Hopitaux de Rouen and INSERM U905, Institute for Research and Innovation in Biomedicine (IRIB), Rouen University, Normandy, France
| | - Takayuki Sumida
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Japan
| | - Margarita Hurtado-Nedelec
- INSERM U773 CRB3, F-75018, Paris, France Department of Hematology and Immunology, UF Dysfonctionnements Immunitaires Assistance Publique Hôpitaux de Paris, Bichat Hospital, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France
| | - Christophe Richez
- Department of Rheumatology, Pellegrin Hospital, Bordeaux Selagen University, Bordeaux, France
| | - Sylvie Chollet-Martin
- Department of Immunology, Assistance Publique Hôpitaux de Paris, Bichat Hospital, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France
| | - Thierry Schaeverbeke
- Department of Rheumatology, Pellegrin Hospital, Bordeaux Selagen University, Bordeaux, France
| | - Bernard Combe
- Department of Rheumatology, Montpellier University Hospital, Montpellier, France
| | - Liliane Khoryati
- Department of Rheumatology, Pellegrin Hospital, Bordeaux Selagen University, Bordeaux, France
| | - Baptiste Coustet
- Department of Rheumatology, DHU FIRE, Assistance Publique Hôpitaux de Paris, Bichat Hospital, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France
| | | | - Katherine Siminovitch
- Samuel Lunenfeld and Toronto General Research Institutes and the Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Plenge
- Department of Genetics and Pharmacogenomics, Merck Research Laboratories, Boston, Massachusetts, USA
| | - Leonid Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Javier Martin
- Instituto de Parasitologia y Biomedicina Lopez-Neyra, CSIC, Granada, Spain
| | - Naoyuki Tsuchiya
- Faculty of Medicine, Molecular and Genetic Epidemiology Laboratory, University of Tsukuba, Tsukuba, Japan
| | - Philippe Dieudé
- Department of Rheumatology, DHU FIRE, Assistance Publique Hôpitaux de Paris, Bichat Hospital, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France Bichat Faculty of Medicine, INSERM U699, Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France
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Shahali Y, Nicaise P, Brázdová A, Charpin D, Scala E, Mari A, Sutra JP, Chollet-Martin S, Sénéchal H, Poncet P. Complementarity between microarray and immunoblot for the comparative evaluation of IgE repertoire of French and Italian cypress pollen allergic patients. Folia Biol (Praha) 2014; 60:192-201. [PMID: 25152053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cypress pollen represents the primary cause of respiratory allergies in Mediterranean areas. Patients allergic to Cupressus sempervirens pollen (Cups) (CPA) can be discriminated on the basis of the immunoglobulin E (IgE) binding to a basic 14 kDa protein (BP14) or to high-molecular-weight (HMW) glycoproteins only. Specific IgE repertoires of two differentially exposed CPA cohorts, French and Italian, were investigated using an IgE microarray system (some known major allergens from several allergenic sources) and individual IgE immunoblotting (IB) of whole Cups pollen extract separated by SDS-PAGE (all allergens from one allergenic source: cypress pollen). The prevalence of sensitization to BP14 was higher in French (37 %) than in Italian patients (17 %) and major differences were observed in IgE reactivities to lipid transfer proteins (LTPs). Thirty percent of the Italian CPA (4 % in the French group) had specific IgE against the Parietaria pollen LTP, independently of IB subgroups. Regarding peach LTP sensitization, all Pru p 3+ Italian CPA (10 %) were in the HMW+ subgroup, while Pru p 3+ French CPA (20 %) were all included in the BP14+ subgroup. BP14 sensitization is likely a marker of Cups exposure and is, in French CPA, significantly correlated to Pru p 3 sensitization. The IgE immunoblot and microarray are complementary tools that highlight differences in the subtle sensitization profile between groups of patients in comparative studies.
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Affiliation(s)
- Y Shahali
- Armand Trousseau Hospital, Biochemistry and Molecular Biology D epartment, Allergy & Environment Group, Paris, France
| | - P Nicaise
- Bichat-Claude Bernard Hospital, Auto-immunity & Hypersensitivity D epartment, Paris, France
| | - A Brázdová
- Institute of Chemical Technology, Department of Biochemistry and Microbiology, Prague, Czech Republic
| | - D Charpin
- North Hospital, Pneumo-Allergology D epartment, Marseille Cedex 20, France
| | - E Scala
- IDI-IRCCS, Experimental Allergology D epartment, Rome, Italy
| | | | - J P Sutra
- Armand Trousseau Hospital, Biochemistry and Molecular Biology D epartment, Allergy & Environment Group, Paris, France
| | - S Chollet-Martin
- Bichat-Claude Bernard Hospital, Auto-immunity & Hypersensitivity D epartment, Paris, France
| | - H Sénéchal
- Armand Trousseau Hospital, Biochemistry and Molecular Biology D epartment, Allergy & Environment Group, Paris, France
| | - P Poncet
- Armand Trousseau Hospital, Biochemistry and Molecular Biology D epartment, Allergy & Environment Group, Paris, France
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17
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Maître E, Debien C, Nicaise P, Wyngaerden F, Le Galudec M, Genest P, Ducrocq F, Delamillieure P, Lavoisy B, Walter M, Dubois V, Vaiva G. [Advanced directives in psychiatry: A review of the qualitative literature, a state-of-the-art and viewpoints]. Encephale 2013; 39:244-51. [PMID: 23537636 DOI: 10.1016/j.encep.2012.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 10/22/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Advance Directives are written documents, which are used for people to notify their preference for a future situation when they are unable to give their consent. In psychiatry, psychiatric advance directives (PADs) can be used for patients with chronic psychotic disorders such as schizophrenia, or a bipolar disorder. PADs give the patient an opportunity to state wishes in advance about his/her treatment when he/she is in an acute state of illness. PADs were initially developed as a way for patients to defend themselves against the power of the psychiatrists, but are likely to become a useful tool in psychiatric care. PADs may contain information about medication, non pharmaceutical devices, and the name of a proxy decision maker. The main objective is to reduce the number of compulsory hospitalisations. OBJECTIVE This article is a qualitative review which carries out a state-of-the-art on the use of PADs for people with chronic psychotic disorders and defines suggestions to include this intervention in the French psychiatric context. METHOD We used the keywords psychiatric advance directives, crisis card, Ulysse directives, joint crisis plan (JCP) in the MEDLINE