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Carrara M, Aubertin G, Khirani S, Massenavette B, Bierme P, Griffon L, Ioan I, Schweitzer C, Binoche A, Lampin ME, Mordacq C, Rubinsztajn R, Debeilleix S, Galode F, Bui S, Hullo E, Becourt A, Lubrano M, Moreau J, Renoux MC, Matecki S, Stremler N, Baravalle-Einaudi M, Mazenq J, Sigur E, Labouret G, Genevois AL, Heyman R, Pomedio M, Masson A, Hangard P, Menetrey C, Le Clainche L, Bokov P, Dudoignon B, Fleurence E, Bergounioux J, Mbieleu B, Breining A, Giovannin-Chami L, Fina A, Ollivier M, Gachelin E, Perisson C, Pervillé A, Barzic A, Cros P, Jokic M, Labbé G, Diaz V, Coutier L, Fauroux B, Taytard J. Pediatric long-term noninvasive respiratory support in children with central nervous system disorders. Pediatr Pulmonol 2024; 59:642-651. [PMID: 38088209 DOI: 10.1002/ppul.26796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/31/2023] [Accepted: 11/27/2023] [Indexed: 02/16/2024]
Abstract
RATIONALE The use of long-term noninvasive respiratory support is increasing in children along with an extension of indications, in particular in children with central nervous system (CNS) disorders. OBJECTIVE The aim of this study was to describe the characteristics of children with CNS disorders treated with long-term noninvasive respiratory support in France. METHODS Data were collected from 27 French pediatric university centers through an anonymous questionnaire filled for every child treated with noninvasive ventilatory support ≥3 months on 1st June 2019. MAIN RESULTS The data of 182 patients (55% boys, median age: 10.2 [5.4;14.8] years old [range: 0.3-25]) were collected: 35 (19%) patients had nontumoral spinal cord injury, 22 (12%) CNS tumors, 63 (35%) multiple disabilities, 26 (14%) central alveolar hypoventilation and 36 (20%) other CNS disorders. Seventy five percent of the patients were treated with noninvasive ventilation (NIV) and 25% with continuous positive airway pressure (CPAP). The main investigations performed before CPAP/NIV initiation were nocturnal gas exchange recordings, alone or coupled with poly(somno)graphy (in 29% and 34% of the patients, respectively). CPAP/NIV was started in an acute setting in 10% of the patients. Median adherence was 8 [6;10] hours/night, with 12% of patients using treatment <4 h/day. Nasal mask was the most common interface (70%). Airway clearance techniques were used by 31% of patients. CONCLUSION CPAP/NIV may be a therapeutic option in children with CNS disorders. Future studies should assess treatment efficacy and patient reported outcome measures.
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Affiliation(s)
- Marion Carrara
- Department of Pediatric Pulmonology, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Guillaume Aubertin
- Department of Pediatric Pulmonology, AP-HP, Hôpital Armand Trousseau, Paris, France
- Sorbonne Université, INSERM UMR-S 938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
- Centre de pneumologie de l'enfant, Ramsay Générale de Santé, Paris, France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- Université Paris Cité, VIFASOM, Paris, France
- ASV Santé, Gennevilliers, France
| | - Bruno Massenavette
- Pediatric Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - Priscille Bierme
- Pediatric Pulmonology and Allergology Unit, Hospices Civils de Lyon, Bron, France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- Université Paris Cité, VIFASOM, Paris, France
| | - Iulia Ioan
- Department of Pediatric, University Children's Hospital, CHRU Nancy; Université de Lorraine, DevAH, Nancy, France
| | - Cyril Schweitzer
