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Bauke F, Schmitz T, Harmel E, Raake P, Heier M, Linseisen J, Peters A, Meisinger C. Anterior-wall and non-anterior-wall STEMIs do not differ in long-term mortality: results from the augsburg myocardial infarction registry. Front Cardiovasc Med 2024; 10:1306272. [PMID: 38259315 PMCID: PMC10800510 DOI: 10.3389/fcvm.2023.1306272] [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] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Background Different ST-segment elevation myocardial infarction (STEMI) localizations go along with dissimilarities in the size of the affected myocardium, the causing coronary vessel occlusion, and the right ventricular participation. Therefore, this study aims to clarify if there is any difference in long-term survival between anterior- and non-anterior-wall STEMI. Methods This study included 2,195 incident STEMI cases that occurred between 2009 and 2017, recorded by the population-based Augsburg Myocardial Infarction Registry, Germany. The study population comprised 1.570 men and 625 women aged 25-84 years at acute myocardial infarction. The patients were observed from the day of their first acute event with an average follow-up period of 4.3 years, (standard deviation: 3.0). Survival analyses and multivariable Cox regression analyses were performed to examine the association between infarction localizations and long-term all-cause mortality. Results Of the 2,195 patients, 1,118 had an anterior (AWS)- and 1,077 a non-anterior-wall-STEMI (NAWS). No significant associations of the STEMI localization with long-term mortality were found. When comparing AWS with NAWS, a hazard ratio of 0.91 [95% confidence interval: 0.75-1.10] could be calculated after multivariable adjustment. In contrast to NAWS, AWS was associated with a greater <28 day mortality, less current or former smoking and higher creatine kinase-myocardial band levels (CK-MB) and went along with a higher frequency of impaired left ventricular ejection fraction (<30%). Conclusions Despite pathophysiological differences between AWS and NAWS, and identified differences in multiple clinical characteristics, no significant differences in long-term mortality between both groups were observed.
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Affiliation(s)
- F. Bauke
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - T. Schmitz
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - E. Harmel
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - P. Raake
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - M. Heier
- KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute for Epidemiology, Neuherberg, Germany
| | - J. Linseisen
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - A. Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute for Epidemiology, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
- German Research Center for Cardiovascular Research (DZHK e.V.), Partner Site Munich Heart Alliance, Munich, Germany
| | - C. Meisinger
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
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Sentilhes L, Sénat MV, Bouchghoul H, Delorme P, Gallot D, Garabedian C, Madar H, Sananès N, Perrotin F, Schmitz T. [Intrahepatic cholestasis of pregnancy: French College of Obstetricians and Gynecologists guidelines for clinical practice]. Gynecol Obstet Fertil Senol 2023; 51:493-510. [PMID: 37806861 DOI: 10.1016/j.gofs.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To identify strategies for reducing neonatal and maternal morbidity associated with intrahepatic cholestasis pregnancy (ICP). MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE methodology with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and a (i) strong or (ii) weak recommendations or (iii) no recommendation were formulated. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Of the 14 questions (from 12 PICO questions and one definition question outside the PICO format), there was agreement between the working group and the external reviewers on 14 (100%). The level of evidence of the literature was insufficient to provide a recommendation on two questions. ICP is defined by the occurrence of suggestive pruritus (palmoplantar, nocturnal) associated with a total bile acid level>10μmol/L or an alanine transaminase level above 2N after ruling out differential diagnoses. In the absence of suggestive symptoms of a differential diagnosis, it is recommended not to carry out additional biological or ultrasound tests. In women with CIP, ursodeoxycholic acid is recommended to reduce the intensity of maternal pruritus (Strong recommendation. Quality of the evidence moderate) and to decrease the level of total bile acids and alanine transaminases. (Strong recommendation. Quality of the evidence moderate). S-adenosyl-methionine, dexamethasone, guar gum or activated charcoal should not be used to reduce the intensity of maternal pruritus (Strong recommendation. Quality of evidence low), and there is insufficient data to recommend the use of antihistamines (No recommendation. Quality of evidence low). Rifampicin (Weak recommendation. Very low quality of evidence) or plasma exchange (Strong recommendation. Very low quality of evidence) should not be used to reduce maternal pruritus and perinatal morbidity. Serum monitoring of bile acids is recommended to reduce perinatal morbidity and mortality (stillbirth, prematurity) (Low recommendation. Quality of the evidence low). The level of evidence is insufficient to determine whether fetal heart rate or fetal ultrasound monitoring are useful to reduce perinatal morbidity (No recommendation). Birth is recommended when bile acid level is above 99μmol/L from 36 weeks gestation to reduce perinatal morbidity, in particular stillbirth. When bile acid level is above 99μmol/L is below 100μmol/L, women should be informed that induction of labor could be considered 37 and 39 weeks gestation to reduce perinatal morbidity. (Strong recommendation. Quality of evidence low). In postpartum, total bile acids and alanine transaminases level should be checked and normalized before prescribing estrogen-progestin contraception, ideally with a low estrogen dose (risk of recurrence of pruritus and cytolysis) (Low recommendation. Quality of evidence very low). CONCLUSION Although the quality of evidence regarding ICP gestational cholestasis remains low, there is a strong consensus in France, as shown by our Delphi study, on how to manage women with ICP. The reference first-line treatment is ursodeoxycholic acid.
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Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - M-V Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - H Bouchghoul
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - P Delorme
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, Paris, France
| | - D Gallot
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Garabedian
- Service de gynécologie-obstétrique, CHU de Lille, université de Lille, ULR 2694-METRICS, 59000 Lille, France
| | - H Madar
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - N Sananès
- Service de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - F Perrotin
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Tours, Tours, France
| | - T Schmitz
- Service de gynécologie obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
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Harmel E, Schmitz T, Meisinger C, Linseisen J, von Scheidt W, Thilo C, Kirchberger I. COVID-19 risk perceptions, worries and preventive behaviors in patients with previous myocardial infarction: results from the myocardial infarction registry Augsburg. PSYCHOL HEALTH MED 2023; 28:1873-1882. [PMID: 35635262 DOI: 10.1080/13548506.2022.2083200] [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: 07/27/2021] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
Abstract
Despite the known association of chronic cardiovascular diseases and more severe courses of COVID-19, little is known about individual risk perception of patients with a history of acute myocardial infarction (AMI) and resulting preventive behaviours. In May 2020, a postal survey was conducted, including 150 patients with previous AMI from the myocardial infarction registry Augsburg. The study objective was to assess COVID-19 knowledge, individual risk perception, worries, infection likelihood and preventive behaviours in this patient cohort. From the 100 respondents, 69.7% perceived themselves to be at high risk of developing a severe course of COVID-19. There was a significant positive correlation between dangerousness assessment and knowledge on COVID-19. Despite a majority (70%) of patients rating their susceptibility for an infection as moderate to very high, the individual likelihood of being infected was rated at only 3%. Almost 70% of patients with previous MI classified themselves at high risk for a severe course of COVID-19 infection. As seen in other risk groups as well, the availability of valuable information sources as well as the support in individual risk reduction strategies and psychological coping mechanisms are mandatory, especially since higher knowledge correlates with dangerousness assessment and might lead to better compliance with preventive behaviours.
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Affiliation(s)
- E Harmel
- Department of Cardiology, University Hospital Augsburg, Augsburg, Germany
| | - T Schmitz
- Chair of Epidemiology at the University of Augsburg, University Hospital Augsburg, Augsburg, Germany
| | - C Meisinger
- Chair of Epidemiology at the University of Augsburg, University Hospital Augsburg, Augsburg, Germany
| | - J Linseisen
- Chair of Epidemiology at the University of Augsburg, University Hospital Augsburg, Augsburg, Germany
| | - W von Scheidt
- Department of Cardiology, University Hospital Augsburg, Augsburg, Germany
| | - C Thilo
- Department of Cardiology, Hospital of Rosenheim, Rosenheim, Germany
| | - I Kirchberger
- Chair of Epidemiology at the University of Augsburg, University Hospital Augsburg, Augsburg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology- IBE, Ludwig- Maximilians Universität München, Munich, Germany
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Schmitz T, Freuer D, Linseisen J, Meisinger C. Associations between serum cholesterol and immuno-phenotypical characteristics of circulatory B cells and Tregs. J Lipid Res 2023:100399. [PMID: 37276940 PMCID: PMC10394386 DOI: 10.1016/j.jlr.2023.100399] [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: 04/03/2023] [Revised: 05/25/2023] [Accepted: 05/28/2023] [Indexed: 06/07/2023] Open
Abstract
Blood lipids play a major role in the manifestation of cardiovascular diseases. Recent research suggested that there are connections between cholesterol levels and immunological alterations. We investigated whether there is an association between serum cholesterol levels (total, HDL, LDL) and immune cells (B cell and regulatory T cells [Tregs]). The analysis was based on data from 231 participants of the MEGA study in Augsburg, Germany, recruited between 2018 and 2021. Most participants was examined two different times within a time period of 9 months. At every visit, fasting venous blood samples were taken. Immune cells were analyzed immediately afterwards using flow cytometry. Using multivariable-adjusted linear regression models, the associations between blood cholesterol concentrations and the relative quantity of several B cell and Treg subsets were analyzed. We found that particularly HDL cholesterol concentrations were significantly associated to some immune cell subpopulations: HDL cholesterol showed significant positive associations with the relative frequency of CD25++ Tregs (as proportion of all CD4+CD25++ T cells) and conventional Tregs (defined as the proportion of CD25+CD127- cells on all CD45RA- CD4+ T cells). Regarding B cells, HDL cholesterol values were inversely associated with the cell surface expression of IgD and with naïve B cells (CD27- IgD+ B cells). In conclusion, HDL cholesterol levels were associated with modifications in the composition of B cell and Tregs subsets demonstrating an important interconnection between lipid metabolism and immune system. Knowing that this association exists might be crucial for a deeper and more comprehensive understanding of the pathophysiology of atherosclerosis.
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Affiliation(s)
- T Schmitz
- Epidemiology, Medical Faculty, University of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany.
| | - D Freuer
- Epidemiology, Medical Faculty, University of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
| | - J Linseisen
- Epidemiology, Medical Faculty, University of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
| | - C Meisinger
- Epidemiology, Medical Faculty, University of Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
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Sentilhes L, Schmitz T, Madar H, Bouchghoul H, Fuchs F, Garabédian C, Korb D, Nouette-Gaulain K, Pécheux O, Sananès N, Sibiude J, Sénat MV, Goffinet F. [The cesarean procedure: Guidelines for clinical practice from the French College of Obstetricians and Gynecologists]. Gynecol Obstet Fertil Senol 2023; 51:7-34. [PMID: 36228999 DOI: 10.1016/j.gofs.2022.10.002] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify procedures to reduce maternal morbidity during cesarean. MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE® method with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane and EMBASE databases. The quality of the evidence was assessed (high, moderate, low, very low) and a (i) strong or (ii) weak recommendations or (iii) no recommendation were formulated. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Of the 27 questions, there was agreement between the working group and the external reviewers on 26. The level of evidence of the literature was insufficient to provide a recommendation on 15 questions. Preventing hypothermia is recommended to increase maternal satisfaction and comfort (weak recommendation) and to reduce neonatal hypothermia (strong recommendation). The quality of the evidence of the literature did not allow to recommend the skin disinfectant to be used nor the relevance of a preoperative vaginal disinfection nor the choice between the use or nonuse of an indwelling bladder catheterization (if micturition takes place 1 hour before the cesarean section). The Misgav-Ladach technique or its analogues should be considered rather than the Pfannenstiel technique to reduce maternal morbidity (weak recommendation) bladder flap before uterine incision should not be performed routinely (weak recommendation), but a blunt (weak recommendation) and cephalad-caudad extension of uterine incision (weak recommendation) should be considered to reduce maternal morbidity. Antibiotic prophylaxis is recommended to reduce maternal infectious morbidity (strong recommendation) without recommendation on its type or the timing of administration (before incision or after cord clamping). The administration of carbetocin after cord clamping does not significantly decrease the incidence of blood loss>1000 ml, anemia, or blood transfusion compared with the administration of oxytocin. Thus, it is not recommended to use carbetocin rather than oxytocin in cesarean. It is recommended that systematic manual removal of the placenta not to be performed (weak recommendation). An antiemetic should be administered after cord clamping in women having a planned cesarean under locoregional anaesthesia to reduce intraoperative and postoperative nausea and vomiting (strong recommendation) with no recommendation regarding choice of use one or two antiemetics. The level of evidence of the literature was insufficient to provide any recommendation concerning single or double-layer closure of the uterine incision, or the uterine exteriorization. Closing the peritoneum (visceral or parietal) should not be considered (weak recommendation). The quality of the evidence of the literature was not sufficient to provide recommendation on systematic subcutaneous closure, including in obese or overweight patients, or the use of subcuticular suture in obese or overweight patients. The use of subcuticular suture in comparison with skin closure by staples was not considered as a recommendation due to the absence of a consensus in the external review rounds. CONCLUSION In case of cesarean, preventing hypothermia, administering antiemetic and antibiotic prophylaxis after cord clamping are the only strong recommendations. The Misgav-Ladach technique, the way of performing uterine incision (no systematic bladder flap, blunt cephalad-caudad extension), not performing routine manual removal of the placenta nor closure of the peritoneum are weak recommendations and may reduce maternal morbidity.
