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Friel CP, Goodwin AM, Robles PL, Butler MJ, Pahlevan-Ibrekic C, Duer-Hefele J, Vicari F, Gordon S, Chandereng T, Cheung YKK, Davidson KW. Feasibility Test of Personalized (N-of-1) Trials for Increasing Middle-Aged and Older Adults' Physical Activity. Res Sq 2023:rs.3.rs-3788631. [PMID: 38234781 PMCID: PMC10793496 DOI: 10.21203/rs.3.rs-3788631/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Purpose To test the feasibility of a remotely-delivered intervention to increase low-intensity physical activity (walking) in middle-aged and older adults. Design This study used a Personalized (N-of-1) trial design. Setting This study took place at a major healthcare system from November 2021 to February 2022. Subjects Sixty adults (45-75 years, 92% female, 80% white) were recruited. Intervention A 10-week study comprising a 2-week baseline, followed by four 2-week periods where 4 Behavior Change Techniques (BCTs) - self-monitoring, goal setting, action planning and feedback - were delivered one at a time in random order. Measures Activity was measured by a Fitbit, and intervention components delivered by email/text. Average daily steps were compared between baseline and intervention. Participants completed satisfaction items derived from the System Usability Scale and reported attitudes and opinions about personalized trials. Results Participants rated personalized trial components as feasible and acceptable. Changes in steps between baseline and intervention were not significant, but a large heterogeneity of treatment effects existed, suggesting some participants significantly increased walking while others significantly decreased. Conclusions Our intervention was well-accepted but use of BCTs delivered individually did not result in a significant increase in steps. Feasibility and heterogeneity of treatment effects support adopting a personalized trial approach to optimize intervention results.
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Butler MJ, Romain AMN, Augustin R, Robles P, Friel CP, Chandereng T, Suls JM, Vrany EA, Vicari F, Cheung YK, Davidson KW. The effect of a multi-component behavior change technique intervention on medication adherence among individuals on primary prevention statin therapy: a dose-finding protocol. Trials 2023; 24:523. [PMID: 37573428 PMCID: PMC10422706 DOI: 10.1186/s13063-023-07549-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND In the USA, the primary cause of death and morbidity continues to be cardiovascular disease (CVD). Numerous trials have shown that statin medication reduces the likelihood of CVD events; it is a cornerstone of CVD prevention. However, studies have also indicated that up to 60% of the estimated 26.8 million Americans prescribed primary prevention statin treatment are nonadherent during the first year. Multi-component behavioral change technique (BCT) therapies have shown moderate promise in improving medication adherence as well as other positive health behaviors (such as physical activity). However, no research has looked at the duration of multi-component BCT intervention needed to result in a clinically significant improvement in statin adherence behaviors. This study aims to determine the necessary dose of a multi-component BCT intervention (defined as duration in weeks) to promote adherence to statin medication among those on primary prevention statin treatment by utilizing the modified time-to-event continuous reassessment method (TiTE-CRM). METHODS AND DESIGN The study will utilize the modified TiTE-CRM in 42 participants, recruited in 14 cohorts of 3 participants each. The goal of this analysis is to identify the minimum effective dose (MED) of a multi-behavior change technique (BCT) intervention required to increase adherence to statins by 20% between baseline and follow-up periods. Using the TiTE-CRM method, the dose of the behavior intervention in weeks will be assigned to each cohort based on the performance of the prior cohort. At the end of the study, the intervention dose that has been found to be associated with a 20% increase in statin adherence among 80% of participants assigned to that dose will be identified as the MED. DISCUSSION If successful, the current trial will provide additional guidance to researchers and clinicians seeking to increase statin medication adherence using a BCT intervention by identifying the dose (i.e., the duration) of an intervention required to meaningfully increase adherence. TRIAL REGISTRATION ClinicalTrials.gov NCT05273736. Registered on March 10, 2022. https://www. CLINICALTRIALS gov/ct2/show/NCT05273736.
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Affiliation(s)
- Mark J Butler
- Feinstein Institutes for Medical Research, Institute of Health System Science, Northwell Health, Manhasset, 130 East 59th Street, Suite 14C, New York, NY, 10022, USA.