database to propose a qualitative review. We selected original clinical studies about the use of PADs for people with psychotic disorders. RESULTS We included 36 articles. The qualitative analysis identified seven main themes: different types of PADs, effectiveness of PADs, practical use of PADs, patient's views, clinician's views, economical aspects, and legal aspects. The content of the PADs is consistent with psychiatric standard care in nearly all cases, regarding medical instructions, pre-emergency interventions, non-hospital alternatives and non-medical personal care. Patients use their PADs to describe prodromal symptoms of relapse and to suggest a treatment and a hospitalisation in advance. PADs are not used to refuse all treatments. Patients show a strong interest in creating a directive and a high level of satisfaction when using it. They feel they have more control over their mental health problem and are more respected and valued as a person. Thirty-six to fifty-three percent of clinicians had positive opinions regarding PADs. They valued the increase of the patient's autonomy and the prevention of relapse, but were concerned about difficulties for accessing the documents, and about the lack of training of the medical teams. Clinicians also feared the pressure of relatives or partners on treatment decisions. The qualitative analysis revealed the specific benefit of the JCP, a particular type of PADs negotiated with the medical team, on the reduction of the general number of admissions. We can identify practical problems such as the lack of accessibility to PADs in emergency situations, and the clinician's reluctance to use PADs. The only economical evaluation showed a non-significant decrease in total costs. DISCUSSION PADs are used in a few countries, although their benefits in terms of patient's perceptions and compulsory admissions are promising. The JCP proposes a specific clinical approach based on therapeutic alliance. Its creation also involves the clinician, family members and a neutral mediator in a negotiated process. The JCP is likely to be the most efficient PAD model in reducing compulsory admissions. The use of the JCP appears to be relevant in the context of the new French legislation, establishing outpatient commitment orders and could be an effective way to improve the relationships with patients.
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Affiliation(s)
- E Maître
- Pôle de psychiatrie, médecine légale et médecine en milieu pénitentiaire, service de psychiatrie adulte, université Lille Nord de France, hôpital Michel-Fontan, CHRU de Lille, rue André-Verhaeghe, 59037 Lille cedex, France
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Salliot C, Dawidowicz K, Lukas C, Guedj M, Paccard C, Benessiano J, Dougados M, Nicaise P, Meyer O, Dieude P. PTPN22 R620W genotype-phenotype correlation analysis and gene-environment interaction study in early rheumatoid arthritis: results from the ESPOIR cohort. Rheumatology (Oxford) 2011; 50:1802-8. [DOI: 10.1093/rheumatology/ker224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Nicaise P. FC21-02 - Mental health and social care collaboration: A Cross-national whole network analysis of organisational partnerships in Europe. Eur Psychiatry 2011. [DOI: 10.1016/s0924-9338(11)73632-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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionSocially marginalised people with mental health disorders have complex needs that require integrated care. However, mental health and social care sectors are fragmented, and inter-organisational collaboration is challenging.AimA cross-national whole Network Analysis was carried out to detect and interpret patterns of relations between mental health and social care services in several European cities and assess their levels of care integration, following Leutz's levels: linkage, coordination and full integration.MethodData on referrals and service routine meetings were collected in deprived areas of 14 European cities and processed within a Social Network Analysis approach. Structural indicators included degrees, components and overlapping cliques, betweenness centrality and centralisation and brokerage roles. Patterns of collaboration were compared across cities.ResultsFew cities had full integrated services. Whole networks had relatively low densities, including denser sub-networks of similar services. The linkage across sectors remained weaker than the linkage within sectors. Services situated in broker positions were not always integrated nor commissioned for care coordination. The centrality of these services was higher when the linkage density was lower.ConclusionsAlthough differences between structural patterns of mental health and social care networks mainly depend on national care integration policies, the study revealed structural gaps in the achievement of these patterns, whatever the policy model. This could explain why different systems are basically facing the same problems in service delivery despite these differences. These gaps constitute potential weaknesses in the quality of mental health and social care integration at the system level.
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Tesmoingt C, Lidove O, Reberga A, Thetis M, Ackaert C, Nicaise P, Arnaud P, Papo T. Enzyme therapy in Fabry disease: severe adverse events associated with anti-agalsidase cross-reactive IgG antibodies. Br J Clin Pharmacol 2010; 68:765-9. [PMID: 19917001 DOI: 10.1111/j.1365-2125.2009.03501.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS To report a severe adverse event related to enzyme replacement therapy with agalsidase in an hemizygous male patient treated for Fabry disease. METHODS Retrospective analysis of clinical, radiological and biochemical data in a patient who suffered adverse events related to both agalsidase alfa and agalsidase beta treatments. RESULTS A hemizygous male patient was first treated for Fabry disease with agalsidase alfa. After more than 1 year of therapy, infusion-related symptoms necessitated systemic steroids and antihistaminic therapy. Decline in kidney function prompted a switch for agalsidase beta. Anaphylactoid shock occurred after the second infusion. No serum IgE antibodies were disclosed. Skin-test reactivity to agalsidase beta was negative. Following a published rechallenge infusion protocol, agalsidase beta was reintroduced, leading to a second anaphylactoid shock episode. Enzyme replacement therapy was stopped and the patient was treated with symptomatic therapy only. This case was referred to the pharmacovigilance department. CONCLUSION The negativity of immunological tests (specific anti-agalsidase IgE antibodies and skin tests) does not rule out the risk of repeated anaphylactoid shock following agalsidase infusion.