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Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - T Schmitz
- Service de gynécologie obstétrique, hôpital Robert-Debré, université Paris Diderot, AP-HP, Paris, France
| | - H Madar
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - H Bouchghoul
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - F Fuchs
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Montpellier, Montpellier, France
| | - C Garabédian
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Lille, Lille, France
| | - D Korb
- Service de gynécologie obstétrique, hôpital Robert-Debré, université Paris Diderot, AP-HP, Paris, France
| | - K Nouette-Gaulain
- Service d'anesthésie, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - O Pécheux
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Lille, Lille, France
| | - N Sananès
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Strasbourg, Strasbourg, France
| | - J Sibiude
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, AP-HP Louis-Mourier, Colombes, France
| | - M-V Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP Le Kremlin-Bicêtre, Paris, France
| | - F Goffinet
- Maternité Port-Royal, groupe hospitalier Cochin Broca, Hôtel-Dieu, université Paris-Descartes, AP-HP, Paris, France
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Deruelle P, Sentilhes L, Ghesquière L, Desbrière R, Ducarme G, Attali L, Jarnoux A, Artzner F, Tranchant A, Schmitz T, Sénat MV. [Expert consensus from the College of French Gynecologists and Obstetricians: Management of nausea and vomiting of pregnancy and hyperemesis gravidarum]. Gynecol Obstet Fertil Senol 2022; 50:700-711. [PMID: 36150647 DOI: 10.1016/j.gofs.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To determine the management of patients with 1st trimester nausea and vomiting and hyperemesis gravidarum. METHODS A panel of experts participated in a formal consensus process, including focus groups and two Delphi rounds. RESULTS Hyperemesis gravidarum is distinguished from nausea and vomiting during pregnancy by weight loss≥5 % or signs of dehydration or a PUQE score≥7. Hospitalization is proposed when there is, at least, one of the following criteria: weight loss≥10%, one or more clinical signs of dehydration, PUQE (Pregnancy Unique Quantification of Emesis and nausea) score≥13, hypokalemia<3.0mmol/L, hyponatremia<120mmol/L, elevated serum creatinine>100μmol/L or resistance to treatment. Prenatal vitamins and iron supplementation should be stopped without stopping folic acid supplementation. Diet and lifestyle should be adjusted according to symptoms. Aromatherapy is not to be used. If the PUQE score is<6, even in the absence of proof of their benefit, ginger, pyridoxine (B6 vitamin), acupuncture or electrostimulation can be used, even in the absence of proof of benefit. It is proposed that drugs or combinations of drugs associated with the least severe and least frequent side effects should always be chosen for uses in 1st, 2nd or 3rd intention, taking into account the absence of superiority of a class over another to reduce the symptoms of nausea and vomiting of pregnancy and hypermesis gravidarum. To prevent Gayet Wernicke encephalopathy, Vitamin B1 must systematically be administered for hyperemesis gravidarum needing parenteral rehydration. Patients hospitalized for hyperemesis gravidarum should not be placed in isolation (put in the dark, confiscation of the mobile phone or ban on visits, etc.). Psychological support should be offered to all patients with hyperemesis gravidarum as well as information on patient' associations involved in supporting these women and their families. When returning home after hospitalization, care will be organized around a referring doctor. CONCLUSION This work should contribute to improving the care of women with hyperemesis gravidarum. However, given the paucity in number and quality of the literature, researchers must invest in the field of nausea and vomiting in pregnancy, and HG to identify strategies to improve the quality of life of women with nausea and vomiting in pregnancy or hyperemesis gravidarum.
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Affiliation(s)
- P Deruelle
- UNISTRA, département de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, 67000 Strasbourg cedex, France.
| | - L Sentilhes
- Department of obstetrics and gynecology, Bordeaux university hospital, Bordeaux, France
| | - L Ghesquière
- ULR 2694 - METRICS - évaluation des technologies de santé et des pratiques médicales, university Lille, CHU Lille, 59000 Lille, France; Department of obstetrics, CHU Lille, 59000 Lille, France
| | | | - G Ducarme
- Service de gynécologie obstétrique, centre hospitalier départemental Vendée, 85000 La Roche-sur-Yon, France
| | - L Attali
- UNISTRA, département de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, 67000 Strasbourg cedex, France
| | | | - F Artzner
- Association 9mois avec ma bassine, France
| | - A Tranchant
- Association de lutte contre l'hyperémèse gravidique, France
| | - T Schmitz
- Université Paris Cité, 75006 Paris, France; Service de gynécologie obstétrique, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, Paris, France
| | - M-V Sénat
- Department of obstetrics and gynecology, Bicêtre hospital, Assistance publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
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Schmitz T, Harmel E, Heier M, Peters A, Linseisen J, Meisinger C. Inflammatory plasma proteins predict short-term mortality in patients with an acute myocardial infarction. J Transl Med 2022; 20:457. [PMID: 36209229 PMCID: PMC9547640 DOI: 10.1186/s12967-022-03644-9] [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: 07/26/2022] [Accepted: 09/18/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the association between inflammatory markers and 28-day mortality in patients with ST-elevation myocardial infarction (STEMI). METHODS In 398 STEMI patients recorded between 2009 and 2013 by the population-based Myocardial Infarction Registry Augsburg, 92 protein biomarkers were measured in admission arterial blood samples using the OLINK inflammatory panel. In multivariable-adjusted logistic regression models, the association between each marker and 28-day mortality was investigated. The values of the biomarkers most significantly associated with mortality were standardized and summarized to obtain a prediction score for 28-day mortality. The predictive ability of this biomarker score was compared to the established GRACE score using ROC analysis. Finally, a combined total score was generated by adding the standardized biomarker score to the standardized GRACE score. RESULTS The markers IL-6, IL-8, IL-10, FGF-21, FGF-23, ST1A1, MCP-1, 4E-BP1, and CST5 were most significantly associated with 28-day mortality, each with FDR-adjusted (false discovery rate adjusted) p-values of < 0.01 in the multivariable logistic regression model. In a ROC analysis, the biomarker score and the GRACE score showed comparable predictive ability for 28-day mortality (biomarker score AUC: 0.7859 [CI: 0.6735-0.89], GRACE score AUC: 0.7961 [CI: 0.6965-0.8802]). By combining the biomarker score and the Grace score, the predictive ability improved with an AUC of 0.8305 [CI: 0.7269-0.9187]. A continuous Net Reclassification Improvement (cNRI) of 0.566 (CI: 0.192-0.94, p-value: 0.003) and an Integrated Discrimination Improvement (IDI) of 0.083 ((CI: 0.016-0.149, p-value: 0.015) confirmed the superiority of the combined score over the GARCE score. CONCLUSIONS Inflammatory biomarkers may play a significant role in the pathophysiology of acute myocardial infarction (AMI) and AMI-related mortality and might be a promising starting point for personalized medicine, which aims to provide each patient with tailored therapy.
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Affiliation(s)
- T. Schmitz
- grid.419801.50000 0000 9312 0220Epidemiology, Medical Faculty, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
| | - E. Harmel
- grid.419801.50000 0000 9312 0220Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - M. Heier
- grid.419801.50000 0000 9312 0220University Hospital of Augsburg, KORA Study Centre, Augsburg, Germany ,Helmholtz Zentrum München, Institute for Epidemiology, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany
| | - A. Peters
- Helmholtz Zentrum München, Institute for Epidemiology, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany ,grid.5252.00000 0004 1936 973XChair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany ,grid.452622.5German Center for Diabetes Research (DZD), Neuherberg, Germany ,grid.452396.f0000 0004 5937 5237German Research Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - J. Linseisen
- grid.419801.50000 0000 9312 0220Epidemiology, Medical Faculty, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
| | - C. Meisinger
- grid.419801.50000 0000 9312 0220Epidemiology, Medical Faculty, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156 Augsburg, Germany
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Schmitz T, Freuer D, Harmel E, Heier M, Peters A, Linseisen J, Meisinger C. Prognostic value of stress hyperglycemia ratio on short- and long-term mortality after acute myocardial infarction. Acta Diabetol 2022; 59:1019-1029. [PMID: 35532812 PMCID: PMC9242951 DOI: 10.1007/s00592-022-01893-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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] [Received: 12/13/2021] [Accepted: 04/09/2022] [Indexed: 01/08/2023]
Abstract
AIMS Prior studies demonstrated an association between hospital admission blood glucose and mortality in acute myocardial infarction (AMI). Because stress hyperglycemia ratio (SHR) has been suggested as a more reliable marker of stress hyperglycemia this study investigated to what extent SHR in comparison with admission blood glucose is associated with short- and long-term mortality in diabetic and non-diabetic AMI patients. METHODS The analysis was based on 2,311 AMI patients aged 25-84 years from the population-based Myocardial Infarction Registry Augsburg (median follow-up time 6.5 years [IQR: 4.9-8.1]). The SHR was calculated as admission glucose (mg/dl)/(28.7 × HbA1c (%)-46.7). Using logistic and COX regression analyses the associations between SHR and admission glucose and mortality were investigated. RESULT Higher admission glucose and higher SHR were significantly and nonlinearly associated with higher 28-day mortality in AMI patients with and without diabetes. In patients without diabetes, the AUC for SHR was significantly lower than for admission glucose (SHR: 0.6912 [95%CI 0.6317-0.7496], admission glucose: 0.716 [95%CI 0.6572-0.7736], p-value: 0.0351). In patients with diabetes the AUCs were similar for SHR and admission glucose. Increasing admission glucose and SHR were significantly nonlinearly associated with higher 5-year all-cause mortality in AMI patients with diabetes but not in non-diabetic patients. AUC values indicated a comparable prediction of 5-year mortality for both measures in diabetic and non-diabetic patients. CONCLUSIONS Stress hyperglycemia in AMI patients plays a significant role mainly with regard to short-term prognosis, but barely so for long-term prognosis, underlining the assumption that it is a transient dynamic disorder that occurs to varying degrees during the acute event, thereby affecting prognosis.
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Affiliation(s)
- T Schmitz
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
| | - D Freuer
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
| | - E Harmel
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - M Heier
- KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany
- Institute for Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - A Peters
- Institute for Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - J Linseisen
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - C Meisinger
- Chair of Epidemiology, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany
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9
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Butler J, Schmitz T, Lambio C, Manafa G, Savaskan N, Lakes T. Raum-zeitliche Exploration von COVID-19 Daten und lokalen
Risikofaktoren in Berlin: am Beispiel des Bezirks
Neukölln. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753723] [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: 12/12/2022]
Affiliation(s)
- J Butler
- Humboldt-Universität zu Berlin, Geographisches Institut,
Berlin, Deutschland
| | - T Schmitz
- Humboldt-Universität zu Berlin, Geographisches Institut,
Berlin, Deutschland
| | - C Lambio
- Humboldt-Universität zu Berlin, Geographisches Institut,
Berlin, Deutschland
| | - G Manafa
- Humboldt-Universität zu Berlin, Geographisches Institut,
Berlin, Deutschland
| | - N Savaskan
- Bezirksamt Neukölln von Berlin, Gesundheitsamt, Berlin,
Deutschland
| | - T Lakes
- Humboldt-Universität zu Berlin, Geographisches Institut,
Berlin, Deutschland
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10
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Betts TR, Grygier M, Nielsen-Kudsk JE, Schmitz T, Sandri M, Casu G, Bergmann M, Hildick-Smith D, Christen T, Allocco DJ. One-year results from the FLXibility post-approval study: final real-world clinical outcomes with a next-generation left atrial appendage closure device. Europace 2022. [DOI: 10.1093/europace/euac053.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Boston Scientific Corporation, Marlborough, MA, USA
Background
The WATCHMAN FLX left atrial appendage (LAA) closure device received CE-mark and FDA approval based on the results of the PINNACLE FLX IDE study, but evidence of outcomes with this next-generation device in everyday clinical practise is limited.
Purpose
The FLXibility Post-Approval Study collected real-world data on patients implanted with a WATCHMAN FLX in a routine clinical practise.
Methods
Patients were implanted with a WATCHMAN FLX per local standard of care, with a subsequent first follow-up visit from 45-120 days post-implant and a final follow-up at 1 year post procedure. A Clinical Event Committee adjudicated all major adverse events and TEE/CT imaging results were adjudicated by a core laboratory.
Results
Among 300 patients enrolled at 17 centres in Europe, the mean age was 74.6±8.0 years, mean CHA2DS2-VASc score was 4.3±1.6, mean HAS-BLED score was 2.6±1.0, and 62.1% were male. The device was successfully implanted in 99.0% (297/300) of patients; 97.0% (289/298) required only 1 device for an implantation attempt and no patient required >2 devices. TEE was used for 78% of procedures and ICE for 22%. The post-implant medication regimen was DAPT for 87.3% (262/300). At first follow-up, among 170 patients with evaluable imaging, 87.6% (149/170) had no leak, 12.4% (21/170) had leak >0mm to ≤5mm with 16 (9.4%) of these <3mm, and no patient had leak >5mm, per core lab adjudication. At 1 year, 93.3% (280/300) patients had final follow-up or death. At final follow-up, 61% of patients were on a single antiplatelet medication, 21% were on DAPT, 6% were on a direct oral anticoagulation medication, and 12% were not taking any antiplatelet/anticoagulation medication. One-year all-cause mortality was 10.8% (32/295), among which 5.1% (15/295) were cardiovascular or unexplained. Disabling stroke occurred in 1.0% (3/295) of patients and nondisabling stroke also in 1.0% (3/295) of patients; all were nonfatal. No patient experienced a systemic embolism. Device-related thrombus was detected in 2.4% (7/295) patients. Pericardial effusion requiring surgery or pericardiocentesis occurred in 1.0% (3/295), with all of these events occurring in the first 7 days post-procedure. Cumulative BARC-3 or -5 bleeding occurred in 3.7% (11/300) of patients from 0 to 7 days, in 7.3% (22/300) at 6 months, and in 8.1% (24/295) patients at 1 year. One patient (0.3%) had a peri-procedural device embolisation, with no subsequent device embolisations or any device migration reported for any patient through 1 year.
Conclusions
The WATCHMAN FLX device had excellent procedural success rates, with high effective LAA closure rates and low serious adverse event rates in everyday clinical practise.