| | - Anne-Marie N Romain
- Feinstein Institutes for Medical Research, Institute of Health System Science, Northwell Health, Manhasset, 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
- Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, USA
| | - Rumisha Augustin
- Feinstein Institutes for Medical Research, Institute of Health System Science, Northwell Health, Manhasset, 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
- Temple University School of Pharmacy, Temple University, Philadelphia, PA, USA
| | - Patrick Robles
- Feinstein Institutes for Medical Research, Institute of Health System Science, Northwell Health, Manhasset, 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Ciaran P Friel
- Feinstein Institutes for Medical Research, Institute of Health System Science, Northwell Health, Manhasset, 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Thevaa Chandereng
- Feinstein Institutes for Medical Research, Institute of Health System Science, Northwell Health, Manhasset, 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Jerry M Suls
- Feinstein Institutes for Medical Research, Institute of Health System Science, Northwell Health, Manhasset, 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Elizabeth A Vrany
- Feinstein Institutes for Medical Research, Institute of Health System Science, Northwell Health, Manhasset, 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Frank Vicari
- Feinstein Institutes for Medical Research, Institute of Health System Science, Northwell Health, Manhasset, 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Ying Kuen Cheung
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Karina W Davidson
- Feinstein Institutes for Medical Research, Institute of Health System Science, Northwell Health, Manhasset, 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, USA
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Friel CP, Robles PL, Butler M, Pahlevan-Ibrekic C, Duer-Hefele J, Vicari F, Chandereng T, Cheung K, Suls J, Davidson KW. Testing Behavior Change Techniques to Increase Physical Activity in Middle-Aged and Older Adults: Protocol for a Randomized Personalized Trial Series. JMIR Res Protoc 2023; 12:e43418. [PMID: 37314839 PMCID: PMC10337349 DOI: 10.2196/43418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Being physically active is critical to successful aging, but most middle-aged and older adults do not move enough. Research has shown that even small increases in activity can have a significant impact on risk reduction and improve quality of life. Some behavior change techniques (BCTs) can increase activity, but prior studies on their effectiveness have primarily tested them in between-subjects trials and in aggregate. These design approaches, while robust, fail to identify those BCTs most influential for a given individual. In contrast, a personalized, or N-of-1, trial design can assess a person's response to each specific intervention. OBJECTIVE This study is designed to test the feasibility, acceptability, and preliminary effectiveness of a remotely delivered personalized behavioral intervention to increase low-intensity physical activity (ie, walking) in adults aged 45 to 75 years. METHODS The intervention will be administered over 10 weeks, starting with a 2-week baseline period followed by 4 BCTs (goal-setting, self-monitoring, feedback, and action planning) delivered one at a time, each for 2 weeks. In total, 60 participants will be randomized post baseline to 1 of 24 intervention sequences. Physical activity will be continuously measured by a wearable activity tracker, and intervention components and outcome measures will be delivered and collected by email, SMS text messages, and surveys. The effect of the overall intervention on step counts relative to baseline will be examined using generalized linear mixed models with an autoregressive model that accounts for possible autocorrelation and linear trends for daily steps across time. Participant satisfaction with the study components and attitudes and opinions toward personalized trials will be measured at the intervention's conclusion. RESULTS Pooled change in daily step count will be reported between baseline and individual BCTs and baseline versus overall intervention. Self-efficacy scores will be compared between baseline and individual BCTs and between baseline and the overall intervention. Mean and SD will be reported for survey measures (participant satisfaction with study components and attitudes and opinions toward personalized trials). CONCLUSIONS Assessing the feasibility and acceptability of delivering a personalized, remote physical activity intervention for middle-aged and older adults will inform what steps will be needed to scale up to a fully powered and within-subjects experimental design remotely. Examining the effect of each BCT in isolation will allow for their unique impact to be assessed and support design of future behavioral interventions. In using a personalized trial design, the heterogeneity of individual responses for each BCT can be quantified and inform later National Institutes of Health stages of intervention development trials. TRIAL REGISTRATION clinicaltrials.gov NCT04967313; https://clinicaltrials.gov/ct2/show/NCT04967313. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/43418.