- Department of Pediatric, University Children's Hospital, CHRU Nancy; Université de Lorraine, DevAH, Nancy, France
| | - Alexandra Binoche
- Pediatric Intensive Care Unit, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Marie-Emilie Lampin
- Pediatric Intensive Care Unit, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Clémence Mordacq
- Pediatic Pulmonology and Allergology Unit, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Robert Rubinsztajn
- Department of Pediatric orthopedic surgery, Hôpital Necker-Enfants malades, Paris, France
| | | | - François Galode
- Pediatric Pulmonology Unit, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - Stéphanie Bui
- Pediatric Pulmonology Unit, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - Eglantine Hullo
- Pediatric Pulmonology Unit, Hôpital Couple-Enfant, CHU Grenoble, Grenoble, France
| | - Arnaud Becourt
- Pediatric Pulmonology Department, CHU Amiens Picardie, Amiens, France
| | - Marc Lubrano
- Respiratory Diseases, Allergy and CF Unit, Department of Pediatric, University Hospital Charles Nicolle, Rouen, France
| | - Johan Moreau
- Department of Pediatric Cardiology and Pulmonology, Montpellier University Hospital, Montpellier, France
- Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, Montpellier, France
| | - Marie-Catherine Renoux
- Department of Pediatric Cardiology and Pulmonology, Montpellier University Hospital, Montpellier, France
| | - Stefan Matecki
- Department of Pediatric Cardiology and Pulmonology, Montpellier University Hospital, Montpellier, France
- Functional Exploration Laboratory, University Hospital, Montpellier, France
| | - Nathalie Stremler
- Pediatric Ventilation Unit, Department of Pediatric, AP-HM, Hôpital La Timone, Marseille, France
| | | | - Julie Mazenq
- Pediatric Ventilation Unit, Department of Pediatric, AP-HM, Hôpital La Timone, Marseille, France
| | - Elodie Sigur
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, Toulouse, France
| | - Géraldine Labouret
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, Toulouse, France
| | - Anne-Laure Genevois
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, Toulouse, France
| | - Rachel Heyman
- Pediatric Unit, Department of Physical Medicine and Rehabilitation, Hôpital Pontchaillou, Rennes, France
| | - Michael Pomedio
- Pediatric Intensive Care Unit, American Memorial Hospital, CHU Reims, Reims, France
| | - Alexandra Masson
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, Limoges, France
| | - Pauline Hangard
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, Limoges, France
| | - Céline Menetrey
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, Limoges, France
| | - Laurence Le Clainche
- Pediatric Noninvasive Ventilation Unit, AP-HP, Hôpital Robert Debré, Paris, France
| | - Plamen Bokov
- Pediatric Noninvasive Ventilation Unit, AP-HP, Hôpital Robert Debré, Paris, France
- Université Paris Cité, INSERM NeuroDiderot, Paris, France
| | - Benjamin Dudoignon
- Pediatric Noninvasive Ventilation Unit, AP-HP, Hôpital Robert Debré, Paris, France
| | | | - Jean Bergounioux
- Pediatric Intensive Care Unit, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Blaise Mbieleu
- Pediatric Intensive Care Unit, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | | | - Lisa Giovannin-Chami
- Department of Pediatric Pulmonology and Allergology, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Agnes Fina
- Department of Pediatric Pulmonology and Allergology, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | | | - Elsa Gachelin
- Department of Pediatric, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Caroline Perisson