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Affiliation(s)
- TR Betts
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - M Grygier
- University Hospital of Lords Transfiguration, Poznan, Poland
| | | | - T Schmitz
- Elisabeth Krankenhaus Essen, Essen, Germany
| | - M Sandri
- Herzzentrum Universitat Leipzig, Leipzig, Germany
| | - G Casu
- Sassari University Hospital, Sassari, Italy
| | | | - D Hildick-Smith
- Royal Sussex County Hospital, Brighton, United Kingdom of Great Britain & Northern Ireland
| | - T Christen
- Boston Scientific Corporation, Marlborough, United States of America
| | - DJ Allocco
- Boston Scientific Corporation, Marlborough, United States of America
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11
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Eslier M, Deneux-Tharaux C, Sauvegrain P, Schmitz T, Luton D, Mandelbrot L, Estellat C, Azria E. 317 Severe maternal morbidity among undocumented migrant women in the precare prospective cohort study. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Grieshaber P, Heringlake M, Bauer A, Thiele H, Schmitz T, Miera O, Groesdonk H, Böning A, Trummer G. The Use of Intraaortic Balloon Counterpulsation in Cardiac Surgery in Germany. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742843] [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: 10/19/2022]
Affiliation(s)
- P. Grieshaber
- Division of Congenital Cardiac Surgery, Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Deutschland
| | | | - A. Bauer
- Lerchenfeld 1, Coswig, Deutschland
| | - H. Thiele
- Leipzig Heart Center, Leipzig, Deutschland
| | | | - O. Miera
- Pediatric cardiology, German Heart Institute Berlin, Berlin, Deutschland
| | | | - A. Böning
- Rudolf-Buchheim-Str. 7, Gießen, Deutschland
| | - G. Trummer
- Hugstetter Straße 55, Freiburg, Deutschland
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13
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Brun JL, Sentilhes L, Torre A, Huchon C, Garabedian C, Legendre G, Sibiude J, Sénat MV, Marret H, Schmitz T. [CNGOF clinical practice guidelines: Evaluation one year after revision of the methodology]. Gynecol Obstet Fertil Senol 2022; 50:130-135. [PMID: 34801762 DOI: 10.1016/j.gofs.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 11/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To evaluate the revision of methodology of the clinical practice guidelines (CPG) of the French National College of Gynecologists and Obstetricians (CNGOF). METHOD Three CPGs were organized in 2020 on the topics of severe preeclampsia, menorrhagia, and prophylactic surgery according to AGREE II (Apraisal of Guidelines for Research & Evaluation). Questions were presented in PICO (Population, Intervention, Comparison, Outcome) format and the grading of scientific evidence was based on the GRADE (Grading of Recommendation Assessment, Development and Evaluation) method. RESULTS All three CPGs groups adhered to this new methodology. However, the presentation of the arguments, the formulation of the recommendations and the development of the GRADE tables were heterogeneous from one group to another. A homogenization of the presentation is proposed, as well as a guide to the critical analysis of the literature to help the experts to rate the evidence. CONCLUSION Adherence to these quality criteria should make it easier to apply the recommendations at the national level and improve international recognition of the work done by the CNGOF.
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Affiliation(s)
- J-L Brun
- Pôle d'obstétrique-reproduction-gynécologie, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux, France; UMR 5234 (MFP), microbiologie fondamentale et pathogénicité, université de Bordeaux, 33076 Bordeaux, France.
| | - L Sentilhes
- Pôle d'obstétrique-reproduction-gynécologie, centre Aliénor d'Aquitaine, hôpital Pellegrin, CHU Bordeaux, place Amélie Raba Léon, 33076 Bordeaux, France
| | - A Torre
- Centre de procréation médicalement assistée, centre hospitalier Sud Francilien, 40, avenue Serge Dassault, 91106 Corbeil-Essonnes, France
| | - C Huchon
- Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, 2, rue Ambroise Paré, 75010 Paris, France; UMR 1123 (ECEVE), épidémiologie clinique, évaluation économique, populations vulnérables, université de Paris, Paris, France
| | - C Garabedian
- Clinique d'obstétrique, hôpital Jeanne de Flandre, CHU de Lille, avenue Eugène Avinée, 59000 Lille, France; ULR 2694 (METRICS), évaluation des technologies de santé et des pratiques médicales, université de Lille, 59000 Lille, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49933 Angers, France; UMR 1018 (CESP), centre de recherche en épidémiologie et santé des populations, 94076 Villejuif, France
| | - J Sibiude
- Service de gynécologie-obstétrique, hôpital Louis Mourier, AP-HP, 92700 Colombes, France; UMR 1137 (IAME), centre de recherche infection-antimicrobiens-modélisation-évolution, université de Paris, 75018 Paris, France
| | - M-V Sénat
- UMR 1018 (CESP), centre de recherche en épidémiologie et santé des populations, 94076 Villejuif, France; Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - H Marret
- Service de chirurgie pelvienne gynécologique et oncologique, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours, France; UMR 1253, Imagerie et cerveau, université de Tours, 37032 Tours, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; INSERM U1153 (EPOPé), épidémiologie obstétricale périnatale et pédiatrique, université de Paris, 75006 Paris, France
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14
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Bonnet MP, Garnier M, Keita H, Compere V, Arthuis C, Raia-Barjat T, Berveiller P, Burey J, Bouvet L, Bruyère M, Castel A, Clouqueur E, Estevez MG, Faitot V, Fischer C, Fuchs F, Lecarpentier E, Le Gouez A, Rigouzzo A, Rossignol M, Simon E, Vial F, Vivanti AJ, Zieleskewicz L, Sénat MV, Schmitz T, Sentilhes L. [Reprint of: Severe pre-eclampsia: guidelines for clinical practice from the French Society of anesthesiology and intensive care (SFAR) and the French College of gynaecologists and obstetricians (CNGOF)]. ACTA ACUST UNITED AC 2021; 50:2-25. [PMID: 34781016 DOI: 10.1016/j.gofs.2021.11.003] [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] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To provide national guidelines for the management of women with severe preeclampsia. DESIGN A consensus committee of 26 experts was formed. A formal conflict of interest (COI) policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS The last SFAR and CNGOF guidelines on the management of women with severe preeclampsia was published in 2009. The literature is now sufficient for an update. The aim of this expert panel guidelines is to evaluate the impact of different aspects of the management of women with severe preeclampsia on maternal and neonatal morbidities separately. The experts studied questions within 7 domains. Each question was formulated according to the PICO (Patients Intervention Comparison Outcome) model and the evidence profiles were produced. An extensive literature review and recommendations were carried out and analyzed according to the GRADE® methodology. RESULTS The SFAR/CNGOF experts panel provided 25 recommendations: 8 have a high level of evidence (GRADE 1±), 9 have a moderate level of evidence (GRADE 2±), and for 7 recommendations, the GRADE method could not be applied, resulting in expert opinions. No recommendation was provided for 3 questions. After one scoring round, strong agreement was reached between the experts for all the recommendations. CONCLUSIONS There was strong agreement among experts who made 25 recommendations to improve practices for the management of women with severe preeclampsia.
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Affiliation(s)
- M-P Bonnet
- Sorbonne Université, GRC 29, DMU DREAM, Department of Anaesthesiology and Intensive Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche épidémiologie et Statistiques Sorbonne Paris Cité (CRESS) U1153, INSERM, Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé) Research Team, Université de Paris, Paris, France.
| | - M Garnier
- Sorbonne Université, APHP, GRC 29, DMU DREAM, Département d'Anesthesie-réanimation, CHU Tenon, Paris, France
| | - H Keita
- Département d'anesthésie-réanimation pédiatrique et obstétricale, hôpital Necker-Enfants malades, université de Paris, AP-HP, Paris, France
| | - V Compere
- Département d'anesthésie-réanimation, CHU de Rouen, Rouen, France
| | - C Arthuis
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Nantes, hôpital Mère-Enfant, Nantes, France
| | - T Raia-Barjat
- Inserm, U 1059 SainBioSE, département de gynécologie, obstétrique, et médecine de la reproduction, CHU de Saint-Étienne, université de Saint-Étienne Jean-Monnet, 42023 Saint-Étienne, France
| | - P Berveiller
- Service de gynécologie-obstétrique, école nationale vétérinaire d'Alfort, CHI Poissy Saint-Germain, UVSQ, INRAE, BREED, Jouy-en-Josas, BREED, Poissy université Paris-Saclay, Maisons-Alfort, France
| | - J Burey
- Service d'anesthésie-réanimation chirurgicale, hôpital Tenon, AP-HP, Paris, France
| | - L Bouvet
- Service d'anesthésie-réanimation, groupement hospitalier Est, hospices civils de Lyon, Bron, Claude-Bernard Lyon 1, hôpital Femme Mère-Enfant, université de Lyon, Villeurbanne, France
| | - M Bruyère
- Service d'anesthésie-réanimation médecine périopératoire, hôpital Bicêtre, AP-HP, université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - A Castel
- Département d'anesthésie-réanimation, hôpital Paule-de-Viguier, Toulouse, France
| | - E Clouqueur
- Service de gynécologie-obstétrique, centre hospitalier de Tourcoing, Tourcoing, France
| | - M Gonzalez Estevez
- Service d'anesthésie-réanimation et de médecine périopératoire, hôpital Jeanne-de-Flandre, CHU de Lille, Lille, France
| | - V Faitot
- Département d'anesthésie-réanimation, hôpital de Hautepierre, CHU de Strasbourg, Strasbourg, France
| | - C Fischer
- Département d'anesthésie-réanimation chirurgicale, hôpital Cochin, Paris, France
| | - F Fuchs
- UMR Inserm, service de gynécologie-obstétrique, institut Desbrest d'épidémiologie et de santé publique (IDESP), IURC, CHU de Montpellier, hôpital Arnaud-de-Villeneuve, université de Montpellier, Campus Santé, Montpellier, France
| | - E Lecarpentier
- Inserm U955, département de gynécologie-obstétrique et médecine de la reproduction, CHIC de Créteil, institut biomédical Henri-Mondor, université Paris Est Créteil, Créteil, France
| | - A Le Gouez
- Département d'anesthésie-réanimation, hôpital Antoine-Béclère, AP-HP, Clamart, France
| | - A Rigouzzo
- Service d'anesthésie-réanimation chirurgicale, hôpital Armand Trousseau, AP-HP, Paris, France
| | - M Rossignol
- Département d'anesthésie-réanimation et SMUR, hôpital Lariboisière, AP-HP, université de Paris, Paris, France
| | - E Simon
- Pôle de gynécologie-obstétrique et biologie de la reproduction, CHU de Dijon-Bourgogne, UFR Sciences de santé Dijon, université de Bourgogne, Bourgogne, France
| | - F Vial
- Service d'anesthésie-réanimation, maternité régionale universitaire-CHRU de Nancy, Nancy, France
| | - A J Vivanti
- Université Paris Saclay, service de gynécologie-obstétrique, hôpital Antoine Béclère, AP-HP, Paris, France
| | - L Zieleskewicz
- Inserm, INRA, département d'anesthésie-réanimation, centre de recherche cardiovasculaire et de nutrition (C2VN), hôpital Nord, université d'Aix-Marseille, université Aix-Marseille, Marseille, France
| | - M-V Sénat
- Inserm, service de gynécologie-obstétrique, UVSQ, CESP, hôpital Bicêtre, université Paris-Saclay, AP-HP, Villejuif, France
| | - T Schmitz
- Inserm, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), service de gynécologie-obstétrique, centre de recherche épidémiologie et statistique Sorbonne Paris Cité (CRESS), hôpital Robert-Debré, université de Paris, AP-HP, 75004 Paris, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, CHU de Bordeaux, Bordeaux, France
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15
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Voigt I, Schmitz T. [eCPR in a young adult : Rare cause of refractory cardiac arrest]. Med Klin Intensivmed Notfmed 2021; 116:708-711. [PMID: 34061212 DOI: 10.1007/s00063-021-00829-w] [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] [Received: 08/30/2020] [Revised: 12/31/2020] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- I Voigt
- Klinik für Akut- und Notfallmedizin, Elisabeth-Krankenhaus Essen, Klara-Kopp-Weg 1, 45138, Essen, Deutschland.