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Affiliation(s)
- Ciaran P Friel
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Patrick L Robles
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Mark Butler
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Challace Pahlevan-Ibrekic
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Joan Duer-Hefele
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Frank Vicari
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Thevaa Chandereng
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Ken Cheung
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Jerry Suls
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
| | - Karina W Davidson
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, New York, NY, United States
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Suls J, Friel CP, Butler M, Duer-Hefele J, Robles PL, Vicari F, Chandereng T, Cheung YK(K, Davidson KW. Protocol of a feasibility study of a virtual personalized (N-of-1) trial for increasing low-intensity physical activity in older adults via habit formation. Contemp Clin Trials Commun 2023; 33:101135. [PMID: 37333978 PMCID: PMC10276207 DOI: 10.1016/j.conctc.2023.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/01/2023] [Accepted: 04/10/2023] [Indexed: 06/20/2023] Open
Abstract
Background Personalized interventions that can be delivered remotely are needed to increase physical activity (PA) in older adults to reduce risk of CV disease and mortality. Prior research indicates that Behavioral Change Techniques (BCTs) (e.g., goal setting, self-monitoring, behavioral repetition) can instill a habit for increasing daily walking. However, past interventions relied on between-subject randomized clinical trials, which can only only be informative about response of the hypothetical average person. Personalized trial designs can identify the benefits of an intervention for a specific individual although extended periods are required for collecting frequent measurements within-subject. Advances in remote, virtual technologies (e.g., text messaging, activity trackers), integrated with automatic platforms, can meet these requirements because they capacitate delivery of BCT interventions, and collection of data during daily life without personal contact. This Stage I-b trial is designed test whether a virtual, personalized intervention is feasible and acceptable to older adults, can elicit participant adherence and exhibit preliminary evidence for efficacy. Methods A series of up to 60 single-arm, personalized trials, involving no personal contact, will recruit adults, 45-75 years of age, to wear an activity tracker during a 2-week baseline and a 10-week intervention. Five BCT prompts to execute a walking plan will be delivered on a daily basis during the intervention phase. Participants will rate satisfaction with personalized trial components and whether automaticity of the walking plan can be achieved. Step-counts, adherence to the walking plan and self-monitoring of step-count will also be recorded.
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Affiliation(s)
- Jerry Suls
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Ciarán P. Friel
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Mark Butler
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Joan Duer-Hefele
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Patrick L. Robles
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Frank Vicari
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Thevaa Chandereng
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Ying Kuen (Ken) Cheung
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
| | - Karina W. Davidson
- Institute for Health System Science Feinstein Institutes for Medical Research Northwell Health 130 East 59th Street, Suite 14C, New York, NY, 10022, USA
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Butler MJ, Romain AMN, Augustin R, Robles P, Friel CP, Vicari F, Chandereng T, Alfano CM, Cheung YK, Davidson KW. The effect of a multi-component behavior change technique intervention on physical activity among individuals on primary prevention statin therapy: A dose-finding trial protocol. Contemp Clin Trials 2023; 130:107205. [PMID: 37105318 PMCID: PMC10368194 DOI: 10.1016/j.cct.2023.107205] [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: 12/12/2022] [Revised: 04/05/2023] [Accepted: 04/21/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Statin therapy is a mainstay of cardiovascular disease (CVD) prevention, but research shows that statin therapy alone is insufficient for preventing incident CVD and mortality. Combining statin medication with increased physical activity (PA) can lower mortality risk more than either statin or PA alone. However, PA levels often remain the same and may even decline following statin prescription. Additional information is needed to identify how to increase PA among statin users and determine the minimal length of an intervention (i.e., intervention dose) necessary to increase PA. OBJECTIVE The study aims to identify the required dose of a behavioral change technique (BCT) intervention to increase PA among individuals on primary prevention statin therapy who have an elevated risk for cardiovascular disease (CVD). METHODS The study will utilize the modified time-to-event continual reassessment method (TiTE-CRM) in 42 participants. We expect insights relating to dose-efficacy models and BCTs (Behavioral Change Techniques) to improve PA in adults at risk for CVD. This trial will also examine potential mechanisms of action (MoAs) for interventions to increase PA, identify any effect a PA intervention may have on medication adherence, and determine whether participants respond uniformly to their respective behavioral interventions. ETHICS AND DISSEMINATION This trial was approved by the Northwell Health Institutional Review Board (IRB) and all participants will complete informed consent. The trial results will be published in a peer-reviewed journal. All publications resulting from this series of personalized trials will follow the CONSORT reporting guidelines. REGISTRATION DETAILS This trial is registered on www. CLINICALTRIALS gov (Number NCT05273723).
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Affiliation(s)
- Mark J Butler
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America.