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Affiliation(s)
- Chloe Tesmoingt
- Department of Clinical Pharmacy, Bichat-Claude Bernard University Hospital (AP-HP), Paris, France
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21
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Foulon G, Delaval P, Valeyre D, Wallaert B, Debray MP, Brauner M, Nicaise P, Cadranel J, Cottin V, Tazi A, Aubier M, Crestani B. ANCA-associated lung fibrosis: Analysis of 17 patients. Respir Med 2008; 102:1392-8. [DOI: 10.1016/j.rmed.2008.04.023] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 04/06/2008] [Accepted: 04/29/2008] [Indexed: 12/18/2022]
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Le Moing V, Géniteau M, Lacassin F, Nicaise P, Leport C, Labarre C, Vildé J. Déséquilibre des sous-classes d'immunoglobulines G au cours des pneumonies à pneumocoque chez les patients infectés par le VIH. Med Mal Infect 1999. [DOI: 10.1016/s0399-077x(00)87136-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Nicaise P, Gleizes A, Sandre C, Kergot R, Lebrec H, Forestier F, Labarre C. The intestinal microflora regulates cytokine production positively in spleen-derived macrophages but negatively in bone marrow-derived macrophages. Eur Cytokine Netw 1999; 10:365-72. [PMID: 10477393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
Besides its role as a barrier against potential pathogens, intestinal flora is presumed to protect the host by priming the immunological defense mechanisms. In this respect, the influence of intestinal flora on macrophage precursors was examined, and its modulating effect was compared on LPS-induced cytokine production by macrophages derived from bone marrow and spleen precursors (BMDM and SDM respectively). The regulation of IL-1, IL-6, TNF-alpha and IL-12 production in macrophages from germ-free and from three groups of flora-associated mice, conventional, conventionalized and E. coli-mono-associated mice, was investigated. The whole flora inhibited IL-1, TNF-alpha and IL-12 secretion by BMDM, whereas it had a stimulatory effect on IL-12 secretion by SDM. Implantation of E. coli alone enhanced cytokine secretion by BMDM but had a more limited effect than whole flora on SDM, enhancing only TNF-alpha and IL-12 secretion. Study of expression of mRNA showed a correlation with protein secretion for IL-6 but not for TNF-alpha and IL-1. IL-12 enhancement in BMDM seemed to be dependent on regulation of p35 mRNA expression while it was correlated to increased p40 mRNA expression in SDM. The results demonstrated that intestinal flora modulated bone marrow and spleen macrophage cytokine production in a differential manner and suggested a role for bacteria other than E. coli among the whole flora. The contrasting effects exerted by the intestinal flora on bone marrow and spleen precursors are an interesting observation in view of the different functions of these organs in immunity. The finding that intestinal flora enhanced IL-12 production in spleen is also potentially important since this cytokine is implicated in the determination of the relative levels of Th1 and Th2 responses and plays a pivotal role in host defense against intracellular microorganisms.
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Affiliation(s)
- P Nicaise
- Faculté de Pharmacie, Département de Microbiologie et Immunologie, Université Paris XI, 5, rue JB-Clément, 92296 Châtenay-Malabry Cedex, France
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Hayem G, Kassis N, Nicaise P, Bouvet P, Andremont A, Labarre C, Kahn MF, Meyer O. Systemic lupus erythematosus-associated catastrophic antiphospholipid syndrome occurring after typhoid fever: a possible role of Salmonella lipopolysaccharide in the occurrence of diffuse vasculopathy-coagulopathy. Arthritis Rheum 1999; 42:1056-61. [PMID: 10323464 DOI: 10.1002/1529-0131(199905)42:5<1056::aid-anr27>3.0.co;2-i] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report a case of well-documented typhoid fever in a 30-year-old woman with inactive systemic lupus erythematosus with asymptomatic lupus anticoagulant and high-titer anticardiolipin antibody (aCL). Despite prompt eradication of the Salmonella typhi obtained with appropriate antibiotic therapy, multiple organ system dysfunction occurred. The central nervous system was involved, with ischemic infarcts in the occipital lobes. High-dose corticosteroid therapy failed to improve the neurologic manifestations, which responded to repeated plasmapheresis. A sharp fall in aCL and anti-beta2-glycoprotein I antibody titers was recorded before the start of plasmapheresis. At the same time, IgM and IgG antibodies to Salmonella group O:9 lipopolysaccharide became detectable; the IgM antibodies disappeared within 4 months, whereas the IgG antibodies remained detectable during the next 13 months. Despite treatment with high-dose corticosteroids and cyclophosphamide, rapidly progressive glomerulonephritis developed, leading to chronic renal failure. There is convincing evidence of a link between the S. typhi infection and the ensuing catastrophic syndrome in this patient, probably precipitated by bacterial antigens.