| | - T Schmitz
- Klinik für Kardiologie und Angiologie, Elisabeth-Krankenhaus Essen, Essen, Deutschland
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16
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Schmitz T, Korb D, Azria E, Garabédian C, Rozenberg P, Sénat MV, Sentilhes L, Vayssière C, Winer N, Goffinet F. Perinatal outcome after planned vaginal delivery in monochorionic compared with dichorionic twin pregnancy. Ultrasound Obstet Gynecol 2021; 57:592-599. [PMID: 33078466 DOI: 10.1002/uog.23518] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/19/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess, according to chorionicity, the perinatal outcome of twin pregnancy in which vaginal delivery is planned. METHODS JUMODA (JUmeaux MODe d'Accouchement) was a national prospective population-based cohort study of twin pregnancies, delivered in 176 maternity units in France, from February 2014 to March 2015. In this planned secondary analysis, we assessed, according to chorionicity, the perinatal outcome of twin pregnancies, in which vaginal delivery was planned, that delivered at or after 32 weeks of gestation with the first twin in cephalic presentation. In order to select a population with well-recognized indications for planned vaginal delivery, we applied the same exclusion criteria as those in the Twin Birth Study, an international randomized trial. Monochorionic twin pregnancies with twin-to-twin transfusion syndrome or twin anemia-polycythemia sequence were defined as complicated and were excluded. The primary outcome was a composite of intrapartum mortality and neonatal morbidity and mortality. Multivariable logistic regression models were used to control for potential confounders. Subgroup analyses were conducted according to birth order (first or second twin) and gestational age at delivery (< 37 or ≥ 37 weeks of gestation). RESULTS Among 3873 twin pregnancies, in which vaginal delivery was planned, that delivered at ≥ 32 weeks' gestation with the first twin in cephalic presentation, meeting the inclusion criteria of the Twin Birth Study, 729 (18.8%) were uncomplicated monochorionic twin pregnancies and 3144 (81.2%) were dichorionic twin pregnancies. The rate of composite intrapartum mortality and neonatal morbidity and mortality did not differ between uncomplicated monochorionic (27/1458 (1.9%)) and dichorionic (107/6288 (1.7%)) twin pregnancies when adjusting for conception by assisted reproductive technologies (adjusted relative risk, 1.07 (95% CI, 0.66-1.75)). No significant difference in the primary outcome was found between the groups on subgroup analyses according to birth order and gestational age at delivery. CONCLUSION When vaginal delivery is planned, and delivery occurs at ≥ 32 weeks of gestation with the first twin in cephalic presentation, uncomplicated monochorionic twin pregnancy is not associated with a higher rate of composite intrapartum mortality and neonatal morbidity and mortality compared with dichorionic twin pregnancy. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Schmitz
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Paris, France
- Université de Paris, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - D Korb
- Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Service de Gynécologie Obstétrique, Paris, France
- Université de Paris, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - E Azria
- Université de Paris, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
- Maternité Notre Dame de Bon Secours, Groupe Hospitalier Saint-Joseph, Paris, France
| | - C Garabédian
- CHRU de Lille, Maternité Jeanne de Flandre, Lille, France
- Université de Lille 2, Lille, France
| | - P Rozenberg
- Centre Hospitalier Intercommunal de Poissy, Service de Gynécologie Obstétrique, Poissy, France
- Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
| | - M V Sénat
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Service de Gynécologie Obstétrique, Le Kremlin-Bicêtre, Paris, France
- Université Paris Sud, Le Kremlin-Bicêtre, Paris, France
| | - L Sentilhes
- CHU de Bordeaux, Service de Gynécologie Obstétrique, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - C Vayssière
- CHU de Toulouse, Service de Gynécologie Obstétrique, Toulouse, France
- Université Toulouse III Paul Sabatier, Toulouse, France
| | - N Winer
- CHU de Nantes, Service de Gynécologie Obstétrique, Nantes, France
- Université de Nantes, Nantes, France
| | - F Goffinet
- Université de Paris, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
- Assistance Publique-Hôpitaux de Paris, Maternité Port-Royal, Paris, France
- DHU Risques et Grossesse, Paris, France
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17
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Petitprez K, Guillaume S, Mattuizzi A, Arnal M, Artzner F, Bernard C, Bonnin M, Bouvet L, Caron FM, Chevalier I, Daussy-Urvoy C, Ducloy-Bouthorsc AS, Garnier JM, Keita-Meyer H, Lavillonnière J, Lejeune-Sadaa V, Leray C, Morandeau A, Morau E, Nadjafizade M, Pizzagalli F, Schantz C, Schmitz T, Shojai R, Hédon B, Sentilhes L. [Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) -- Text of the Guidelines (short text)]. Gynecol Obstet Fertil Senol 2020; 48:873-882. [PMID: 33011381 DOI: 10.1016/j.gofs.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of these guidelines is to define for women at low obstetric risk modalities that respect the physiology of delivery and guarantee the quality and safety of maternal and newborn care. METHODS These guidelines were made by a consensus of experts based on an analysis of the scientific literature and the French and international recommendations available on the subject. RESULTS It is recommended to conduct a complete initial examination of the woman in labor at admission (consensus agreement). The labor will be monitored using a partogram that is a useful traceability tool (consensus agreement). A transvaginal examination may be offered every two to four hours during the first stage of labor and every hour during the second stage of labor or before if the patient requests it, or in case of a warning sign. It is recommended that if anesthesia is required, epidural or spinal anesthesia should be used to prevent bronchial inhalation (grade A). The consumption of clear fluids is permitted throughout labor in patients with a low risk of general anesthesia (grade B). It is recommended to carry out a "low dose" epidural analgesia that respects the experience of delivery (grade A). It is recommended to maintain the epidural analgesia through a woman's self-administration pump (grade A). It is recommended to give the woman the choice of continuous (by cardiotocography) or discontinuous (by cardiotocography or intermittent auscultation) monitoring if the conditions of maternity organization and the permanent availability of staff allow it and, after having informed the woman of the benefits and risks of each technique (consensus agreement). In the active phase of the first stage of labor, the dilation rate is considered abnormal if it is less than 1cm/4h between 5 and 7cm or less than 1cm/2h above 7cm (level of Evidence 2). It is then recommended to propose an amniotomy if the membranes are intact or an oxytocin administration if the membranes are already ruptured, and the uterine contractions considered insufficient (consensus agreement). It is recommended not to start expulsive efforts as soon as complete dilation is identified, but to let the presentation of the fetus drop (grade A). It is recommended to inform the gynecologist-obstetrician in case of nonprogression of the fetus after two hours of complete dilation with sufficient uterine dynamics (consensus agreement). It is recommended not to use abdominal expression (grade B). It is recommended to carry out preventive administration of oxytocin at 5 or 10 IU to prevent PPH after vaginal delivery (grade A). In the case of placental retention, it is recommended to perform a manual removal of the placenta (grade A). In the absence of bleeding, it should be performed 30minutes but not more than 60minutes after delivery (consensus agreement). It is recommended to assess at birth the breathing or screaming, and tone of the newborn to quickly determine if resuscitation is required (consensus agreement). If the parameters are satisfactory (breathing present, screaming frankly, and normal tonicity), it is recommended to propose to the mother that she immediately place the newborn skin-to-skin with her mother if she wishes, with a monitoring protocol (grade B). Delayed cord clamping is recommended beyond the first 30seconds in neonates, not requiring resuscitation (grade C). It is recommended that the first oral dose (2mg) of vitamin K (consensus agreement) be given systematically within two hours of birth. CONCLUSION These guidelines allow women at low obstetric risk to benefit from a better quality of care and optimal safety conditions while respecting the physiology of delivery.
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Affiliation(s)
- K Petitprez
- Service des bonnes pratiques professionnelles, Haute Autorité de santé, 93218 Saint-Denis, France
| | - S Guillaume
- Service de gynécologie-obstétrique, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | - A Mattuizzi
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | | | - F Artzner
- Collectif inter-associatif autour de la naissance (CIANE), 93100 Montreuil, France
| | - C Bernard
- Collectif inter-associatif autour de la naissance (CIANE), 75011 Paris, France
| | - M Bonnin
- Service d'anesthésie-réanimation, hôpital d'Estaing, centre hospitalier universitaire de Clermont-Ferrand, 63100 Clermont-Ferrand, France
| | - L Bouvet
- Service d'anesthésie-réanimation, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 69000 Lyon, France
| | - F-M Caron
- Pôle femme enfant Victor-Pauchet, centre hospitalier universitaire d'Amiens, 80080 Amiens, France
| | | | | | - A-S Ducloy-Bouthorsc
- Service d'anesthésie-réanimation, maternité Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, 59000 Lille, France
| | | | - H Keita-Meyer
- Service d'anesthésie-réanimation, hôpital Necker-Enfants-Malades, Assistance publique des Hôpitaux de Paris, 75015 Paris, France
| | | | - V Lejeune-Sadaa
- Service de gynécologie-obstétrique, centre hospitalier d'Auch, 32008 Auch, France
| | - C Leray
- Service de gynécologie-obstétrique, hôpital Cochin, maternité Port-Royal, Assistance publique des Hôpitaux de Paris, 75014 Paris, France
| | | | - E Morau
- Service d'anesthésie-réanimation, centre hospitalier de Narbonne, 11100 Narbonne, France
| | - M Nadjafizade
- École de sages-femmes, centre hospitalier régional universitaire de Nancy, 54035 Nancy, France
| | - F Pizzagalli
- Service de gynécologie-obstétrique, hôpital Antoine-Béclère, 92140 Clamart, France
| | - C Schantz
- CEPED, IRD, université Paris Descartes, Inserm, équipe SAGESUD, 75006 Paris, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, Assistance publique des Hôpitaux de Paris, 75019 Paris, France
| | - R Shojai
- Service de gynécologie-obstétrique, clinique de l'étoile, 13100 Aix-en-Provence, France
| | - B Hédon
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Montpellier, 34295 Montpellier, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, maternité Aliénor d'Aquitaine, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
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18
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Ledwoch J, Sievert K, Boersma L, Bergmann M, Ince H, Kische S, Pokushalov E, Schmitz T, Schmidt B, Gori T, Meincke F, Protopopov A, Betts T, Mazzone P, Sievert H. Initial and long-term antithrombotic therapy after left atrial appendage closure with the WATCHMAN. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Evidence regarding post-procedural antithrombotic regimes other than used in randomized trials assessing percutaneous left atrial appendage (LAA) closure is limited.
Purpose
The present work aimed to compare different antithrombotic strategies applied in the real-world EWOLUTION study.
Methods
A total of 998 patients with successful WATCHMAN implantation at 47 centers were available for the present analysis. The composite ischemic endpoint of stroke, TIA, systemic embolism and device thrombus as well as the bleeding endpoint defined as at least major bleeding according to BARC were assessed during an initial period (from implant until first medication change) and long-term period (from first change until up to 2 years).
Results
The antithrombotic medication chosen in the initial phase was dual antiplatelet therapy (DAPT) in 60%, oral anticoagulation (OAC) in 27%, single antiplatelet therapy (SAPT) in 7% and no medication in 6%. In the long-term phase SAPT was used in 65%, DAPT in 23%, no therapy in 8% and OAC in 4%. No significant differences were found between the groups regarding the ischemic endpoint both in the initial period (Kaplan-Meier estimated rate 2.9% for DAPT vs. 4.3% for OAC vs. 3.9% for SAPT or no therapy; p=0.97) and in the second period (4.2% for SAPT vs. 1.8% for DAPT vs. 3.5% for no therapy; p=0.36). With respect to bleeding events the only difference was found in the initial phase with a higher incidence in patients under SAPT or no therapy (1.0% for DAPT vs. 0.8% for OAC vs. 7.4% for SAPT or no therapy; p=0.01). No differences in bleeding complications were observed during the second period (2.6% for SAPT vs. 2.9% for DAPT vs. 2.2% for no therapy; p=0.88).
Conclusions
Tailored antithrombotic treatment using even very reduced strategies such as SAPT or no therapy showed no significant differences regarding ischemic complications after LAA closure.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Boston Scientific
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Affiliation(s)
- J Ledwoch
- Klinikum Neuperlach, Munich, Germany
| | - K Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany
| | - L Boersma
- St Antonius Hospital, Nieuwegein, Netherlands (The)
| | | | - H Ince
- Vivantes Klinikum Am Urban, Berlin, Germany
| | - S Kische
- Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - E Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation
| | | | - B Schmidt
- CardioVascular Center Bethanien (CCB), Frankfurt, Germany
| | - T Gori
- Johannes Gutenberg University Mainz (JGU), Mainz, Germany
| | - F Meincke
- Asklepios Clinic St. Georg, Hamburg, Germany
| | - A Protopopov
- Krasnoyarsk regional hospital, Krasnoyarsk, Russian Federation
| | - T Betts
- John Radcliffe Hospital, Oxford, United Kingdom
| | | | - H Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany
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19
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Sentilhes L, Senat MV, Schmitz T, Fauconnier A, Fritel X. [CNGOF Guidelines: Time to Change!]. ACTA ACUST UNITED AC 2020; 48:1-2. [PMID: 31901335 DOI: 10.1016/j.gofs.2019.11.002] [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: 11/17/2022]
Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm, centre de recherche en épidémiologie et santé des populations, UVSQ, université Paris-Saclay, université Paris-Sud, hôpital Paul Brousse, 16, avenue Paul Vaillant-Couturier, 94800 Villejuif, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Inserm, Inra, epidemiology and statistics research center (CRESS), université de Paris, 75004 Paris, France
| | - A Fauconnier
- Service de gynécologie-obstétrique, CHI Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France; Unité de recherche EA 7285 (RISCQ), université Versailles Saint-Quentin (UVSQ), 78180 Montigny-le-Bretonneux, France
| | - X Fritel
- CIC 1402 Inserm, CHU de Poitiers, université de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
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Verspyck É, Schmitz T, Rozenberg P, Senat MV, Sentilhes L. [Breech Presentation: CNGOF Guidelines for Clinical Practice - Introduction]. ACTA ACUST UNITED AC 2019; 48:59-60. [PMID: 31678564 DOI: 10.1016/j.gofs.2019.10.021] [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] [Received: 10/24/2019] [Indexed: 10/25/2022]
Affiliation(s)
- É Verspyck
- Service de gynécologie-obstétrique, CHU Rouen, 1, rue de Germont, 76031 Rouen, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
| | - P Rozenberg
- Département de gynécologie-obstétrique, hôpital Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France; Université Versailles-St Quentin, 55, avenue de Paris, 78000 Versailles, France
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Kremlin-Bicêtre, faculté Paris-Sud, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; INSERM, centre de recherche en épidémiologie et santé des populations, hôpital Paul-Brousse, université Paris-Saclay, université Paris-Sud, UVSQ, 16, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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21
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Sentilhes L, Schmitz T, Rozenberg P, Verspyck E, Senat MV. [Breech Presentation: CNGOF Guidelines for Clinical Practice - Methods and Organization]. ACTA ACUST UNITED AC 2019; 48:61-62. [PMID: 31678565 DOI: 10.1016/j.gofs.2019.10.020] [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] [Received: 10/24/2019] [Indexed: 11/27/2022]
Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, CHU Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
| | - P Rozenberg
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy, 10, rue du Champ-Gaillard, 78300 Poissy, France; Université Versailles-St Quentin, 55, avenue de Paris, 78000 Versailles, France
| | - E Verspyck
- Service de gynécologie-obstétrique, CHU Rouen, 1, rue de Germont, 76031 Rouen, France
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Kremlin-Bicêtre, faculté Paris-Sud, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; INSERM, centre de recherche en épidémiologie et santé des populations, hôpital Paul-Brousse, université Paris-Saclay, université Paris-Sud, UVSQ, 16, avenue Paul-Vaillant-Couturier, 98000 Villejuif, France
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22
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Schmitz T, Senat MV, Sentilhes L, Azria É, Deneux-Tharaux C, Huchon C, Bourdel N, Fritel X, Fauconnier A. [CNGOF Guidelines for Clinical Practice: Revision of the Methodology]. ACTA ACUST UNITED AC 2019; 48:3-11. [PMID: 31678506 DOI: 10.1016/j.gofs.2019.10.028] [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] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To revise the organization and the methodology of the Practice Clinical Guidelines (PCG) of the French College of Gynecologists and Obstetricians (CNGOF). METHODS The different available methods of PCG organization and of scientific evidence grading have been consulted after searching in the Medline database. RESULTS The PCG group of the CNGOF has decided to adopt the AGREE II (for Appraisal of Guidelines for REsearch and Evaluation) methology for PCG organization and the GRADE (for Grading of Recommendation Assessment, Development, and Evaluation) system for grading scientific evidence. CONCLUSION By adopting the AGREE II consortium criteria and grading scientific evidence according to the GRADE system, the CNGOF will increase the quality of the overall process, will deliver more targeted and easy to assimilate recommendations, to facilitate professional decision making.