| | - Anne-Marie N Romain
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Gordon F. Derner School of Psychology, Adelphi University, Garden City, NY, United States of America
| | - Rumisha Augustin
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Temple University School of Pharmacy, Temple University, Philadelphia, PA, United States of America
| | - Patrick Robles
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Ciaran P Friel
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Frank Vicari
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Thevaa Chandereng
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Catherine M Alfano
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Northwell Health Cancer Institute, Northwell Health Manhasset, NY(3), United States of America; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, United States of America
| | - Ying-Kuen Cheung
- Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Karina W Davidson
- Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, NY, United States of America
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Vicari F, Randazzo S, López J, Fernández de Labastida M, Vallès V, Micale G, Tamburini A, D'Alì Staiti G, Cortina JL, Cipollina A. Mining minerals and critical raw materials from bittern: Understanding metal ions fate in saltwork ponds. Sci Total Environ 2022; 847:157544. [PMID: 35878854 DOI: 10.1016/j.scitotenv.2022.157544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/05/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
Seawater represents a potential resource for raw materials extraction. Although NaCl is the most representative mineral extracted other valuable compounds such as Mg, Li, Sr, Rb and B and elements at trace level (Cs, Co, In, Sc, Ga and Ge) are also contained in this "liquid mine". Most of them are considered as Critical Raw Materials by the European Union. Solar saltworks, providing concentration factors of up-to 20 to 40, offer a perfect platform for the development of minerals and metal recovery schemes taking benefit of the concentration and purification achieved along the evaporation saltwork ponds. However, the geochemistry of these elements in this environment has not been yet thoroughly evaluated. Their knowledge could enable the deployment of technologies capable to achieve the recovery of valuable minerals. The high ionic strengths expected (0.5-7 mol/kg) and the chemical complexity of the solutions imply that only numerical geochemical codes, as PHREEQC, and the use of Pitzer model to estimate the activity coefficients of the different species in solution can be adopted to provide valuable description of the systems. In the present work, for the first time, PHREEQC Pitzer code database was extended to include the target minor and trace elements using Trapani saltworks (Sicily, Italy) as a case study system. The model was able to predict: i) the purity in halite and the major impurities contained, mainly Ca, Mg and sulphate species; ii) the fate of minor components as B, Sr, Cs, Co, Ge and Ga along the evaporation ponds. The results obtained pose a fundamental step in critical raw materials mining from seawater brine, for process intensification and combination with desalination.
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Affiliation(s)
| | - S Randazzo
- Dipartimento di Ingegneria, Università di Palermo (UNIPA), Palermo, Italy
| | - J López
- Chemical Engineering Department, UPC-BarcelonaTECH, Barcelona, Spain; Barcelona Research Center for Multiscale Science and Engineering, Barcelona, Spain
| | - M Fernández de Labastida
- Chemical Engineering Department, UPC-BarcelonaTECH, Barcelona, Spain; Barcelona Research Center for Multiscale Science and Engineering, Barcelona, Spain
| | - V Vallès
- Chemical Engineering Department, UPC-BarcelonaTECH, Barcelona, Spain; Barcelona Research Center for Multiscale Science and Engineering, Barcelona, Spain
| | - G Micale
- Dipartimento di Ingegneria, Università di Palermo (UNIPA), Palermo, Italy
| | - A Tamburini
- ResourSEAs srl, Palermo, Italy; Dipartimento di Ingegneria, Università di Palermo (UNIPA), Palermo, Italy
| | | | - J L Cortina
- Chemical Engineering Department, UPC-BarcelonaTECH, Barcelona, Spain; Barcelona Research Center for Multiscale Science and Engineering, Barcelona, Spain; Water Technology Center (CETaqua), Cornellà de Llobregat, Spain.
| | - A Cipollina
- Dipartimento di Ingegneria, Università di Palermo (UNIPA), Palermo, Italy
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Vicari F, Mateo S, Fernandez-Morales F, Cañizares P, Galia A, Scialdone O, Rodrigo M. Influence of the methodology of inoculation in the performance of air-breathing microbial fuel cells. J Electroanal Chem (Lausanne) 2017. [DOI: 10.1016/j.jelechem.2017.09.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mulder C, Rastatter J, Patel P, Vicari F. Distal Airway Lesions in Mandibular Distraction Patients. Otolaryngol Head Neck Surg 2012. [DOI: 10.1177/0194599812451438a197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: 1) Determine prevalence and type of synchronous airway lesions (SALs) in patients undergoing mandibular distraction osteogenesis (MDO) at Children’s Memorial Hospital. 2) To determine whether these SALs affect surgical success of MDO in relieving airway obstruction. Method: Restrospective review of patients with micrognathia undergoing MDO and direct laryngoscopy and bronchoscopy (DLB) over a period of 11 years (2001-2011) at a tertiary care pediatric hospital. Charts were reviewed for demographics, prevalence/type of SALs, success rate for airway improvement for MDO, and coexisting medical and craniofacial conditions. Results: Eighteen patients were found who had undergone both MDO and DLB. The incidence of at least 1 SAL was 77.8%. Types of SALs encountered include laryngeal edema (61.1%), tracheobronchitis (50%), laryngomalacia (38.9%), tracheomalacia (16.7%), bronchomalacia (16.7%), subglottic stenosis (11.1%), pulsatile airway compression (11.1%), posterior laryngeal cleft (0%), and subglottic cysts (0%). 94.4% of MDO patients received tracheostomy, and 88.9% had airway improvement following MDO. Craniofacial anomalies include micrognathia (100%), cleft palate (61.1%), midface hypoplasia (33.3%), craniosynostosis (5.6%), choanal stenosis/atresia (5.6%), pyriform aperture stenosis (5.6%), and macroglossia (0%). Baseline medical characteristics/syndromes include Pierre Robin sequence (61.1%), Nager syndrome (11.1%), Stickler syndrome (11.1%), asthma (11.1%), Goldenhar syndrome (11.1%), arthrogryposis (5.6%), Mobius syndrome (5.6%), and Cornelia de Lange syndrome (5.6%). Conclusion: There is a high rate of SALs in patients undergoing MDO. The most common SALs are laryngeal edema, tracheobronchitis, and laryngomalacia. MDO is highly successful in relieving upper airway obstruction in micrognathic patients despite the high incidence of SALs. DLB should be considered in all patients who require MDO.