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Affiliation(s)
- G Hayem
- Centre Hospitalier Universitaire, Paris, France
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Hayem G, Chazerain P, Combe B, Elias A, Haim T, Nicaise P, Benali K, Eliaou JF, Kahn MF, Sany J, Meyer O. Anti-Sa antibody is an accurate diagnostic and prognostic marker in adult rheumatoid arthritis. J Rheumatol 1999; 26:7-13. [PMID: 9918234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES To evaluate in various groups of patients with chronic joint disease the sensitivity and specificity of anti-Sa antibody, recently described in sera from adults with rheumatoid arthritis (RA); and to determine the prognostic significance of anti-Sa in initial sera from patients with long standing RA with or without severe joint destruction. METHODS Serum samples from 489 patients were included. Of these, 154 were collected from patients with RA attending 2 rheumatology units. Controls were 335 patients with a variety of inflammatory joint diseases other than RA. IgG anti-Sa was detected using an immunoblotting method with purified Sa antigen from human placenta extracts. All patients were tested for the following antibodies: rheumatoid factor (RF), anti-keratin antibody (AKA), antiperinuclear factor (APF), and anti-RA 33. HLA class II DRB alleles were also determined. RESULTS Anti-Sa was detected in 39.8% of RA sera overall, 46.7% of sera from the long standing RA group, and 23.5% of sera from the recent onset RA group (p<0.01). In patients with long standing RA, statistically significant associations were found between the presence of anti-Sa and the following variables: RF (p<0.0001), AKA (p<0.0001), APF (p<0.00001), and HLA DRB1*04 or 01 (p<0.01). In contrast, no association was found with anti-RA33. Anti-Sa was positive in 11 adult controls (7.8%) and in 26 pediatric patients with juvenile chronic arthritis (22%). The specificity of anti-Sa for RA was 92.1% in adults with well characterized rheumatic diseases and 85.9% in adults and children together. Among patients with long standing RA, those with destructive disease were more likely to test positive for anti-Sa (66.6%) than those with nondestructive disease (22.2%) (p<0.0001). Comparisons with other serologic markers for RA demonstrated that anti-Sa was sensitive (68.4%) and was also the test with the highest specificity (79%), positive predictive value (75%), and negative predictive value (71%) for discriminating between patients who do and those that do not develop late severe radiographic damage. CONCLUSION Immunoblot-detected IgG anti-Sa is a sensitive serologic marker for RA patients with severe radiographic damage.
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Affiliation(s)
- G Hayem
- Department of Rheumatology, Bichat Hospital, Paris, France
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Nicaise P, Gleizes A, Sandre C, Forestier F, Kergot R, Quero AM, Labarre C. Influence of intestinal microflora on murine bone marrow and spleen macrophage precursors. Scand J Immunol 1998; 48:585-91. [PMID: 9874492 DOI: 10.1046/j.1365-3083.1998.00487.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To investigate the adjuvant effect of intestinal flora on macrophage-colony-stimulating factor-responsive macrophage progenitors from spleen and bone marrow, we compared progenitor numbers and phenotypic characteristics of in vitro matured macrophages in germ-free and flora-associated mice (conventional, Escherichia coli-monoassociated and conventionalized mice). The data obtained show that the flora affected differentially bone marrow and spleen progenitors. It increased the numbers of progenitors in the spleen but not in the bone marrow. It did not modify the expression of F4/80, Mac-1 and major histocompatibility complex (MHC) class II on bone-marrow-derived macrophages (BMDM), while it clearly up-regulated MHC class II expression on spleen-derived macrophages (SDM). This effect was more pronounced in flora-associated ex germ-free mice than in conventional mice and it was greatly enhanced in the absence of M-CSF. In vitro stimulation by lipopolysaccharide had no effect on marker expression of BMDM, while it decreased F4/80 and enhanced MHC class II molecules on SDM from germ-free and flora-associated mice. However, the expression of MHC class II remained lower in germ-free mice. Enhancement of MHC class II molecule expression on SDM may contribute to the protective role of flora, because successful immune responses are dependent on the expression of these molecules.
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Affiliation(s)
- P Nicaise
- Département de Microbiologie et Immunologie, Unité Associée INRA Ecologie Microbienne du Tube Digestif et Santé, Faculté de Pharmacie, Université Paris XI, Châtenay-Malabry, France
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27
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Benamer H, Steg PG, Benessiano J, Vicaut E, Gaultier CJ, Boccara A, Aubry P, Nicaise P, Brochet E, Juliard JM, Himbert D, Assayag P. Comparison of the prognostic value of C-reactive protein and troponin I in patients with unstable angina pectoris. Am J Cardiol 1998; 82:845-50. [PMID: 9781965 DOI: 10.1016/s0002-9149(98)00490-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study assessed the prognostic value of cardiac troponin I (cTnI) and C-reactive protein (CRP) in unstable angina, and specifically in patients with angiographically proven coronary artery disease. These biochemical parameters, which are related to myocardial injury or to systemic inflammation, may help in short-term risk stratification of unstable angina. We prospectively studied 195 patients with unstable angina, 100 of whom had angiographically proven coronary artery disease (with normal creatine kinase [CK] and CK-MB mass). Serum concentrations of cTnI (N < 0.4 ng/ml) and CRP (N < 3 mg/L) were measured at admission, 12, and 24 hours later. The rate of in-hospital major adverse cardiac events (death, myocardial infarction, or emergency revascularization) was higher in patients with increased cTnI within the first 24 hours, regardless of the results of coronary angiography (23% vs 7%; p < 0.001). Conversely, events occurred at similar rates in patients with or without increased CRP. In patients with angiographic evidence of coronary artery disease, multivariate analysis showed that increased cTnI within 24 hours of admission (35 patients) was an independent predictor of major adverse cardiac events (odds ratio 6.7, range 1.7 to 27.3), but not cTnI levels at admission and CRP at 0, 12, and 24 hours. Thus, both in unselected patients with unstable angina and in patients with angiographically proven coronary artery disease, increased cTnI within 24 hours of admission, but not CRP, is a predictor of in-hospital clinical outcome. We also found a temporal link between cTnI increase and late elevation of CRP, suggesting that systemic inflammation may partially be a consequence of myocardial injury.