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Affiliation(s)
- T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Epidemiology and Statistics Research Center/CRESS, Inserm, Inra, université de Paris, 75004 Paris, France.
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm, université Paris-Saclay, University Paris-Sud, UVSQ, Centre de recherche en épidémiologie et santé des populations, hôpital Paul-Brousse, 16, avenue Paul-Vaillant-Couturier, 94076 Villejuif, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - É Azria
- Epidemiology and Statistics Research Center/CRESS, Inserm, Inra, université de Paris, 75004 Paris, France; Maternité Notre-Dame-de-Bon-Secours, groupe hospitalier Paris Saint-Joseph, DHU risques et grossesse, 185, rue Raymond-Losserad, 75014 Paris, France
| | - C Deneux-Tharaux
- Epidemiology and Statistics Research Center/CRESS, Inserm, Inra, université de Paris, 75004 Paris, France
| | - C Huchon
- Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France; Unité de recherche EA 7285 (RISCQ), université Versailles St-Quentin (UVSQ), 78180 Montigny-le-Bretonneux, France
| | - N Bourdel
- Service de gynécologie-obstétrique, CHU Estaing, CHU Clermont-Ferrand, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - X Fritel
- CIC 1402 Inserm, université de Poitiers, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France
| | - A Fauconnier
- Service de gynécologie-obstétrique, CHI Poissy-St-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France; Unité de recherche EA 7285 (RISCQ), université Versailles St-Quentin (UVSQ), 78180 Montigny-le-Bretonneux, France
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23
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Siddiqui A, Deneux-Tharaux C, Luton D, Schmitz T, Mandelbrot L, Estellat C, Howell EA, Khoshnood B, Bertille N, Azria E. Maternal obesity and severe preeclampsia among immigrant women: a mediation analysis. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz187.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Severe preeclampsia is known to be associated with both maternal place of birth and obesity. However, the role of prepregnancy obesity has not been well elucidated on the causal pathway between maternal origin and severe preeclampsia. We aimed to test for and quantify a mediation effect of obesity in this association.
Methods
A secondary analysis of the PreCARE prospective French cohort of pregnant women (n = 9,579). Adjusted path analysis logistic regression models tested for a mediation effect of obesity in the association between maternal place of birth and severe preeclampsia. Adjusted odds ratios and 95% confidence intervals for the total exposure-outcome association and for the direct and indirect/obesity-mediated components were calculated in addition to an estimate of the indirect/obesity-mediated effect.
Results
95 (0.99%) women developed severe preeclampsia: 47.6% were non-European immigrants, 16.3% were born in Sub-Saharan Africa, and 12.6% were obese. Obesity was both associated with Sub-Saharan African place of birth and severe preeclampsia. Women from Sub-Saharan Africa had an increased risk of severe preeclampsia compared to European-born mothers (aOR 2.53, 95% CI 1.39-4.58). The obesity-mediated effect of the association was 18% (aOR 1.18, 95%CI 1.03-1.35).
Conclusions
Sub-Saharan African immigrant women have a two-fold higher risk of developing severe preeclampsia as compared to European-born women, one-fifth of which is mediated by prepregnancy obesity. Our results provide estimates of the benefit of decreasing obesity among at-risk women.
Key messages
Obesity, a modifiable risk factor, is a target for interventions to prevent severe preeclampsia among immigrant women from Sub-Saharan Africa. Future investigations should focus on better elucidating the role of other modifiable mediators such as interaction with the health care system and quality of prenatal care.
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Affiliation(s)
- A Siddiqui
- UMR 1153, INSERM-epope, Paris, France
- Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - D Luton
- Obstetrics and Gynecology, Beaujon-Bichat Hospital, University Hospital Department (DHU) Risks in Pregnancy, Paris Diderot University, Paris, France
| | - T Schmitz
- Obstetrics and Gynecology, Robert Debré Hospital, Paris Diderot University, Paris, France
| | - L Mandelbrot
- Obstetrics and Gynecology, Louis Mourier Hospital, University Hospital Department (DHU) Risks in Pregnancy, Paris Diderot University, Colombes, France
| | - C Estellat
- Biostatistics, Public Health and Medical Information, Clinical Research Unit, Pharmacoepidemiology Center (Céphépi), Sorbonne University; INSERM UMR-S 1136, Paris, France
| | - E A Howell
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Blavatnik Family Women’s Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - E Azria
- UMR 1153, INSERM-epope, Paris, France
- Maternity Unit, Notre Dame de Bon Secours -Paris Saint Joseph Hospital, University Hospital Department (DHU) Risks in Pregnancy, Paris Descartes University, Paris, France
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24
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Eslier M, Schmitz T, Luton D, Mandelbrot L, Estellat C, Azria E. Association between legal status, prenatal care utilization, severe perinatal and maternal morbidity. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Some groups of migrant women have a higher risk of inadequate prenatal care utilization (PCU), severe maternal morbidity (SMM) and severe perinatal morbidity (SPM). To better understand this association, our aim was to assess the association between the legal status and PCU, SMM and SPM during pregnancy.
Methods
The analysis was performed in the database of the multicenter prospective PreCARE cohort. All pregnant women registered for delivery in 4 university hospital maternity units in Paris north area from October 2010 to May 2012 were included (N = 10 419). Women whose pregnancies ended before 22 weeks of gestation or who delivered in another maternity unit were excluded (N = 820). Women were distributed according to legal status in 4 groups: non-migrants, migrants with French or European nationality, legal migrants and undocumented migrants. The associations between the legal status and the composite variables of prenatal care utilization, SMM and SPM were tested through multivariate logistic regressions also adjusted for maternal characteristics.
Results
The illegal status was associated with increased risk of inadequate prenatal care utilization [adjusted odds ratio (aOR) 2,52 (2,10 - 3,01)]. Overall, the prevalence of SMM was 3,2 % and SPM 7,0 %. The illegal status was associated with higher risk of SMM [aOR 1,84 (1,21 - 2,79)], especially severe hypertensive disorder of pregnancy [aOR 2,29 (1,19 - 4,40)]. However, no significant association with SPM was found [aOR 1,29 (0,95 - 1,74)]. The sensitivity analysis demonstrates that results do not change after exclusion of women who arrived less than 12 months before delivery and those who started their follow-up after 14 weeks of gestation.
Conclusions
The illegal status was associated with an inadequate prenatal care utilization and a higher risk of SMM, especially severe hypertensive disorder of pregnancy.
Key messages
The illegal status was associated with increased risk of inadequate prenatal care utilization. The illegal status was associated with higher risk of severe maternal morbidity during pregnancy.
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Affiliation(s)
- M Eslier
- UMR1153, Obstetrical, Perinatal and Paediatric Epidemiology (EPOP_x0001_e research team), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - T Schmitz
- Department of Obstetrics and Gynaecology, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France
| | - D Luton
- Department of Obstetrics and Gynaecology, Beaujon-Bichat Hospital, DHU Risks in Pregnancy, APHP, Paris Diderot University, Paris, France
| | - L Mandelbrot
- Department of Obstetrics and Gynaecology, Louis Mourier Hospital, DHU Risks in Pregnancy, AP-HP, Paris Diderot University, Colombes, France
| | - C Estellat
- Epidemiology and Clinical Research Department, URC Paris-Nord, APHP, Paris, France
- UMR 1123, CIC 1425-EC, Paris, France
| | - E Azria
- UMR1153, Obstetrical, Perinatal and Paediatric Epidemiology (EPOP_x0001_e research team), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
- Maternity Unit, Paris Saint Joseph Hospital, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Sentilhes L, Schmitz T, Azria E, Gallot D, Ducarme G, Korb D, Mattuizzi A, Parant O, Sananès N, Baumann S, Rozenberg P, Senat MV, Verspyck É. [Breech Presentation: CNGOF Guidelines for Clinical Practice - Short Text]. ACTA ACUST UNITED AC 2019; 48:63-69. [PMID: 31678505 DOI: 10.1016/j.gofs.2019.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To determine the optimal management of singleton breech presentation. MATERIALS AND METHODS The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS In France, 5% of women have breech deliveries (Level of Evidence [LE3]). One third of them have a planned vaginal delivery (LE3) of whom 70% deliver vaginally (LE3). External cephalic version (ECV) is associated with a reduced rate of breech presentation at birth (LE2), and with a lower rate of cesarean section (LE3) without increases in severe maternal (LE3) and perinatal morbidity (LE3). It is therefore recommended to inform women with a breech presentation at term that ECV could be attempted from 36 weeks of gestation (Professional consensus). In case of breech presentation, planned vaginal compared with planned cesarean delivery might be associated with an increased risk of composite perinatal mortality or serious neonatal morbidity (LE2). No difference has been found between planned vaginal and planned cesarean delivery for neurodevelopmental outcomes at two years (LE2), cognitive and psychomotor outcomes between 5 and 8 years (LE3), and adult intellectual performances (LE4). Short and long term maternal complications appear similar in case of planned vaginal compared with planned cesarean delivery in the absence of subsequent pregnancies. A previous cesarean delivery results for subsequent pregnancies in higher risks of uterine rupture, placenta accreta spectrum and hysterectomy (LE2). It is recommended to offer women who wish a planned vaginal delivery a pelvimetry at term (Grade C) and to check the absence of hyperextension of the fetal head by ultrasonography (Professional consensus) to plan their mode of delivery. Complete breech presentation, previous cesarean, nulliparity, term prelabor rupture of membranes do not contraindicate planned vaginal delivery (Professionnal consensus). Term breech presentation is not a contraindication to labor induction when the criteria for acceptance of vaginal delivery are met (Grade C). CONCLUSION In case of breech presentation at term, the risks of severe morbidity for the child and the mother are low after both planned vaginal and planned cesarean delivery. For the French College of Obstetricians and Gynecologists (CNGOF), planned vaginal delivery is a reasonable option in most cases (Professional consensus). The choice of the planned route of delivery should be shared by the woman and her caregiver, respecting the right to woman's autonomy.
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Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, université de Bordeaux, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Serrurier, 75019 Paris, France; Inserm, Inra, Epidemiology and Statistics Research Center/CRESS, université de Paris, 75004 Paris, France
| | - E Azria
- Inserm, Inra, Epidemiology and Statistics Research Center/CRESS, université de Paris, 75004 Paris, France; Maternité Notre-Dame-de-Bon-Secours, groupe hospitalier Paris Saint-Joseph, DHU risques et grossesse, 185, rue Raymond-Losserand, 75014 Paris, France
| | - D Gallot
- Pôle Femme et Enfant, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; R2D2-EA7281, faculté de médecine, université d'Auvergne, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - G Ducarme
- Service de gynécologie-obstétrique, centre hospitalier départemental, 85000 La Roche-sur-Yon, France
| | - D Korb
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Serrurier, 75019 Paris, France; Inserm, Inra, Epidemiology and Statistics Research Center/CRESS, université de Paris, 75004 Paris, France
| | - A Mattuizzi
- Service de gynécologie-obstétrique, université de Bordeaux, CHU Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - O Parant
- Inserm, UMR1027, équipe SPHERE, 31073 Toulouse, France; UMR1027, université de Toulouse III, 31073 Toulouse, France; Pôle de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU Toulouse, 31059 Toulouse, France
| | - N Sananès
- Service de gynécologie-obstétrique, hôpitaux universitaires de Strasbourg, avenue Molière, BP 426, 67091 Strasbourg cedex, France; Unité Inserm UMR-S 1121 « Biomatériaux et Bioingénierie », 11, rue Humann, 67000 Strasbourg, France
| | - S Baumann
- Collège national des sages-femmes de France, 136, avenue Émile-Zola, 75015 Paris, France
| | - P Rozenberg
- Département de gynécologie-obstétrique, hôpital Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy, France; Université Versailles-St Quentin, 55, avenue de Paris, 78000 Versailles, France
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Inserm, Centre de recherche en épidémiologie et santé des populations, hôpital Paul-Brousse, université Paris-Saclay, university Paris-Sud, UVSQ, 16, avenue Paul Vaillant Couturier, 94800 Villejuif, France
| | - É Verspyck
- Service de gynécologie-obstétrique, université de Rouen, CHU de Rouen, 76000 Rouen, France
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Senat MV, Schmitz T, Bouchghoul H, Diguisto C, Girault A, Paysant S, Sibiude J, Lassel L, Sentilhes L. [Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Short Text]. ACTA ACUST UNITED AC 2019; 48:15-18. [PMID: 31669527 DOI: 10.1016/j.gofs.2019.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine the management of patients with term prelabor rupture of membranes. METHODS Synthesis of the literature from the PubMed and Cochrane databases and the recommendations of French and foreign societies and colleges. RESULTS Term prelabor rupture of membranes is considered a physiological process up to 12hours of rupture (Professional consensus). In case of expectant management and with a low rate of antibiotic prophylaxis, home care compared to hospitalization could be associated with an increase in neonatal infections (LE3), especially in case of group B streptococcus colonization (LE3). Home care is therefore not recommended (Grade C). In the absence of spontaneous labor within 12hours of rupture, antibiotic prophylaxis could reduce the risk of maternal intrauterine infection but not of neonatal infection (LE3). Its use after 12hours of rupture in term prelabor rupture of the membranes is therefore recommended (Grade C). When antibiotic prophylaxis is indicated, intravenous beta-lactams are recommended (Grade C). Induction of labor with oxytocin (LE1), prostaglandin E2 (LE1) or misoprostol (LE1), is associated with shorter rupture of membranes to delivery intervals when compared to expectant management. Compared with expectant management, immediate induction of labor is not associated with lower rates of neonatal infection (LE1), even among women with a positive streptococcus B vaginal swab (LE2). Thus, expectant management can be offered without increasing the risk of neonatal infection (Grade B). Induction of labor is not associated with an increase or decrease in the cesarean delivery rate (LE2), whatever parity (LE2) or Bishop score at admission (LE3). Induction can thus be proposed without increasing the risk of cesarean delivery (Grade B). No induction method (oxytocin, dinoprostone, misoprostol or Foley® catheter) has demonstrated superiority over another, whether to reduce rate of intrauterine or neonatal infection, rate of cesarean delivery or to shorten rupture of membranes to delivery intervals regardless of Bishop's score and parity. CONCLUSION Term prelabor rupture of membranes is a frequent event. A 12-hour delay without onset of spontaneous labor was chosen to differentiate a physiological condition from a potentially unsafe situation justifying an antibiotic prophylaxis. Expectant management or induction of labor can both be proposed, even in case of positive screening for streptococcus B, depending on the patient's wishes and maternity units' organization (Professional consensus).