- Department of Pediatric, CHU Sud Réunion, Saint Pierre, La Réunion, France
| | - Anne Pervillé
- Department of Pédiatrics, Hôpital d'Enfants-ASFA, Saint Denis, La Réunion, France
| | | | | | - Mickaël Jokic
- Pediatric Intensive Care Unit, CHU de Caen Normandie, Caen, France
| | - Guillaume Labbé
- Pediatric Pulmonology and Allergology Unit, CHU d'Estaing, Clermont-Ferrand, France
| | - Véronique Diaz
- Department of Respiratory Physiology, CHU Poitiers, Poitiers, France
| | - Laurianne Coutier
- Pediatric Pulmonology and Allergology Unit, Hospices Civils de Lyon, Bron, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- Université Paris Cité, VIFASOM, Paris, France
| | - Jessica Taytard
- Department of Pediatric Pulmonology, AP-HP, Hôpital Armand Trousseau, Paris, France
- INSERM UMR-S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Sorbonne Université, Paris, France, Paris, France
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Fauroux B, Khirani S, Amaddeo A, Massenavette B, Bierme P, Taytard J, Stremler N, Baravalle-Einaudi M, Mazenq J, Ioan I, Schweitzer C, Lampin ME, Binoche A, Mordacq C, Bergounioux J, Mbieleu B, Rubinsztajn R, Sigur E, Labouret G, Genevois A, Becourt A, Hullo E, Pin I, Debelleix S, Galodé F, Bui S, Moreau J, Renoux MC, Matecki S, Lavadera ML, Heyman R, Pomedio M, Le Clainche L, Bokov P, Masson A, Hangard P, Menetrey C, Jokic M, Gachelin E, Perisson C, Pervillé A, Fina A, Giovannini-Chami L, Fleurence E, Barzic A, Breining A, Ollivier M, Labbé G, Coutier L, Aubertin G. Paediatric long term continuous positive airway pressure and noninvasive ventilation in France: A cross-sectional study. Respir Med 2021; 181:106388. [PMID: 33848922 DOI: 10.1016/j.rmed.2021.106388] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 09/03/2020] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe the characteristics of children treated with long term continuous positive airway pressure (CPAP) or noninvasive ventilation (NIV) in France. DESIGN Cross-sectional national survey. SETTING Paediatric CPAP/NIV teams of 28 tertiary university hospitals in France. PATIENTS Children aged <20 years treated with CPAP/NIV since at least 3 months on June 1st, 2019. INTERVENTION An anonymous questionnaire was filled in for every patient. RESULTS The data of 1447 patients (60% boys), mean age 9.8 ± 5.8 years were analysed. The most frequent underlying disorders were: upper airway obstruction (46%), neuromuscular disease (28%), disorder of the central nervous system (13%), cardiorespiratory disorder (7%), and congenital bone disease (4%). Forty-five percent of the patients were treated with CPAP and 55% with NIV. Treatment was initiated electively for 92% of children, while 8% started during an acute illness. A poly(somno)graphy (P(S)G) was performed prior to treatment initiation in 26%, 36% had a P(S)G with transcutaneous carbon dioxide monitoring (PtcCO2), while 23% had only a pulse oximetry (SpO2) with PtcCO2 recording. The decision of CPAP/NIV initiation during an elective setting was based on the apnea-hypopnea index (AHI) in 41% of patients, SpO2 and PtcCO2 in 25% of patients, and AHI with PtcCO2 in 25% of patients. Objective adherence was excellent with a mean use of 7.6 ± 3.2 h/night. Duration of CPAP/NIV was 2.7 ± 2.9 years at the time of the survey. CONCLUSION This survey shows the large number of children treated with long term CPAP/NIV in France with numerous children having disorders other than neuromuscular diseases.
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Affiliation(s)
- Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France; Université de Paris, VIFASOM, F-75004, Paris, France.