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Affiliation(s)
- H Benamer
- Service de Cardiologie, Hôpital Bichat, Paris, France
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28
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Puddu P, Fantuzzi L, Borghi P, Varano B, Rainaldi G, Guillemard E, Malorni W, Nicaise P, Wolf SF, Belardelli F, Gessani S. IL-12 induces IFN-gamma expression and secretion in mouse peritoneal macrophages. The Journal of Immunology 1997. [DOI: 10.4049/jimmunol.159.7.3490] [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] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract
We previously reported that resting mouse peritoneal macrophages (PM) constitutively express low levels of IFN-gamma, whose production is consistently enhanced by exogenous IFN-gamma. In this study, we investigated the effects of IL-12 on the replication of vesicular stomatitis virus and on IFN-gamma gene expression in mouse PM. The addition of IL-12 to freshly explanted PM resulted in the persistence of an antiviral state to vesicular stomatitis virus, while control PM progressively became permissive for virus replication after 3 to 4 days in culture. The IL-12-induced antiviral state was inhibited by Abs to IFN-gamma, suggesting that endogenous IFN-gamma was largely responsible for this antiviral response. Moreover, IL-12 induced a consistent secretion of IFN-gamma, especially in cultured PM. The IL-1 2-induced antiviral state and IFN-gamma production were observed using PM from various strains of mice, including LPS-defective C3H/HeJ, NK-deficient bg/bg, DBA/2, Swiss (CD1), and Swiss nude mice treated or not with anti-asialo GM1 Abs. A 4-h treatment with IL-12 was sufficient to induce a marked accumulation of IFN-gamma mRNA, which was greater in cultured PM than in freshly harvested cells. Lastly, immunofluorescence studies in IL-12-stimulated macrophages clearly showed an enhancement of immunoreactive IFN-gamma compared with basal levels in cells exhibiting a macrophage (i.e., F4/80-positive) phenotype. Together, these findings demonstrate that IL-12 can directly stimulate mouse PM to produce IFN-gamma. We suggest that IL-12-induced IFN-gamma production by macrophages can play some role in the generation of the antiviral and immunoregulatory effects of IL-12.
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Affiliation(s)
- P Puddu
- Laboratorie of Immunology, Istituto Superiore di Sanità, Rome, Italy
| | - L Fantuzzi
- Laboratorie of Immunology, Istituto Superiore di Sanità, Rome, Italy
| | - P Borghi
- Laboratorie of Immunology, Istituto Superiore di Sanità, Rome, Italy
| | - B Varano
- Laboratorie of Immunology, Istituto Superiore di Sanità, Rome, Italy
| | - G Rainaldi
- Laboratorie of Immunology, Istituto Superiore di Sanità, Rome, Italy
| | - E Guillemard
- Laboratorie of Immunology, Istituto Superiore di Sanità, Rome, Italy
| | - W Malorni
- Laboratorie of Immunology, Istituto Superiore di Sanità, Rome, Italy
| | - P Nicaise
- Laboratorie of Immunology, Istituto Superiore di Sanità, Rome, Italy
| | - S F Wolf
- Laboratorie of Immunology, Istituto Superiore di Sanità, Rome, Italy
| | - F Belardelli
- Laboratorie of Immunology, Istituto Superiore di Sanità, Rome, Italy
| | - S Gessani
- Laboratorie of Immunology, Istituto Superiore di Sanità, Rome, Italy
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29
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Puddu P, Fantuzzi L, Borghi P, Varano B, Rainaldi G, Guillemard E, Malorni W, Nicaise P, Wolf SF, Belardelli F, Gessani S. IL-12 induces IFN-gamma expression and secretion in mouse peritoneal macrophages. J Immunol 1997; 159:3490-7. [PMID: 9317148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We previously reported that resting mouse peritoneal macrophages (PM) constitutively express low levels of IFN-gamma, whose production is consistently enhanced by exogenous IFN-gamma. In this study, we investigated the effects of IL-12 on the replication of vesicular stomatitis virus and on IFN-gamma gene expression in mouse PM. The addition of IL-12 to freshly explanted PM resulted in the persistence of an antiviral state to vesicular stomatitis virus, while control PM progressively became permissive for virus replication after 3 to 4 days in culture. The IL-12-induced antiviral state was inhibited by Abs to IFN-gamma, suggesting that endogenous IFN-gamma was largely responsible for this antiviral response. Moreover, IL-12 induced a consistent secretion of IFN-gamma, especially in cultured PM. The IL-1 2-induced antiviral state and IFN-gamma production were observed using PM from various strains of mice, including LPS-defective C3H/HeJ, NK-deficient bg/bg, DBA/2, Swiss (CD1), and Swiss nude mice treated or not with anti-asialo GM1 Abs. A 4-h treatment with IL-12 was sufficient to induce a marked accumulation of IFN-gamma mRNA, which was greater in cultured PM than in freshly harvested cells. Lastly, immunofluorescence studies in IL-12-stimulated macrophages clearly showed an enhancement of immunoreactive IFN-gamma compared with basal levels in cells exhibiting a macrophage (i.e., F4/80-positive) phenotype. Together, these findings demonstrate that IL-12 can directly stimulate mouse PM to produce IFN-gamma. We suggest that IL-12-induced IFN-gamma production by macrophages can play some role in the generation of the antiviral and immunoregulatory effects of IL-12.