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Tarrerias AL, Costil V, Vicari F, Létard JC, Adenis-Lamarre P, Aisène A, Batistelli D, Bonnaud G, Carpentier S, Dalbiès P, Ecuer S, Etienne J, Fantoli M, Grunberg B, Lannoy P, Lapuelle J, Margulies A, Neumeier M, Rouillon JM, Schmets L, Pingannaud MP, Coulom P, Kholer F, Canard JM. The effect of inactivated Lactobacillus LB fermented culture medium on symptom severity: observational investigation in 297 patients with diarrhea-predominant irritable bowel syndrome. Dig Dis 2011; 29:588-91. [PMID: 22179215 DOI: 10.1159/000332987] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Little is known about the intensity of symptoms of diarrhea-predominant IBS (IBS-D) or the consequences of the disease on patients' health-related quality of life (HRQOL). This observational investigation assessed the symptoms (abdominal pain, bloating, number of stools per day, and stool consistency), impact on HRQOL, and consequence on anal continence in 297 patients with IBS-D before and after 1 month of probiotic treatment with Lacteol (inactivated Lactobacillus LB plus fermented culture medium). METHODS Functional assessment using a standardized visual analogue scale in order to quantify abdominal pain, bloating, and quality of life before and after 1 month of treatment with 2 capsules/day of Lacteol. The number of symptomatic days per week, number of stools, consistency of stools, secondary fecal incontinence rate, and potential trigger effect of food were quantified. A χ2 test was used to compare qualitative data and the variance of quantitative criteria was analyzed. RESULTS The pain score decreased from 4.46±0.15 on a scale of 0-10 before treatment to 2.8±0.14 after treatment (p<0.0001). Bloating decreased from 4.49±0.18 to 2.5±0.15 on a scale of 0-10 (p<0.0001). The HRQOL score, which is inversely correlated with quality of life, decreased from 5.99±0.14 to 3.92±0.16 (p<0.0001). In this cohort study, the fecal incontinence rate secondary to diarrhea was clearly higher than that of the general population: 18% versus a prevalence of 9-10%, according to different studies. The mean number of stools per week decreased from 17.59 to 12.83 after treatment (p<0.0001). Before treatment, 54% of patients had watery stools and 46% had smooth stools; at the end of treatment, only 18.5% of patients still had watery stools, and 34% had normal stools. 52% of patients attributed their symptoms to their diet: 34% to vegetables, 29% to fruit, 15% to milk, 15% to fat, 6% to peppers and spices, and 4% to sugar. CONCLUSION This observational investigation shed new light on patients with IBS-D, the HRQOL of which is altered by a fecal incontinence rate twice as high as that of the general population. Correlation with diet is confirmed by 1 out of 2 patients reporting poor tolerance of fiber and dairy products. Nutritional management should thus be part of these patients' treatment. Inactivated Lactobacillus LB plus fermented culture medium is a probiotic drug that has been used by physicians for a long time to treat patients with diarrhea. Strongly concentrated, it has no side effects and seems to help these patients. Due to a strong placebo effect in patients with this pathology, however, a controlled study is necessary to confirm this result.
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Affiliation(s)
- A L Tarrerias
- Hôpital Foch, 40, rue Worth, FR–92151 Suresnes, France.