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France; Université de Paris, VIFASOM, F-75004, Paris, France; ASV Santé, F-92000, Gennevilliers, France
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants Malades, F-75015, Paris, France; Université de Paris, VIFASOM, F-75004, Paris, France
| | - Bruno Massenavette
- Paediatric Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, 69677, Bron, France
| | - Priscille Bierme
- Pediatric Pulmonology and Allergology Unit, Hospices Civils de Lyon, 69677, Bron, France
| | - Jessica Taytard
- Pediatric Pulmonology Department, AP-HP, Hôpital Armand Trousseau, F-75012, Paris, France; Sorbonne Université, INSERM UMR-S, 1158, Paris, France
| | - Nathalie Stremler
- Pediatric Ventilation Unit, Pediatric Department, AP-HM, Hôpital La Timone, 13385, Marseille, France
| | | | - Julie Mazenq
- Pediatric Ventilation Unit, Pediatric Department, AP-HM, Hôpital La Timone, 13385, Marseille, France
| | - Iulia Ioan
- Pediatric Department, University Children's Hospital, CHRU Nanc, Université de Lorraine, DevAH, F-54000, Nancy, France
| | - Cyril Schweitzer
- Pediatric Department, University Children's Hospital, CHRU Nanc, Université de Lorraine, DevAH, F-54000, Nancy, France
| | - Marie Emilie Lampin
- Pediatric Intensive Care Unit, Hôpital Jeanne de Flandre, CHU Lille, Avenue Eugène Avinée, 59037, Lille Cédex, France
| | - Alexandra Binoche
- Pediatric Intensive Care Unit, Hôpital Jeanne de Flandre, CHU Lille, Avenue Eugène Avinée, 59037, Lille Cédex, France
| | - Clemence Mordacq
- Pediatic Pulmonology and Allergology Unit, Hôpital Jeanne de Flandre, CHU Lille, Avenue Eugène Avinée, 59037, Lille Cédex, France
| | - Jean Bergounioux
- Pediatric Intensive Care Unit, AP-HP, Hôpital Raymond Poincaré, F-92380, Garches, France
| | - Blaise Mbieleu
- Pediatric Intensive Care Unit, AP-HP, Hôpital Raymond Poincaré, F-92380, Garches, France
| | | | - Elodie Sigur
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, 31000, Toulouse, France
| | - Geraldine Labouret
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, 31000, Toulouse, France
| | - Aline Genevois
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, 31000, Toulouse, France
| | - Arnaud Becourt
- Pediatric Pulmonology, CHU Amiens Picardie, 80054, France
| | - Eglantine Hullo
- Pediatric Pulmonology Unit, Hôpital Couple-Enfant, CHU Grenoble, 38000, Grenoble, France
| | - Isabelle Pin
- Pediatric Pulmonology Unit, Hôpital Couple-Enfant, CHU Grenoble, 38000, Grenoble, France; INSERM, Institute for Advanced Biosciences, 38000, Grenoble, France; Grenoble Alpes University, 38000, Grenoble, France
| | - Stéphane Debelleix
- Pediatric Pulmonology Unit, Hôpital Pellegrin-Enfants, CIC-P Bordeaux 1401, CHU de Bordeaux, 33076, Bordeaux, France
| | - François Galodé
- Pediatric Pulmonology Unit, Hôpital Pellegrin-Enfants, CIC-P Bordeaux 1401, CHU de Bordeaux, 33076, Bordeaux, France
| | - Stéphanie Bui
- Pediatric Pulmonology Unit, Hôpital Pellegrin-Enfants, CIC-P Bordeaux 1401, CHU de Bordeaux, 33076, Bordeaux, France
| | - Johan Moreau
- Pediatric Cardiology and Pulmonology Department, Montpellier University Hospital, 34000, Montpellier, France; Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, 34000, Montpellier, France
| | - Marie Catherine Renoux
- Pediatric Cardiology and Pulmonology Department, Montpellier University Hospital, 34000, Montpellier, France
| | - Stefan Matecki
- Pediatric Cardiology and Pulmonology Department, Montpellier University Hospital, 34000, Montpellier, France; Functional Exploration Laboratory, Physiology Department, University Hospital, 34000, Montpellier, France
| | - Marc Lubrano Lavadera
- Respiratory Diseases, Allergy and CF Unit, Pediatric Department, University Hospital Charles Nicolle, 76000, Rouen, France
| | - Rachel Heyman
- Pediatric Unit, Department of Physical Medicine and Rehabilitation, Hôpital Pontchaillou, Rennes, 35033, Rennes, France
| | - Michael Pomedio
- Pediatric Intensive Care Unit, American Memorial Hospital, CHU Reims, 51000, Reims, France