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Affiliation(s)
- M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Inserm, centre de recherche en épidémiologie et en santé en population, université Paris-Saclay, université Paris-Sud, université de Versailles Saint-Quentin-en-Yvelines, 94800 Villejuif, France.
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Université de Paris, 75014 Paris, France; Université de Paris, epidemiology and statistics research Center/CRESS, Inserm, INRA, 75004 Paris, France
| | - H Bouchghoul
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; Inserm, centre de recherche en épidémiologie et en santé en population, université Paris-Saclay, université Paris-Sud, université de Versailles Saint-Quentin-en-Yvelines, 94800 Villejuif, France
| | - C Diguisto
- Université de Paris, epidemiology and statistics research Center/CRESS, Inserm, INRA, 75004 Paris, France; Service de gynécologie-obstétrique, CHU Bretonneau, Maternité Olympe de Gouges, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 37044 Tours, France
| | - A Girault
- Université de Paris, epidemiology and statistics research Center/CRESS, Inserm, INRA, 75004 Paris, France; Service de gynécologie-obstétrique, maternité Port-Royal, université de Paris, DHU risques et grossesse, AP-HP, 123, boulevard de Port-Royal, 75014 Paris, France
| | - S Paysant
- Collège national des sages-femmes de France, 136, avenue Emile-Zola, 75015 Paris, France
| | - J Sibiude
- Service de gynécologie-obstétrique, maternité Louis-Mourier, université de Paris, DHU risques et grossesse, AP-HP, 178, rue des Renouillers, 92701 Colombes cedex, France
| | - L Lassel
- Département de gynécologie-obstétrique et reproduction humaine, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
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Lassel L, Schmitz T, Sentilhes L, Senat MV. [Term Prelabor Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Introduction]. ACTA ACUST UNITED AC 2019; 48:12. [PMID: 31669524 DOI: 10.1016/j.gofs.2019.10.013] [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: 10/22/2019] [Indexed: 11/18/2022]
Affiliation(s)
- L Lassel
- Département de gynécologie-obstétrique et reproduction humaine, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35203 Rennes, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, bd Sérurier, 75019 Paris, France; Université de Paris, 75014 Paris, France; Université de Paris, Epidemiology and Statistics Research Centre/CRESS, INSERM, INRA, 75004 Paris, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, hôpital Pellegrin, Centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 94270 Le Kremlin-Bicêtre, France; INSERM, centre de recherche en épidémiologie et en santé en population, université Paris-Saclay, université Paris-Sud, université de Versailles Saint-Quentin-en-Yvelines, 94076 Villejuif, France.
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Weigel T, Schmitz T, Jannasch M, Schürlein S, Al Hijailan R, Suliman S, Walles H, Hansmann J. Session 9: Biomaterials -Elektrospinning. ACTA ACUST UNITED AC 2019; 64:59-62. [PMID: 30753141 DOI: 10.1515/bmt-2019-7009] [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: 11/15/2022]
Affiliation(s)
- T Weigel
- University clinic of Wuerzburg, Dept. Tissue Engineering & Regenerative Medicine,Wuerzburg, Germany
| | - T Schmitz
- University clinic of Wuerzburg, Dept. Tissue Engineering & Regenerative Medicine,Wuerzburg, Germany
| | - M Jannasch
- University clinic of Wuerzburg, Dept. Tissue Engineering & Regenerative Medicine,Wuerzburg, Germany
| | - S Schürlein
- University clinic of Wuerzburg, Dept. Tissue Engineering & Regenerative Medicine,Wuerzburg, Germany
| | - R Al Hijailan
- University clinic of Wuerzburg, Dept. Tissue Engineering & Regenerative Medicine,Wuerzburg, Germany
- King Faisal Hospital and Research Center, Cell Biology Department,Riyadh, Saudi Arabia
| | - S Suliman
- University of Bergen, Department of Clinical Dentistry,Bergen, Norway
| | - H Walles
- University clinic of Wuerzburg, Dept. Tissue Engineering & Regenerative Medicine,Wuerzburg, Germany
- Fraunhofer Institute for Silicate Research , Translational Center Regenerative Therapies ,Wuerzburg, Germany
| | - J Hansmann
- University clinic of Wuerzburg, Dept. Tissue Engineering & Regenerative Medicine,Wuerzburg, Germany
- Fraunhofer Institute for Silicate Research , Translational Center Regenerative Therapies ,Wuerzburg, Germany
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Métairie M, Korb D, Morin C, Schmitz T, Sibony O. [Effectiveness of preventive cervical cerclage to prevent preterm birth in women with twin gestation with obstetrical history of late pregnancy loss or preterm birth]. ACTA ACUST UNITED AC 2019; 47:286-290. [PMID: 30686725 DOI: 10.1016/j.gofs.2018.12.009] [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: 07/01/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Evaluate the effectiveness of preventive cervical cerclage for twin pregnancy with obstetrical history. METHODS Through this retrospective cohort study, subjects exposed between 2002 and 2017 were compared with unexposed ones. All patients who had twin pregnancy with at least one previous late pregnancy loss or prematurity before 34SA were included. Two groups were compared: "preventive cerclage" versus "no preventive cerclage". The outcome was the prematurity before 34 gestation weeks (GW) rate. RESULTS Among 1972 twin pregnancies registered between 2002 and 2017, 69 (3.5%) patients with at least one previous late pregnancy loss or prematurity before 34 GW, were part of the study. There were 20 (29.0%) women in the group "preventive cerclage" and 49 (71.0%) women in the group "no preventive cerclage". Women in the "preventive cerclage" group had poorer obstetrical history. The rate of prematurity before 34GW was not significantly different between these both groups (45.0% versus 44.9%; P=0.99, crude OR: 1.00 (0.35-2.83), adjusted OR: 1.06 (0.33-3.44)). CONCLUSIONS The prematurity rate before 34GW, in twin pregnancies with a previous late pregnancy loss or preterm birth, is not different with or without preventive cervical cerclage.
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Affiliation(s)
- M Métairie
- Maternité, hopital Robert-Debré, AP-HP, 48, boulevard Sérurier 75019 Paris, France.
| | - D Korb
- Maternité, hopital Robert-Debré, AP-HP, 48, boulevard Sérurier 75019 Paris, France; Inserm U1153, équipe EPOPé, CRESS, DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - C Morin
- Maternité, hopital Robert-Debré, AP-HP, 48, boulevard Sérurier 75019 Paris, France
| | - T Schmitz
- Maternité, hopital Robert-Debré, AP-HP, 48, boulevard Sérurier 75019 Paris, France; Inserm U1153, équipe EPOPé, CRESS, DHU risques et grossesse, université Paris Descartes, 75014 Paris, France
| | - O Sibony
- Maternité, hopital Robert-Debré, AP-HP, 48, boulevard Sérurier 75019 Paris, France
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Schmitz T, Sentilhes L, Lorthe E, Gallot D, Madar H, Doret-Dion M, Beucher G, Charlier C, Cazanave C, Delorme P, Garabedian C, Azria É, Tessier V, Senat MV, Kayem G. [Preterm premature rupture of membranes: CNGOF Guidelines for clinical practice - Short version]. ACTA ACUST UNITED AC 2018; 46:998-1003. [PMID: 30392986 DOI: 10.1016/j.gofs.2018.10.016] [Citation(s) in RCA: 7] [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] [Received: 10/04/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To determine management of women with preterm premature rupture of membranes (PPROM). METHODS Bibliographic search from the Medline and Cochrane Library databases and review of international clinical practice guidelines. RESULTS In France, PPROM rate is 2 to 3% before 37 weeks of gestation (level of evidence [LE] 2) and less than 1% before 34 weeks of gestation (LE2). Prematurity and intra-uterine infection are the two major complications of PPROM (LE2). Compared to other causes of prematurity, PPROM is not associated with an increased risk of neonatal mortality and morbidity, except in case of intra-uterine infection, which is associated with an augmentation of early-onset neonatal sepsis (LE2) and of necrotizing enterocolitis (LE2). PPROM diagnosis is mainly clinical (professional consensus). In doubtful cases, detection of IGFBP-1 or PAMG-1 is recommended (professional consensus). Hospitalization of women with PPROM is recommended (professional consensus). There is no sufficient evidence to recommend or not recommend tocolysis (grade C). If a tocolysis should be prescribed, it should not last more than 48hours (grade C). Antenatal corticosteroids before 34 weeks of gestation (grade A) and magnesium sulfate before 32 weeks of gestation (grade A) are recommended. Antibiotic prophylaxis is recommended (grade A) because it is associated with a reduction of neonatal mortality and morbidity (LE1). Amoxicillin, 3rd generation cephalosporins, and erythromycin in monotherapy or the association erythromycin-amoxicillin can be used (professional consensus), for 7 days (grade C). However, in case of negative vaginal culture, early cessation of antibiotic prophylaxis might be acceptable (professional consensus). Co-amoxiclav, aminosides, glycopetides, first and second generation cephalosporins, clindamycin, and metronidazole are not recommended for antibiotic prophylaxis (professional consensus). Outpatient management of women with clinically stable PPROM after 48hours of hospitalization is a possible (professional consensus). During monitoring, it is recommended to identify the clinical and biological elements suggesting intra-uterine infection (professional consensus). However, it not possible to make recommendation regarding the frequency of this monitoring. In case of isolated elevated C-reactive protein, leukocytosis, or positive vaginal culture in an asymptomatic patient, it is not recommended to systematically prescribe antibiotics (professional consensus). In case of intra-uterine infection, it is recommended to immediately administer an antibiotic therapy associating beta-lactamine and aminoside (grade B), intravenously (grade B), and to deliver the baby (grade A). Cesarean delivery should be performed according to the usual obstetrical indications (professional consensus). Expectative management is recommended before 37 weeks of gestation in case of uncomplicated PPROM (grade A), even in case of positive vaginal culture for B Streptococcus, provided that an antibiotic prophylaxis has been prescribed (professional consensus). Oxytocin and prostaglandins are two possible options to induce labor in case of PPROM (professional consensus). CONCLUSION Expectative management is recommended before 37 weeks of gestation in case of uncomplicated PPROM (grade A).
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Affiliation(s)
- T Schmitz
- Service de gynécologie obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France; Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France.
| | - L Sentilhes
- Service de gynécologie-obstétrique, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - E Lorthe
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France; EPIUnit-Institute of Public Health, University of Porto, Rua das Taipas, n(o) 135, 4050-600 Porto, Portugal
| | - D Gallot
- Pôle femme et enfant, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand cedex 1, France; R2D2-EA7281, faculté de médecine, université d'Auvergne, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - H Madar
- Service de gynécologie-obstétrique, hôpital Pellegrin, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - M Doret-Dion
- Service de gynécologie obstétrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, 59, boulevard Pinel, 69500 Bron, France
| | - G Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, avenue Côte-de-Nacre, 14033 Caen cedex 9, France
| | - C Charlier
- Service des maladies infectieuses et tropicales, hôpital Necker-Enfants-Malades, AP-HP, Paris, France; Université Paris Descartes, 75005 Paris, France; Centre d'infectiologie Necker-Pasteur, Institut IMAGINE, 75015 Paris, France
| | - C Cazanave
- Service des maladies infectieuses et tropicales, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Infections humaines à mycoplasmes et à chlamydiae, université de Bordeaux, USC EA 3671, 33000 Bordeaux, France
| | - P Delorme
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France; Université Paris Descartes, 75005 Paris, France; DHU risques et grossesse, maternité Port-Royal, hôpital Cochin, hôpitaux universitaires Paris Centre, AP-HP, 75014 Paris, France
| | - C Garabedian
- Clinique d'obstétrique, hôpital Jeanne-de-Flandre, CHU de Lille, Lille, France; Université de Lille, EA 4489-environnement périnatal et croissance, 59000 Lille, France
| | - É Azria
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France; Université Paris Descartes, 75005 Paris, France; Maternité Notre Dame de Bon Secours, DHU risques et grossesse, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - V Tessier
- DHU risques et grossesse, maternité Port-Royal, hôpital Cochin, hôpitaux universitaires Paris Centre, AP-HP, 75014 Paris, France; Collège national des sages-femmes de France, 136, avenue Emile-Zola, 75015 Paris, France
| | - M-V Senat
- Service de gynécologie obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - G Kayem
- Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris Cité, 75005 Paris, France; Service de gynécologie obstétrique, hôpital Trousseau, AP-HP, 26, rue du Docteur-Arnold-Netter, 75012 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France
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Schmitz T, Kayem G, Senat MV, Sentilhes L. [Preterm Premature Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Method and Organization]. ACTA ACUST UNITED AC 2018; 46:996-997. [PMID: 30385353 DOI: 10.1016/j.gofs.2018.10.018] [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: 09/27/2018] [Indexed: 11/19/2022]
Affiliation(s)
- T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Inserm UMR 1153 équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, Sorbonne Paris cité, 75005 Paris, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France.