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Lin SJ, Koltz PF, Davis W, Vicari F. Lower extremity ischemia following umbilical artery catheterization: A case study and clinical update. Int J Surg 2009; 7:182-6. [DOI: 10.1016/j.ijsu.2008.12.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 11/11/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
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Pachman LM, Veis A, Stock S, Abbott K, Vicari F, Patel P, Giczewski D, Webb C, Spevak L, Boskey AL. Composition of calcifications in children with juvenile dermatomyositis: association with chronic cutaneous inflammation. Arthritis Rheum 2006; 54:3345-50. [PMID: 17009308 PMCID: PMC2329813 DOI: 10.1002/art.22158] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Calcific deposits develop in 20-40% of children with juvenile dermatomyositis (juvenile DM), contributing to disease morbidity and mortality. This study was undertaken to define the structure and composition of these deposits and to characterize their association with chronic inflammation. METHODS We examined calcific deposits from 5 children with juvenile DM (2 boys and 3 girls). The crystal structure and mineral content of the deposits was analyzed by x-ray diffraction, Fourier transform infrared spectroscopy, and imaging. The protein content of the deposits, following solubilization, was assayed by Western blotting. RESULTS All 5 children had both a young age at disease onset (mean +/- SD 3.3 +/- 1.9 years) and, despite therapy, persistent cutaneous inflammation (mean +/- SD duration 81.3 +/- 58.7 months). The bone proteins, osteopontin, osteonectin, and bone sialoprotein, were identified in the protein extracts; the only mineral detected was hydroxyapatite, but the tissue was distinct from bone, with an extremely high mineral content and an irregular distribution of mineral. CONCLUSION These results indicate that chronic cutaneous inflammation may contribute to the formation of hydroxyapatite-containing pathologic calcifications in children with juvenile DM.
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Affiliation(s)
- Lauren M Pachman
- Children's Memorial Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60614, USA.
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Cavorsi J, Vicari F, Wirthlin DJ, Ennis W, Kirsner R, O'Connell SM, Steinberg J, Falanga V. Best-practice algorithms for the use of a bilayered living cell therapy (ApligrafR) in the treatment of lower-extremity ulcers. Wound Repair Regen 2006; 14:102-9. [PMID: 16630097 DOI: 10.1111/j.1743-6109.2006.00098.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Tissue-engineered skin substitutes such as Apligraf have emerged over the past 20 years as among the most carefully studied and efficacious of the advanced wound modalities. These products have been proven as effective enhancements to general wound care, promoting wound closure particularly in instances where conventional wound care fails. Marketed for hard-to-heal wounds since 1998, Apligraf has become part of standard wound care in many wound centers across the United States. Despite this situation, few general wound care guidelines incorporate advanced and active wound-healing technologies, such as tissue-engineered skin products. Because of this deficiency, appropriate patient selection and proper use of these product remain largely unaddressed within the general wound care community. Here, we describe the development of guidelines surrounding optimal use of the bilayered living cell therapy, Apligraf, in the treatment of the two types of lower extremity ulcers for which the product is FDA approved: venous leg ulcer and diabetic foot ulcer. The guidelines detailed in this article focus on the identification and selection of patients who are at risk for failure of standard wound care therapy and thus appropriate for Apligraf treatment. The intended audience for these guidelines is the general wound care practitioner, for whom the developed treatment algorithms and accompanying figure legends should provide practical, user-friendly direction simplifying both patient selection and appropriate use of Apligraf within the context of good wound-healing practice.
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Affiliation(s)
- Joseph Cavorsi
- Center for Advanced Wound Care, St. Joseph's Medical Center, Reading, Pennsylvania, USA
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Morisset M, Kanny G, Kolopp-Sarda M, Vicari F, Moneret-Vautrin D. Allergie à la farine de blé à expression digestive intérêt des tests épicutanés et du test d'activation lymphocytaire. À propos d'un cas. Rev Med Interne 2002. [DOI: 10.1016/s0248-8663(02)80591-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Bellobuono A, Mondazzi L, Tempini S, Silini E, Vicari F, Idéo G. Ribavirin and interferon-alpha combination therapy vs interferon-alpha alone in the retreatment of chronic hepatitis C: a randomized clinical trial. J Viral Hepat 1997; 4:185-91. [PMID: 9181527 DOI: 10.1046/j.1365-2893.1997.00142.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Interferon-alpha (IFN-alpha) induces sustained remission of chronic hepatitis C in approximately 25% of patients. In patients who are non-responders to the first course of therapy, retreatment with IFN-alpha is of limited efficacy. Ribavirin has also been used to treat chronic hepatitis C, but it induces only a transient response. In this study, we evaluated the efficacy of ribavirin and IFN-alpha combination therapy for IFN-alpha resistant chronic hepatitis C. Twenty-four IFN-alpha non-responders and 24 relapsers were randomized to receive either ribavirin (1000 mg per day) together with IFN-alpha (3-6 million units (MU) thrice weekly) or the same dose of IFN-alpha alone, for 6 months. Both at the end of treatment and 6 months later, normal transaminase levels were more common in the patients receiving combination therapy than in the group receiving IFN-alpha alone: 17 (70.8%) vs seven (29.2%) patients (P = 0.009) and six (25%) vs one (4.2%) patient (P = 0.034), respectively. At the end of treatment and 6 months later, serum HCV RNA was no longer detectable in eight (33.3%) and five (20.8%) patients in the combination therapy group and in six (25%) and one (4.2%) patient in the IFN-alpha therapy group, respectively. Three patients (12.5%) were withdrawn prematurely from combination therapy because of side-effects; ribavirin therapy was ceased or dosage reduced in six other patients (25%), again because of side-effects. In conclusion, this combination treatment was more effective than retreatment with IFN-alpha, alone, in inducing sustained biochemical remission of chronic hepatitis C that was resistant to a previous course of IFN-alpha. The combination treatment, however, was frequently associated with significant side-effects.