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MESH Headings
- Animals
- Antibodies/pharmacology
- Antigens, Differentiation/analysis
- Antiviral Agents/pharmacology
- Cells, Cultured
- G(M1) Ganglioside/immunology
- Interferon-gamma/biosynthesis
- Interferon-gamma/genetics
- Interferon-gamma/metabolism
- Interferon-gamma/physiology
- Interleukin-12/pharmacology
- Intracellular Fluid/immunology
- Macrophages, Peritoneal/immunology
- Macrophages, Peritoneal/metabolism
- Macrophages, Peritoneal/virology
- Male
- Mice
- Mice, Inbred C3H
- Mice, Inbred DBA
- Mice, Nude
- RNA, Messenger/biosynthesis
- RNA, Messenger/drug effects
- Species Specificity
- Tumor Cells, Cultured
- Vesicular stomatitis Indiana virus/drug effects
- Vesicular stomatitis Indiana virus/immunology
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Affiliation(s)
- P Puddu
- Laboratorie of Immunology, Istituto Superiore di Sanità, Rome, Italy
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30
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Tubach F, Hayem G, Elias A, Nicaise P, Haim T, Kahn MF, Meyer O. Anticentromere antibodies in rheumatologic practice are not consistently associated with scleroderma. Rev Rhum Engl Ed 1997; 64:362-7. [PMID: 9513607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Anticentromere antibodies identified by indirect immunofluorescence are a valuable aid to the diagnosis and prognosis of patients with systemic sclerosis since they are associated in 50% to 80% of cases with limited cutaneous systemic sclerosis, a pattern usually associated with a good prognosis. We studied clinical presentations in rheumatology patients with anticentromere antibodies by indirect immunofluoresence and by ELISA and/or Western blot, but without scleroderma or Raynaud's phenomenon. Eight of 34 (23.5%) rheumatology clinic patients with centromere antibodies met these criteria, seven women and one man, with a median symptom duration of six years (range 1-20 years). Four had Sjögren's syndrome, one had isolated xerostomia, one systemic lupus erythematosus, one seronegative symmetric polyarthritis and one primary biliary cirrhosis with arthralgia. The mean anticentromere antibody titer in these eight patients was similar to that in the patients who had at least Raynaud's phenomenon. Given the low incidence of scleroderma, these data illustrate the poor predictive value of anticentromere antibodies for the diagnosis of scleroderma in rheumatology clinic patients.
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Affiliation(s)
- F Tubach
- Rheumatology Department, Bichat Teaching Hospital, Paris, France
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31
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Bridey F, Bentolila S, Poirier JC, Marcelli A, Nicaise P, Labarre C, Boue F, Piette JC, de Prost D. High familial anticardiolipin antibody titer and major histocompatibility complex. Thromb Haemost 1996; 76:1118-9. [PMID: 8972041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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32
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Cordonnier C, Meyer O, Palazzo E, de Bandt M, Elias A, Nicaise P, Haïm T, Kahn MF, Chatellier G. Diagnostic value of anti-RA33 antibody, antikeratin antibody, antiperinuclear factor and antinuclear antibody in early rheumatoid arthritis: comparison with rheumatoid factor. Br J Rheumatol 1996; 35:620-4. [PMID: 8670593 DOI: 10.1093/rheumatology/35.7.620] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The goal of this prospective longitudinal study was to determine the serological profile of early rheumatoid arthritis (RA), and to test whether antikeratin antibody (AKA), antiperinuclear factor (APF), anti-RA33 antibody and antinuclear antibodies (ANA) had an additional diagnostic value when prescribed after rheumatoid factor (RF)-detecting methods. Sixty-nine patients with early polyarthritis suggestive of RA, seen between 1991 and 1993, were included. Five autoantibodies (i.e. RF, AKA, APF, RA33, ANA) were looked for at regular intervals. After 24 months follow-up, patients were classified as having RA (n = 49), unclassified polyarthritis (UP; n = 15) or other rheumatic diseases. Among patients with early RA, the sensitivity of these markers was 40.8% for RF, 36.7% for AKA, 28.6% for APF and 28.6% for anti-RA33. Among RF-negative RA patients, 51.7% were positive for AKA, APF, anti-RA33 antibodies and/or ANA. Positivity of the three recent markers usually persisted throughout follow-up, whereas RF was lost by 58% of patients with early, RF-positive, treated RA. Using multivariate analysis, only latex, RF test and AKA or APF had an independent and statistically significant diagnostic value for early RA. Our data suggest that RF and AKA (or APF) should be concomitantly determined for diagnosis in patients with suspected early RA.