| | - G Kayem
- Inserm UMR 1153 équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, Sorbonne Paris cité, 75005 Paris, France; Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, rue du Docteur-Arnold-Netter, 75012 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France
| | - M-V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
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Kayem G, Sentilhes L, Senat MV, Schmitz T. [Preterm Premature Rupture of Membranes: CNGOF Guidelines for Clinical Practice - Introduction]. ACTA ACUST UNITED AC 2018; 46:994-995. [PMID: 30385354 DOI: 10.1016/j.gofs.2018.10.015] [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] [Received: 09/28/2018] [Indexed: 11/17/2022]
Affiliation(s)
- G Kayem
- Service de gynécologie-obstétrique, hôpital Trousseau, AP-HP, 26, rue du Docteur-Arnold-Netter, 75012 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France; Inserm UMR 1153 équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, Sorbonne Paris cité, 75005 Paris, France.
| | - L Sentilhes
- Service de gynécologie-obstétrique, CHU Bordeaux, hôpital Pellegrin, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - M V Senat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Université Paris-Sud, université de médecine Paris-Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - T Schmitz
- Inserm UMR 1153 équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique, Sorbonne Paris cité, 75005 Paris, France; Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France; Université Paris Diderot, 5, rue Thomas-Mann, 75013 Paris, France
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Zietzer A, Wang H, Schmitz T, Flender A, Nickenig G, Werner N, Jansen F. 5986The RNA-binding protein hnRNPU mediates microvesicle based microRNA-24 transfer and controls microvesicle function. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.5986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Zietzer
- University Hospital Bonn, Medical Department II, Bonn, Germany
| | - H Wang
- University Hospital Bonn, Medical Department II, Bonn, Germany
| | - T Schmitz
- University Hospital Bonn, Medical Department II, Bonn, Germany
| | - A Flender
- University Hospital Bonn, Medical Department II, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Medical Department II, Bonn, Germany
| | - N Werner
- University Hospital Bonn, Medical Department II, Bonn, Germany
| | - F Jansen
- University Hospital Bonn, Medical Department II, Bonn, Germany
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Wiemer M, Schäufele T, Schmitz T, Hoffmann S, Comberg T, Eggebrecht H, Langer C. Herzkatheter: Diagnostik und Intervention über die Arteria radialis. Kardiologe 2018. [DOI: 10.1007/s12181-018-0264-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liu Y, Li Q, Schmitz T, Flender A, Nickenig G, Werner N, Jansen F. 4110Atherosclerotic conditions promote the packaging of functional microRNA-92 into endothelial microvesicles. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Liu
- University Hospital Bonn, Molecular Cardiology, Bonn, Germany
| | - Q Li
- University Hospital Bonn, Molecular Cardiology, Bonn, Germany
| | - T Schmitz
- University Hospital Bonn, Molecular Cardiology, Bonn, Germany
| | - A Flender
- University Hospital Bonn, Molecular Cardiology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Molecular Cardiology, Bonn, Germany
| | - N Werner
- University Hospital Bonn, Molecular Cardiology, Bonn, Germany
| | - F Jansen
- University Hospital Bonn, Molecular Cardiology, Bonn, Germany
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Sentilhes L, Azria E, Schmitz T. [Is universal first trimester screening for high risk of preterm preeclampsia clinically meaningful?]. ACTA ACUST UNITED AC 2018; 46:617-618. [PMID: 29656070 DOI: 10.1016/j.gofs.2018.03.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Indexed: 12/01/2022]
Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - E Azria
- Maternité Notre-Dame de Bon Secours, groupe hospitalier Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France; Université René-Descartes, 2, rue de l'École-de-Médecine, 75006 Paris, France; Inserm U1153, obstetrical, perinatal and pediatric epidemiology team, epidemiology and biostatistics, Sorbonne-Paris cité research center, 53, avenue de l'Observatoire, 75014 Paris, France
| | - T Schmitz
- Inserm U1153, obstetrical, perinatal and pediatric epidemiology team, epidemiology and biostatistics, Sorbonne-Paris cité research center, 53, avenue de l'Observatoire, 75014 Paris, France; Service de gynécologie obstétrique, hôpital Robert-Debré, Assistance publique-hôpitaux de Paris, boulevard Sérurier, 75019 Paris, France; Université Paris-Diderot, 16, rue Henri-Huchard, 75018 Paris, France
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Feldmann C, Walter C, Chatterjee A, Dogan G, Hanke J, Reiss N, Schmitz T, Hoffmann J, Fischer F, Haverich A, Schmitto J. Expert Interviews: Infrastructural Needs and Expected Benefits of Telemonitoring in VAD Therapy. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628101] [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: 10/28/2022]
Affiliation(s)
- C. Feldmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - C. Walter
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - A. Chatterjee
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - G. Dogan
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - J. Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - N. Reiss
- Schüchtermann-Klinik, Bad Rothenfelde, Germany
| | - T. Schmitz
- Schüchtermann-Klinik, Bad Rothenfelde, Germany
| | - J. Hoffmann
- Schüchtermann-Klinik, Bad Rothenfelde, Germany
| | - F. Fischer
- University of Bielefeld, Faculty of Health Sciences, Bielefeld, Germany
| | - A. Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - J. Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Linard M, Blondel B, Estellat C, Deneux-Tharaux C, Luton D, Oury JF, Schmitz T, Mandelbrot L, Azria E. Association between inadequate antenatal care utilisation and severe perinatal and maternal morbidity: an analysis in the PreCARE cohort. BJOG 2017. [DOI: 10.1111/1471-0528.14794] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M Linard
- UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team); DHU Risks in Pregnancy; Paris Descartes University - INSERM; Paris France
| | - B Blondel
- UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team); DHU Risks in Pregnancy; Paris Descartes University - INSERM; Paris France
| | - C Estellat
- Epidemiology and Clinical Research Department; URC Paris-Nord; APHP; Paris France
- CIC 1425-EC; UMR 1123; INSERM; Paris France
| | - C Deneux-Tharaux
- UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team); DHU Risks in Pregnancy; Paris Descartes University - INSERM; Paris France
| | - D Luton
- Department of Obstetrics and Gynaecology; Beaujon-Bichat Hospital; DHU Risks in Pregnancy; APHP; Paris Diderot University; Paris France
| | - JF Oury
- Department of Obstetrics and Gynaecology; Robert Debré Hospital; AP-HP; Paris Diderot University; Paris France
| | - T Schmitz
- Department of Obstetrics and Gynaecology; Robert Debré Hospital; AP-HP; Paris Diderot University; Paris France
| | - L Mandelbrot
- Department of Obstetrics and Gynaecology; Louis Mourier Hospital; DHU Risks in Pregnancy; AP-HP; Paris Diderot University; Colombes France
| | - E Azria
- UMR1153 - Obstetrical, Perinatal and Paediatric Epidemiology (EPOPé research team); DHU Risks in Pregnancy; Paris Descartes University - INSERM; Paris France
- Maternity Unit; Paris Saint Joseph Hospital; DHU Risks in Pregnancy; Paris Descartes University; Paris France
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Adjaoud C, Estellat C, Luton D, Oury JF, Schmitz T, Mandelbrot L, Branger B, Azria E. Précarité maternelle et alimentation du nouveau-né à la sortie de la maternité. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.03.130] [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: 11/26/2022] Open
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Greling B, Meila D, Grieb D, Melber K, Schmitz T, Schlunz-Hendann M, Brassel F, Loose DA. Interventional treatment of peripheral vascular malformations – Long-term results with special emphasis on Quality of Life aspects. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600483] [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: 10/19/2022]
Affiliation(s)
- B Greling
- Sana Kliniken Duisburg, Radiologie und Neuroradiologie, Duisburg
| | - D Meila
- Sana Kliniken Duisburg, Medizinische Hochschule Hannover, Klinik für Radiologie und Neuroradiologie, Institut für Diagnostische und Interventionelle Neuroradiologie, Duisburg
| | - D Grieb
- Sana Kliniken Duisburg, Klinik für Radiologie und Neuroradiologie, Duisburg
| | - K Melber
- Sana Kliniken Duisburg, Klinik für Radiologie und Neuroradiologie, Duisburg
| | - T Schmitz
- Sana Kliniken Duisburg, Klinik für Radiologie und Neuroradiologie, Duisburg
| | - M Schlunz-Hendann
- Sana Kliniken Duisburg, Klinik für Radiologie und Neuroradiologie, Duisburg
| | - F Brassel
- Sana Kliniken Duisburg, Klinik für Radiologie und Neuroradiologie, Duisburg
| | - DA Loose
- Bereich Gefäßchirurgie und Angiologie, Die Facharztklinik Hamburg und Klinik Fleetinsel Hamburg, Hamburg
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Schmitz T. Prévention des complications de la prématurité par l’administration anténatale de corticoïdes. ACTA ACUST UNITED AC 2016; 45:1399-1417. [DOI: 10.1016/j.jgyn.2016.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 10/20/2022]
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Alberti A, Salomon LJ, Le Lorc'h M, Couloux A, Bussières L, Goupil S, Malan V, Pelletier E, Hyon C, Vialard F, Rozenberg P, Bouhanna P, Oury JF, Schmitz T, Romana S, Weissenbach J, Vekemans M, Ville Y. Non-invasive prenatal testing for trisomy 21 based on analysis of cell-free fetal DNA circulating in the maternal plasma. Prenat Diagn 2016; 35:471-6. [PMID: 25643828 DOI: 10.1002/pd.4561] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 01/04/2015] [Accepted: 01/14/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE By-the-book implementation of non-invasive prenatal test and clinical validation for trisomy 21. STUDY DESIGN Publicly funded prospective study of 225 cases. Women at risk for trisomy 21 > 1/250 based on combined ultrasound and serum markers during first or second trimester were eligible following an informed consent. The technique was established from the available literature and performed on 10 mL of venous blood collected prior to chorionic villus sampling or amniocentesis. Investigators were blinded to the fetal karyotype. Results were expressed in Z-scores of the percentage of each chromosome. RESULTS Among 976 eligible cases, 225 were processed: 8 were used for pretesting phase and 23 to build a reference set. One hundred thirty six euploid cases and 47 with trisomy 21 were then run randomly. Eleven cases yielded no result (4.8%). Z-scores were above 3 (7.58+/-2.41) for chromosome 21 in all 47 trisomies and in none of the euploid cases (0.11+/-1.0). Z-scores were within normal range for the other chromosomes in both groups. Using a cut-off of 3, sensitivity and specificity were of 100% 95% CI [94.1, 100] and 100% 95% CI [98, 100], respectively. CONCLUSION Non-invasive prenatal test for trisomy 21 is a robust strategy that can be translated from seminal publications. Publicly funded studies should refine its indications and cost-effectiveness in prenatal screening and diagnosis. © 2015 John Wiley & Sons, Ltd.
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Meininger M, Schmitz T, Wagner T, Ewald A, Gbureck U, Groll J, Moseke C. Real-time measurement of protein adsorption on electrophoretically deposited hydroxyapatite coatings and magnetron sputtered metallic films using the surface acoustic wave technique. Mater Sci Eng C Mater Biol Appl 2015; 61:351-4. [PMID: 26838860 DOI: 10.1016/j.msec.2015.12.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/09/2015] [Accepted: 12/28/2015] [Indexed: 11/15/2022]
Abstract
Surface acoustic wave (SAW) biosensors are highly sensitive for mass binding and are therefore used to detect protein-protein and protein-antibody interactions. Whilst the standard surface of the chips is a thin gold film, measurements on implant- or bone-like surfaces could significantly enhance the range of possible applications for this technique. The aim of this study was to establish methods to coat biosensor chips with Ti, TiN, and silver-doped TiN using physical vapor deposition as well as with hydroxyapatite by electrophoresis. To demonstrate that protein adsorption can be detected on these surfaces, binding experiments with fibronectin and fibronectin-specific antibodies have been performed with the coatings, which successfully proved the applicability of PVD and EPD for SAW biosensor functionalization.
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Affiliation(s)
- M Meininger
- Department for Functional Materials in Medicine and Dentistry, School of Dentistry, University of Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - T Schmitz
- Department for Functional Materials in Medicine and Dentistry, School of Dentistry, University of Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - T Wagner
- Department for Functional Materials in Medicine and Dentistry, School of Dentistry, University of Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - A Ewald
- Department for Functional Materials in Medicine and Dentistry, School of Dentistry, University of Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - U Gbureck
- Department for Functional Materials in Medicine and Dentistry, School of Dentistry, University of Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - J Groll
- Department for Functional Materials in Medicine and Dentistry, School of Dentistry, University of Würzburg, Pleicherwall 2, 97070 Würzburg, Germany
| | - C Moseke
- Department for Functional Materials in Medicine and Dentistry, School of Dentistry, University of Würzburg, Pleicherwall 2, 97070 Würzburg, Germany.