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Affiliation(s)
- A Bellobuono
- Crespi Division of Medicine, Niguarda Hospital, Milan, Italy
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15
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Roth AG, Vicari F, Stevenson GW. Re: Rigid endotracheal tube stabilization during craniomaxillofacial surgery. Ann Plast Surg 1991; 27:292. [PMID: 1952758 DOI: 10.1097/00000637-199109000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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16
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Rey JF, Legras B, Verdier A, Vicari F, Gorget C. Comparative study of sucralfate versus cimetidine in the treatment of acute gastroduodenal ulcer. Randomized trial with 667 patients. Am J Med 1989; 86:116-21. [PMID: 2660553 DOI: 10.1016/0002-9343(89)90171-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Six-hundred sixty-seven patients with endoscopically proven peptic ulcer were included in a randomized, multicenter trial to assess the comparative efficacy of sucralfate and cimetidine. One hundred eighty-seven patients with gastric ulcer and 480 patients with duodenal ulcer completed the study. Ulcer healing was evaluated endoscopically at six weeks for duodenal ulcer and at eight weeks for gastric ulcer. Patients with unhealed ulcer at this time were assigned to the other therapy for a second period of six or eight weeks of treatment (crossover). In patients with duodenal gastric ulcer, pain relief and healing were not significantly different in the two groups. Eighty-eight percent of duodenal ulcers and 73 percent of gastric ulcers healed with six weeks of sucralfate treatment. Reported side effects and symptoms, pooled together for duodenal and gastric ulcer, were more significant in the sucralfate group (7.5 percent) than in the cimetidine group (3.7 percent). Constipation was the most frequent symptom recorded. In conclusion, sucralfate and cimetidine are both excellent healing agents for short-term treatment of duodenal and gastric ulcer. Both give rapid relief of symptoms without severe side effects.
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Affiliation(s)
- J F Rey
- Club de Reflexion des Cabinets de Groupe de Gastro-Enterologie, St. Laurent du Var, France
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17
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Foliguet B, Vicari F, Guedenet JC, Korwin JDD, Marchal L, Jeanvoine G. Dépistage duCampylobacter pylori en microscopie électronique à balayage Etude chez 1 200 patients. ACTA ACUST UNITED AC 1987. [DOI: 10.1007/bf02968456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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18
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Vicari F, de Korwin JD, Ferry R, Schmitt J, Foliguet B, Marchal L, Conroy MC, Burdin JC, Duprez A. [Campylobacter pyloridis and chronic gastritis]. Gastroenterol Clin Biol 1986; 10:438-9. [PMID: 3732750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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19
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Castot A, Netter P, Arnaudo JP, Andrieu J, Vicari F, Ponge B, Wilhelm JM, Danan G, Trechot P, Frelon JH. [Pirprofen hepatitis with a favorable development. Apropos of 5 cases]. Therapie 1984; 39:297-303. [PMID: 6611604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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20
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Sainpy D, Boileau S, Vicari F. [Comparative study of intravenous midazolam and diazepam used as sedative agents during gastroscopy]. Ann Fr Anesth Reanim 1984; 3:177-80. [PMID: 6742536 DOI: 10.1016/s0750-7658(84)80049-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Midazolam was compared with diazepam for the intravenous sedation of gastroscopy patients. 0.1 mg X kg-1 midazolam were given to patients less than 65 years old, and 0.085 mg X kg-1 after that age; diazepam doses were 0,2 mg X kg-1 and 0.15 mg X kg-1 respectively. The effect and duration of action of both drugs were similar. The main differences between them were as follows: the intravenous injection of midazolam was not painful, and virtually no venous complications were seen; amnesia and patient contentedness were more frequent with midazolam; gastric secretion was reduced with midazolam. Neither drug had clinically significant cardiovascular effects.