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Affiliation(s)
- C Cordonnier
- Rheumatology Department, Centre Hospitalier Universitaire X. Bichat, Paris, France
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33
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Meyer O, Nicaise P, Moreau S, de Bandt M, Palazzo E, Hayem G, Chazerain P, Labarre C, Kahn MF. Antibodies to cardiolipin and beta 2 glycoprotein I in patients with polymyalgia rheumatica and giant cell arteritis. Rev Rhum Engl Ed 1996; 63:241-7. [PMID: 8738442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
IgG antibodies to cardiolipin and beta 2-glycoprotein I were looked for using an enzyme-linked immunosorbent assay (ELISA) in 19 patients with giant cell arteritis (meeting 1990 American College of Rheumatology criteria), including 16 with concomitant polymyalgia rheumatica (meeting Bird's criteria) and in three patients with isolated polymyalgia rheumatica. IgG anti-cardiolipin antibodies were demonstrated in eight patients (36%) and IgG anti-beta 2-glycoprotein I antibodies in two patients (9%) including one without anti-cardiolipin antibodies. Titers of anti-cardiolipin antibodies ranged from 27 to 190 units of IgG antiphospholipid antibodies (UGPL) (mean 71 UGPL). Of the eight patients with anti-cardiolipin antibodies, two had giant cell arteritis without polymyalgia rheumatica and six had polymyalgia rheumatica with clinical (n = 2) or histologic (n = 4) evidence of giant cell arteritis. None of the three patients with polymyalgia rheumatica but no giant cell arteritis had anti-cardiolipin or anti-beta 2 glycoprotein I antibodies. The VDRL was negative in the 14 patients who had this test. Tests for lupus anticoagulant were performed routinely, always with negative results. Among giant cell arteritis patients, those who tested positive for anticardiolipin antibody had significantly higher values for the erythrocyte sedimentation rate (p < 0.006) and for serum C-reactive protein (p < 0.03) and fibrinogen values (p = 0.05), and a trend toward higher platelet counts, as compared to those who tested negative for anticardiolipin antibody. The mean daily prednisone dose at the time of sampling was significantly lower in giant cell arteritis patients with anti-cardiolipin antibodies (p < 0.05); this difference may account for the apparent correlation between anti-cardiolipin antibodies and laboratory markers for inflammation. These data, as well as findings from serial measurements, suggest that anti-cardiolipin antibodies are present early in the course of giant cell arteritis and disappear within a few weeks of initiation of corticosteroid therapy in a dose of more than 25 mg prednisone per day. In this study, only one patient without anticardiolipin antibodies developed a cerebrovascular accident. Positive tests for anti-cardiolipin antibody or anti-beta 2 glycoprotein I antibody in a patient with polymyalgia rheumatica suggest a diagnosis of concomitant giant cell arteritis, which is usually symptomatic.
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Affiliation(s)
- O Meyer
- Rheumatology Department, Bichat Teaching Hospital, Paris, France
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34
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Nicaise P, Gleizes A, Forestier F, Sandre C, Quero AM, Labarre C. The influence of E. coli implantation in axenic mice on cytokine production by peritoneal and bone marrow-derived macrophages. Cytokine 1995; 7:713-9. [PMID: 8580381 DOI: 10.1006/cyto.1995.0084] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
To assess the involvement of bacterial microflora in the development of host defenses, we compared in vitro LPS-induced cytokine production by macrophages in germ-free and E. coli monoxenic mice. E. coli implantation significantly increased IL-1 and IL-6 and, to a lesser extent, TNF activities of peritoneal and bone marrow-derived macrophages. These results suggest that exposure to microflora primes macrophages for an enhanced cytokine production, which may contribute to the activation of the antiinfectious defense. The priming was not restricted to peritoneal macrophages but was associated with a more general effect of the flora since the enhanced response of bone marrow-derived macrophages indicates an effect on macrophage precursors. Furthermore, a higher ability of peritoneal macrophages to produce IL-1 in axenic and monoxenic mice was observed as compared to bone marrow-derived macrophages. In contrast, bone marrow-derived macrophages demonstrated a higher ability to produce IL-6 and TNF but only 3 weeks after bacterial administration.
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Affiliation(s)
- P Nicaise
- Service d'Immunologie biologique, Groupe Hospitalier Bichat-Claude Bernard, Paris, France
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35
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Meyer O, Golstein M, Nicaise P, Labarre C, Kahn MF. Heart valve disease in systemic lupus erythematosus. Role of antiphospholipid antibodies. Clin Rev Allergy Immunol 1995; 13:49-56. [PMID: 7648348 DOI: 10.1007/bf02772248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- O Meyer
- Clinique de Rhumatologie, Université Paris 7, Hôpital Bichat, France
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36
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Golstein M, Meyer O, Bourgeois P, Palazzo E, Nicaise P, Labarre C, Kahn MF. Neurological manifestations of systemic lupus erythematosus: role of antiphospholipid antibodies. Clin Exp Rheumatol 1993; 11:373-9. [PMID: 8403581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Antiphospholipid antibodies (APL) are associated with venous and arterial thrombosis in SLE patients. Various thrombotic and non-thrombotic neurological manifestations have been reported in SLE but whether or not they are related to the presence of APL antibodies remains uncertain. To assess the possible association between neurological involvement in SLE and APL antibodies, IgG anticardiolipin antibodies (IgG ACL) were looked for using an ELISA technique in 92 consecutive SLE patients seen over a one-year period. Other APL determinations included VDRL and lupus anticoagulant (LAC) testing using APTT and the diluted thromboplastin time. Twenty-four SLE patients presented with neurological manifestations (40 episodes): 15/24 (62.5%) were found positive for APL antibodies (11 VDRL, 8 LAC, 7 ACL antibodies) versus 22/68 patients (32%) without neurological symptoms (p < 0.01). APL antibodies antedated neurological symptoms in 13/16 cases. Neurological manifestations were subsequently divided into 3 groups: thrombotic (n = 14), psychosis and convulsions (n = 15), miscellaneous (n = 10). No correlation was found between APL antibodies and any of the 3 subgroups. Among patients with neurological SLE, APL antibodies were present in two with valvular heart disease, as well as in seven with a history of either deep vein thrombosis, livedo reticularis or miscarriage. Among 7 patients with thrombocytopenia and neurological symptoms, 6 had APL antibodies. These data suggest that APL syndrome is associated with neuro-ophthalmological manifestations of SLE regardless of whether or not the mechanism of neurological involvement is thrombotic. SLE patients with APL antibodies may be at risk for future neurological manifestations. However, it is still questionable that APL positivity has definite therapeutic consequences.