| | - Laurence Le Clainche
- Pediatric Noninvasive Ventilation, AP-HP, Hôpital Robert Debré, F-75018, Paris, France
| | - Plamen Bokov
- Pediatric Noninvasive Ventilation, AP-HP, Hôpital Robert Debré, F-75018, Paris, France
| | - Alexandra Masson
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, 87042, Limoges, France
| | - Pauline Hangard
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, 87042, Limoges, France
| | - Celine Menetrey
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, 87042, Limoges, France
| | - Mikael Jokic
- Pediatric Intensive Care Unit, CHU de Caen Normandie, 14033, Caen, France
| | - Elsa Gachelin
- Pediatric Department, CHU Félix Guyon, F-97404, Saint Denis, La Réunion, France
| | - Caroline Perisson
- Pediatric Department, CHU Sud Réunion, F-97448, Saint Pierre, La Réunion, France
| | - Anne Pervillé
- Hôpital d'Enfants - ASFA, F-97404, Saint Denis, La Réunion, France
| | - Agnes Fina
- Pediatric Pulmonology and Allergology Department, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France
| | - Lisa Giovannini-Chami
- Pediatric Pulmonology and Allergology Department, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France
| | | | - Audrey Barzic
- Pediatric Department, CHU Brest, 29200, Brest, France
| | - Audrey Breining
- Pediatric Department, CHU Strasbourg, 67000, Strasbourg, France
| | - Morgane Ollivier
- Pediatric Intensive Care Unit, CHU Angers, 49100, Angers, France
| | - Guillaume Labbé
- Pediatric Pulmonology and Allergology Unit, CHU d'Estaing, 63003, Clermont-Ferrand, France
| | - Laurianne Coutier
- Paediatric Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, 69677, Bron, France
| | - Guillaume Aubertin
- Pediatric Pulmonology and Allergology Unit, Hospices Civils de Lyon, 69677, Bron, France; Sorbonne Université, INSERM UMR-S 938, Centre de Recherche Saint-Antoine (CRSA), F-75014, Paris, France; Centre de Pneumologie de l'enfant, Ramsay Générale de Santé, 92100, Boulogne-Billancourt, France
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Gaillard F, Cretual A, Cordillet S, Le Cornec C, Gonthier C, Bouvier B, Heyman R, Marleix S, Bonan I, Rauscent H. Kinematic motion abnormalities and bimanual performance in children with unilateral cerebral palsy. Dev Med Child Neurol 2018; 60:839-845. [PMID: 29701242 DOI: 10.1111/dmcn.13774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the relationship between the movement abnormalities of the impaired upper limb in children with unilateral cerebral palsy (CP) and bimanual performance. METHOD Twenty-three children with unilateral CP (mean age 11y 10mo [SD 2y 8mo]) underwent evaluation of bimanual performance (Assisting Hand Assessment [AHA]) and a three-dimensional movement analysis to measure deviations in the movement of their affected upper limb, and compared with 23 typically developing children (TDC) (mean age 11y 11mo [SD 2y 5mo]). Kinematic indices, such as the Global Arm Profile Score (APS), which summarizes the global movement deviation of the upper limb from the norm, and the Global Arm Variable Score (AVS), which represent movement deviations for a given joint, were calculated and correlated to AHA. RESULTS Values of kinematic indices were significantly higher in children with unilateral CP than in TDC. A strong correlation between Global-APS and AHA score (r=-0.75) was found. Other significant correlations were found with Global-AVS, especially in distal joints. INTERPRETATION Children with unilateral CP had more movement deviations than TDC. The global movement deviation of the impaired upper limb was strongly correlated with bimanual performance. The influence of distal abnormalities confirms the importance of considering these limitations in therapeutics. WHAT THIS PAPER ADDS Children with unilateral cerebral palsy had more movement deviations than typically developing children in unimanual tasks. A strong relationship was found between movement deviations of the impaired upper limb and bimanual performance.