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21
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Vicari F, Marlière P, Jacquier A, Laurent J, Jeanpierre R, Watrin B, Duprez A. [Contribution of per- and trans-endoscopic pH measurements to the exploration of the upper digestive tract (author's transl)]. Nouv Presse Med 1982; 11:1063-6. [PMID: 7079121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Per- and trans-endoscopic pH measurements in the upper digestive tract have provided new and interesting data. Performed by the authors on a series of 314 patients, they showed that the gastric pH is seldom acid, even in duodenal ulcer, and is always alkaline in gastric ulcer and gastric carcinoma. Gastritis may be divided into two groups, depending on whether the pH is normal or hypoacid (4.5 in the antrum, 2.5 in the fundus). Biopsies demonstrated the presence of intestinal metaplasia and epithelial dysplasia in 57.8% of 83 patients with hypoacid gastritis. The method therefore constitutes a simple and reliable means of determining markers of precancerous lesions.
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22
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Vicari F. Progress in the methods of endoscopic diagnosis in gastroenterology. Endoscopy 1980:19-34. [PMID: 6997026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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23
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Leclere J, Vicari F, Laurent J, Jeanpierre R, Floquet J, Grignon G, Hartemann P. [Islet cell tumor with diarrhea and diabetes (glucagonoma?) associated with hyperparathyroidism. Long-term results of local-regional treatment with streptozotocin]. Ann Endocrinol (Paris) 1977; 38:153-4. [PMID: 197871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A case report of endocrine pancreatic tumour associated with diabetes and hyperparathyroidism is presented. Some arguments are in favour of a glucagonoma. Despite the absence of beta-cells in tumour, an exceptional result was obtained by use of Streptozotocin. This case brings up the relations between endocrine pancreatic tumours and parathyroid, and may be included in polyglandular adenoma syndrome.
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Heully F, Gaucher P, Jeanpierre R, Laurent J, Vicari F, Gay G, Hodez C. [The endoscopic retrograde cholangiography: its interest for the study of the bile ducts after operation for lithiasis (author's transl)]. Acta Gastroenterol Belg 1973; 36:682-8. [PMID: 4788299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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25
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Bigard MA, Laurent J, Vicari F, Gaucher P, Heully F. [Emergency fibroscopy in upper digestive hemorrhage]. Ann Gastroenterol Hepatol (Paris) 1972; 8:317-28. [PMID: 4540665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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26
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Heully P, Gaucher P, Laurent J, Vicari F, Fays J, Bigard MA, Jeanpierre R. [Duodenoscopy and catheterization of the bile and pancreatic ducts]. Nouv Presse Med 1972; 1:313-8. [PMID: 5010446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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27
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Jeanpierre R, Laurent J, Bas M, Fays J, Dornier R, Bigard M, Vicari F, Gaucher P, Heully F. [Catheterization of Vater's ampulla during duodenoscopic examinations. Technics and results]. Arch Fr Mal App Dig 1971; 60:525-33. [PMID: 5159758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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28
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Bigard MA, Laurent J, Vicari F, Gaucher P, Heully F. [Emergency endoscopy in upper digestive hemorrhages]. Arch Fr Mal App Dig 1971; 60:263. [PMID: 5317004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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29
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Bessot M, Gillot C, Laurent J, Vicari F, Arbogast J, Heully F. [3 cases of cancer appearing on operated stomachs]. Sem Hop 1970; 46:1217-9. [PMID: 4315174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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30
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Heully F, Bessot M, Gaucher P, Vicari F, Laurent J, Dossmann J. [Primary cholangitis]. Arch Fr Mal App Dig 1969; 58:757-72. [PMID: 5400388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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31
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Schmitt J, Barrucand D, Vicari F. [Phantom abdominal tumor]. Cah Coll Med Hop Paris 1968; 9:107-8. [PMID: 5743008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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32
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Kissel P, Royer R, Vicari F. [Amitriptyline in the therapy of hiccup]. Bull Mem Soc Med Hop Paris 1967; 118:849-54. [PMID: 6056751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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33
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Vicari F, Dornier R, Gaucher P, Arnould P, Heully F. [The value of the magnetoscope in radiologic observation with the use of a brightness amplifier. Televized presentation of a sound magnetic montage]. Ann Med Nancy 1966; 5:50-53. [PMID: 5904216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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34
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Vicari F, Dornier R, Gaucher P, Arnould P, Jheully F. [Preliminary note on the contribution of cineradiography and magnetoscope to the study of physiologic behavior of the antral region of the stomach]. Ann Med Nancy 1966; 5:37-49. [PMID: 5904215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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35
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Heully F, Streiff F, Paysan P, Gaucher TP, Vicari F. [Digestive manifestations of agammaglobulinemia in adults. Apropos of 2 cases]. Arch Mal Appar Dig Mal Nutr 1965; 54:1013-23. [PMID: 5849518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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36
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