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Affiliation(s)
- M Golstein
- Service de Rhumatologie, Hôpital Universitaire Erasme, Bruxelles, Belgium
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37
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Nicaise P, Gleizes A, Forestier F, Quéro AM, Labarre C. Influence of intestinal bacterial flora on cytokine (IL-1, IL-6 and TNF-alpha) production by mouse peritoneal macrophages. Eur Cytokine Netw 1993; 4:133-8. [PMID: 8318673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The effect of bacterial flora on cytokine production from resident peritoneal macrophages was investigated in the mouse. The production of IL-1, IL-6 and TNF-alpha was determined in germ-free, and "conventionalized" mice, as well as in monoxenic mice implanted with either the Gram-negative bacterium E. coli, or the Gram-positive organism Bifidobacterium bifidum. Macrophages from the "conventionalized" mice produced significantly more IL-1 and IL-6 in vitro than those of the germ-free mice. IL-1 and IL-6 production from germ-free mice implanted with E. coli was comparable to that from "conventionalized" mice. However, implantation with Bifidobacterium bifidum did not increase production of these two cytokines above levels observed for macrophages from the germ-free mice. A little TNF-alpha was produced by only the macrophages from the "conventionalized" and monoxenic mice implanted with E. coli. Soon after implantation, the bacterial flora stimulated cytokine production by mouse peritoneal macrophages and our results suggest that Gram negative bacteria are the most efficient stimulus for this production.
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Affiliation(s)
- P Nicaise
- Service d'Immunologie biologique, Groupe Hospitalier Bichat-Claude Bernard, Paris, France
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38
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Cahen P, Le Bourgeois M, Delacourt C, Coustère C, Nicaise P, de Blic J, Véron M, Scheinmann P, Gaillard JL. Serum bactericidal test as a prognostic indicator in acute pulmonary exacerbations of cystic fibrosis. Pediatrics 1993; 91:451-5. [PMID: 8424026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The serum bactericidal test has been used for many years for optimal assessment of the efficacy of antibiotic therapy in patients with infective endocarditis and other bacterial infections. Its capacity to predict the bacteriological outcome of acute pulmonary exacerbations in patients with cystic fibrosis was evaluated. A total of 54 courses of intravenous antibiotic therapy were analyzed in 22 patients, whose ages ranged from 4 months to 24 years (mean age: 10 years). The serum bactericidal activity of blood samples, taken at expected peak and trough antibiotic levels on day 4 of therapy, were determined against the potentially pathogenic strains isolated in sputum at the time of admission. For 104 isolates (64 Pseudomonas aeruginosa, 28 Staphylococcus aureus, and 12 Haemophilus influenzae strains), the peak and trough bactericidal titers were compared to bacteriological outcome. Bacteriological success was defined as a decrease of 2 log10 units or more in the bacterial density in sputum between days 0 and 7 of therapy. At peak antibiotic levels, serum bactericidal titers of 1:128 or more were 96% (all isolates) and 89% (P aeruginosa isolates), predictive of cure, whereas serum bactericidal titers of less than 1:16 were 100% predictive of failure for all infecting bacteria. In patients aged less than 18 years, the best peak titer for predicting success was 1:64, with a predictive value of 96% for titers of 1:64 or greater. The peak titer that best predicted success in patients aged 18 years or more was 1:128, with a predictive value of only 83% for titers of 1:128 or greater.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- P Cahen
- Department of Microbiology, Hôpital Necker-Enfants Malades, Paris, France
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39
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Teillaud JL, Brunati S, Elmalek M, Astier A, Nicaise P, Moncuit J, Mathiot C, Job-Deslandre C, Fridman WH. Involvement of FcR+ T cells and of IgG-BF in the control of myeloma cells. Mol Immunol 1990; 27:1209-17. [PMID: 2148806 DOI: 10.1016/0161-5890(90)90024-t] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J L Teillaud
- Laboratoire d'Immunologie Cellulaire et Clinique, Unité INSERM 255, Paris, France
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40
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Bougnoux ME, Nicaise P, Heyer F, Ancelle T, Pinquier JL, Dupouy-Camet J, Tourte-Schaeffer C. [Diagnosis of cerebral toxoplasmosis in AIDS patients. Value of antibodies evaluation in cerebrospinal fluid]. Presse Med 1990; 19:1751-3. [PMID: 2147499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The purpose of this study was to evaluate the diagnostic value of search for intrathecally synthesized specific antibodies in cerebral toxoplasmosis. Intrathecal synthesis of antibodies was measured by calculating the immunity load coefficient (ILC) in both serum and cerebrospinal fluid. In this retrospective study the records of 42 AIDS patients with clinically on the basis of computerized tomography and therapeutic results, and was excluded in 31 patients (control group). Specific immunoglobulins G were found in the cerebrospinal fluid of 9 out of the 11 patients with toxoplasmosis, but also in 14 of the 31 controls. Since ILC measurements in serum and cerebrospinal fluid identified 7/11 cases other hand, since the ILC value was higher than the positivity threshold in controls, the specificity of the test was assessed at 68 percent.
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Affiliation(s)
- M E Bougnoux
- Laboratoire de Parasitologie-Mycologie, Hôpital Cochin, Paris
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