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Schmitz T. Modalités de l’accouchement dans la prévention de la dystocie des épaules en cas de facteurs de risque identifiés. ACTA ACUST UNITED AC 2015; 44:1261-71. [DOI: 10.1016/j.jgyn.2015.09.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/18/2015] [Indexed: 10/22/2022]
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Sentilhes L, Sénat MV, Boulogne AI, Deneux-Tharaux C, Fuchs F, Legendre G, Le Ray C, Lopez E, Schmitz T, Lejeune-Saada V. [Shoulder dystocia: Guidelines for clinical practice--Short text]. ACTA ACUST UNITED AC 2015; 44:1303-10. [PMID: 26541561 DOI: 10.1016/j.jgyn.2015.09.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 09/25/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine the available evidence to prevent and treat shoulder dystocia to attempt to decrease its related neonatal and maternal morbidity. MATERIALS AND METHODS The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. RESULTS Shoulder dystocia, defined as a vaginal delivery that requires additional obstetric maneuvers to deliver the fetus after the head has delivered and gentle traction has failed, complicates 0.5-1 % of vaginal deliveries. Risks of brachial plexus birth injury (LE3), clavicle and humeral fracture (LE3), perinatal asphyxia (LE2), hypoxic-ischemic encephalopathy (LE3) and perinatal mortality (LE2) are increased after shoulder dystocia. Its main risk factors are previous shoulder dystocia and macrosomia, but they are poorly predictive; 50 % to 70 % of shoulder dystocia cases occur in their absence, and the great majority of deliveries when they are present are not associated with shoulder dystocia. No study has proven that the correction of these risk factors (except gestational diabetes) would reduce the risk of shoulder dystocia (SD). Physical activity is recommended before and during pregnancy to reduce the occurrence of some risk factors for shoulder dystocia (grade C). In obese patients, physical activity should be coupled with dietary measures to reduce fetal macrosomia and weight gain during pregnancy (grade A). In case of gestational diabetes, diabetes care is recommended (diabetic diet, glucose monitoring, insulin if needed) (grade A) as it reduces the risk of macrosomia and shoulder dystocia (LE1). In order to avoid shoulder dystocia and its complications, only two measures are proposed. Induction of labor is recommended in case of impending macrosomia if the cervix is favourable and gestational age greater than 39 weeks of gestation (professional consensus). Cesarean delivery is recommended before labor in case of EFW greater than 4500g if associated with maternal diabetes (grade C), EFW greater than 5000g in the absence of maternal diabetes (grade C), history of shoulder dystocia associated with severe neonatal or maternal complications (Professional consensus), and finally during labor, in case of fetal macrosomia and failure to progress in the second stage, when the fetal head is above a +2 station (grade C). In case of shoulder dystocia, it is recommended not to pull excessively on the fetal head (grade C), do not perform uterine expression (grade C) and do not realize inverse rotation of the fetal head (professional consensus). McRoberts' maneuver, with or without a suprapubic pressure, is recommended in the first line (grade C). In case of failure, if the posterior shoulder is engaged, Wood's maneuver should be performed preferentially; if the posterior shoulder is not engaged, delivery of the posterior arm should be performed preferentially (professional consensus). It seems necessary to know at least two maneuvers to perform in case of shoulder dystocia unresolved by the maneuver of McRoberts (professional consensus). Pediatrician should be immediately informed in case of shoulder dystocia. The initial clinical examination should search complications such as brachial plexus birth injury or clavicle fracture (professional consensus). In absence of neonatal complication, monitoring of the neonate is not modified (professional consensus). The implementation of a practical training using simulation and concerning all caregivers of the delivery room is associated with a significant reduction in neonatal (LE3) but not maternal (LE3) injury. CONCLUSION Shoulder dystocia remains a non-predictable obstetrics emergency. All physicians and midwives should know and perform obstetric maneuvers if needed quickly but without precipitation. A training program using simulation for the management of shoulder dystocia is encouraged for the initial and continuing formation of different actors in the delivery room (professional consensus).
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Affiliation(s)
- L Sentilhes
- Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France.
| | - M-V Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - A-I Boulogne
- Collège national des sages-femmes, France; Service de gynécologie-obstétrique, hôpital Necker, AP-HP, 149, rue de Sèvres, 75013 Paris, France
| | - C Deneux-Tharaux
- Inserm U1153, ÉPidémiologie Obstétricale, Périnatale et Pédiatrique (équipe EPOPé), CRESS, 75014 Paris, France
| | - F Fuchs
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - G Legendre
- Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France
| | - C Le Ray
- Maternité Port-Royal, hôpital Cochin, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France
| | - E Lopez
- Réanimation néonatale, hôpital Clocheville, CHU de Tours, 49, boulevard Béranger, 37000 Tours, France
| | - T Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, 48, boulevard Sérurier, 75019 Paris, France
| | - V Lejeune-Saada
- Gynérisq, 31000 Toulouse, France; Service de gynécologie-obstétrique, centre hospitalier d'Auch-en-Gascogne, allées Marie-Clarac, 32000 Auch, France
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Schmitz T, Bassler N, Blaickner M, Ziegner M, Hsiao MC, Liu YH, Koivunoro H, Auterinen I, Serén T, Kotiluoto P, Palmans H, Sharpe P, Langguth P, Hampel G. The alanine detector in BNCT dosimetry: dose response in thermal and epithermal neutron fields. Med Phys 2015; 42:400-11. [PMID: 25563280 DOI: 10.1118/1.4901299] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The response of alanine solid state dosimeters to ionizing radiation strongly depends on particle type and energy. Due to nuclear interactions, neutron fields usually also consist of secondary particles such as photons and protons of diverse energies. Various experiments have been carried out in three different neutron beams to explore the alanine dose response behavior and to validate model predictions. Additionally, application in medical neutron fields for boron neutron capture therapy is discussed. METHODS Alanine detectors have been irradiated in the thermal neutron field of the research reactor TRIGA Mainz, Germany, in five experimental conditions, generating different secondary particle spectra. Further irradiations have been made in the epithermal neutron beams at the research reactors FiR 1 in Helsinki, Finland, and Tsing Hua open pool reactor in HsinChu, Taiwan ROC. Readout has been performed with electron spin resonance spectrometry with reference to an absorbed dose standard in a (60)Co gamma ray beam. Absorbed doses and dose components have been calculated using the Monte Carlo codes fluka and mcnp. The relative effectiveness (RE), linking absorbed dose and detector response, has been calculated using the Hansen & Olsen alanine response model. RESULTS The measured dose response of the alanine detector in the different experiments has been evaluated and compared to model predictions. Therefore, a relative effectiveness has been calculated for each dose component, accounting for its dependence on particle type and energy. Agreement within 5% between model and measurement has been achieved for most irradiated detectors. Significant differences have been observed in response behavior between thermal and epithermal neutron fields, especially regarding dose composition and depth dose curves. The calculated dose components could be verified with the experimental results in the different primary and secondary particle fields. CONCLUSIONS The alanine detector can be used without difficulty in neutron fields. The response has been understood with the model used which includes the relative effectiveness. Results and the corresponding discussion lead to the conclusion that application in neutron fields for medical purpose is limited by its sensitivity but that it is a useful tool as supplement to other detectors and verification of neutron source descriptions.
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Affiliation(s)
- T Schmitz
- Institute for nuclear chemistry, Johannes Gutenberg-University, Mainz D-55128, Germany
| | - N Bassler
- Department of Physics and Astronomy, Aarhus University, Ny Munkegade 120, Aarhus C, Aarhus 8000, Denmark
| | - M Blaickner
- AIT Austrian Institute of Technology GmbH, Vienna A-1220, Austria
| | - M Ziegner
- AIT Austrian Institute of Technology GmbH, Vienna A-1220, Austria and TU Wien, Vienna University of Technology, Vienna A-1020, Austria
| | - M C Hsiao
- Insitute of Nuclear Engineering and Science, National Tsing Hua University, Hsinchu 30013, Taiwan, Republic of China
| | - Y H Liu
- Nuclear Science and Technology Development Center, National Tsing Hua University, Hsinchu 30013, Taiwan, Republic of China
| | - H Koivunoro
- Department of Physics, University of Helsinki, POB 64, FI-00014, Finland and HUS Medical Imaging Center, Helsinki University Central Hospital, FI-00029 HUS, Finland
| | - I Auterinen
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - T Serén
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - P Kotiluoto
- VTT Technical Research Centre of Finland, Espoo, Finland
| | - H Palmans
- National Physical Laboratory, Acoustics and Ionising Radiation Division, Teddington TW11 0LW, United Kingdom and Medical Physics Group, EBG MedAustron GmbH, Wiener Neustadt A-2700, Austria
| | - P Sharpe
- National Physical Laboratory, Acoustics and Ionising Radiation Division, Teddington TW11 0LW, United Kingdom
| | - P Langguth
- Department of Pharmacy and Toxicology, University of Mainz, Mainz D-55128, Germany
| | - G Hampel
- Institut für Kernchemie, Johannes Gutenberg-Universität, Mainz D-55128, Germany
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Klein D, Schmitz T, Verhelst V, Panic A, Schenck M, Reis H, Drab M, Sak A, Herskind C, Maier P, Jendrossek V. Endothelial Caveolin-1 regulates the radiation response of epithelial prostate tumors. Oncogenesis 2015; 4:e148. [PMID: 25985209 PMCID: PMC4450264 DOI: 10.1038/oncsis.2015.9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/24/2015] [Accepted: 03/20/2015] [Indexed: 02/08/2023] Open
Abstract
The membrane protein caveolin-1 (Cav1) recently emerged as a novel oncogene involved in prostate cancer progression with opposed regulation in epithelial tumor cells and the tumor stroma. Here we examined the role of stromal Cav1 for growth and radiation response of MPR31-4 prostate cancer xenograft tumors using Cav1-deficient C57Bl/6 mice. Syngeneic MPR31-4 tumors grew faster when implanted into Cav1-deficient mice. Increased tumor growth on Cav1-deficient mice was linked to decreased integration of smooth muscle cells into the wall of newly formed blood vessels and thus with a less stabilized vessel phenotype compared with tumors from Cav1 wild-type animals. However, tumor growth delay of MPR31-4 tumors grown on Cav1 knockout mice to a single high-dose irradiation with 20 Gray was more pronounced compared with tumors grown on wild-type mice. Increased radiation-induced tumor growth delay in Cav1-deficient mice was associated with an increased endothelial cell apoptosis. In vitro studies using cultured endothelial cells (ECs) confirmed that the loss of Cav1 expression increases sensitivity of ECs to radiation-induced apoptosis and reduces their clonogenic survival after irradiation. Immunohistochemical analysis of human tissue specimen further revealed that although Cav1 expression is mostly reduced in the tumor stroma of advanced and metastatic prostate cancer, the vascular compartment still expresses high levels of Cav1. In conclusion, the radiation response of MPR31-4 prostate tumors is critically regulated by Cav1 expression in the tumor vasculature. Thus, Cav1 might be a promising therapeutic target for combinatorial therapies to counteract radiation resistance of prostate cancer at the level of the tumor vasculature.
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Affiliation(s)
- D Klein
- Department of Molecular Cell Biology, Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - T Schmitz
- Department of Molecular Cell Biology, Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - V Verhelst
- Department of Molecular Cell Biology, Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - A Panic
- 1] Department of Molecular Cell Biology, Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, University Hospital Essen, Essen, Germany [2] Department of Urology and Urooncology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - M Schenck
- Department of Urology and Urooncology, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - H Reis
- Institute of Pathology, University of Duisburg-Essen, University Hospital, Essen, Germany
| | - M Drab
- 1] Institute of Immunology and Experimental Therapy, Wroclaw, Poland [2] Wroclaw Research Center EIT+, Wroclaw, Poland
| | - A Sak
- Department of Radiotherapy, University of Duisburg-Essen, University Hospital, Essen, Germany
| | - C Herskind
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - P Maier
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - V Jendrossek
- Department of Molecular Cell Biology, Institute of Cell Biology (Cancer Research), University of Duisburg-Essen, University Hospital Essen, Essen, Germany
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Hertl C, Koll L, Schmitz T, Werner E, Gbureck U. Structural characterisation of oxygen diffusion hardened alpha-tantalum PVD-coatings on titanium. Materials Science and Engineering: C 2014; 41:28-35. [DOI: 10.1016/j.msec.2014.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/09/2014] [Accepted: 03/07/2014] [Indexed: 02/02/2023]
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Spaggiari E, Dreux S, Czerkiewicz I, Favre R, Schmitz T, Guimiot F, Laurichesse Delmas H, Verspyck E, Oury JF, Ville Y, Muller F. Fetal obstructive uropathy complicated by urinary ascites: outcome and prognostic value of fetal serum β-2-microglobulin. Ultrasound Obstet Gynecol 2013; 41:185-189. [PMID: 23090907 DOI: 10.1002/uog.12328] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To determine whether the prognostic value of fetal serum β-2-microglobulin is altered and whether the occurrence of fetal urinary ascites prevents kidney damage in cases of fetal obstructive uropathy with urinary ascites. METHODS This was a retrospective study of cases of fetal bilateral obstructive uropathy that occurred between 2006 and 2010, for which both fetal serum and ascites samples were sent to our laboratory for analysis. β-2-microglobulin was assayed in both fetal serum and the corresponding ascites. Renal outcome was analyzed. Histological features of the kidney in cases of termination of pregnancy and renal function of liveborn infants were recorded. RESULTS Fourteen cases with analysis of fetal serum and fetal ascites in a context of urinary obstruction were included. Renal outcome was unfavorable in eight cases (57%) and favorable in six (43%). When fetal serum β-2-microglobulin was < 5 mg/L, renal outcome was favorable in all cases (4/4). When fetal serum β-2-microglobulin was ≥ 5 mg/L, 8/10 cases (80%) had an unfavorable renal outcome (sensitivity, 100%; specificity, 66%). CONCLUSION Fetal serum β-2-microglobulin reliably predicts postnatal renal outcome in obstructive uropathy complicated by urinary ascites. Moreover, urine extravasation does not seem to protect fetal renal function.
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Affiliation(s)
- E Spaggiari
- Department of Developmental Biology, AP-HP, Robert Debré Hospital, and University Paris Diderot and Paris Sorbonne-Cité, Paris, France.
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Schmitz T. Situations cliniques particulières, maternelles ou fœtales, influençant le choix du mode d’accouchement en cas d’antécédent de césarienne. ACTA ACUST UNITED AC 2012; 41:772-81. [DOI: 10.1016/j.jgyn.2012.09.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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