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Affiliation(s)
- Florence Gaillard
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France.,M2S Lab (Mouvement Sport Santé), Université Rennes 2, ENS Rennes, UEB, Bruz, France
| | - Armel Cretual
- M2S Lab (Mouvement Sport Santé), Université Rennes 2, ENS Rennes, UEB, Bruz, France
| | - Sebastien Cordillet
- M2S Lab (Mouvement Sport Santé), Université Rennes 2, ENS Rennes, UEB, Bruz, France
| | - Caroline Le Cornec
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France
| | | | - Brice Bouvier
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France.,M2S Lab (Mouvement Sport Santé), Université Rennes 2, ENS Rennes, UEB, Bruz, France
| | - Rachel Heyman
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France
| | | | - Isabelle Bonan
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France.,M2S Lab (Mouvement Sport Santé), Université Rennes 2, ENS Rennes, UEB, Bruz, France
| | - Hélène Rauscent
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France
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Beaufils J, Damphousse M, Rauscent H, Heyman R, Bonan I. [Preliminary study: Lower urinary tract dysfunction and anorectal disorders in children with cerebral palsy]. Prog Urol 2015; 25:565-75. [PMID: 26116407 DOI: 10.1016/j.purol.2015.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 07/29/2014] [Revised: 04/28/2015] [Accepted: 05/26/2015] [Indexed: 11/16/2022]
Abstract
GOAL Describe lower urinary tract dysfunction and anorectal disorders to children with cerebral palsy (CP), indicating their impact on quality of life. MATERIALS This was a prospective single-center study. A data collection was: type of PC, Gross Motor Function-Classification System (GMF-CS), mainstream education or not, Functional Independence Measure in children (MIF-kid), standardized vesicosphincteric symptoms and quality of life questionnaires (specific issue of impact sphincter dysfunction and generic scale Kidscreen-52). RESULTS Between January and March 2013, 19 children aged 5-17 years were included, including 16 into mainstream schooling. Of the 19, 16 had bladder and sphincter disorders: 14 urinary incontinence, 3 nycturies, 6 dysuria, 12 urgenturies, no urinary infection. Of the 14 urinary incontinence, 13 were in school. Of the 16 children enrolled, 5 were daytime fecal incontinence and 2 nocturnal fecal incontinence. Functional scores (GMF-CS and MIF-kid) children urinary incontinence were lower than those of children urinary continents (P=0.04 and 0.0007). Ten children had an impact of these disorders on quality of life. All were enrolled, eight (80%) in the mainstream. CONCLUSION The bladder and sphincter disorders were common in children with CP. They led to an impact on quality of life in more than half of the children studied, mostly educated in mainstream schools.
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Affiliation(s)
- J Beaufils
- Service de médecine physique et réadaptation enfant, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
| | - M Damphousse
- Service de médecine physique et réadaptation adulte, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - H Rauscent
- Service de médecine physique et réadaptation enfant, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - R Heyman
- Service de médecine physique et réadaptation enfant, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - I Bonan
- Service de médecine physique et réadaptation adulte, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France
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Hager JH, Darimont B, Joseph J, Govek S, Grillot K, Aparicio A, Bischoff E, Kahraman M, Kaufman J, Lai A, Lee KJ, Lu N, Nagasawa J, Prudente R, Qian J, Sensintaffar J, Shao G, Heyman R, Rix P, Smith ND. Abstract P6-04-12: Novel selective estrogen receptors degraders regress tumors in pre-clinical models of endocrine-resistant breast cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-04-12] [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: 11/16/2022]
Abstract
Abstract
80% of all breast cancers express the estrogen receptor alpha (ERα) and thus are treated with anti-hormonal therapies that directly block ER function (e.g. Tamoxifen) or hormone synthesis (Aromatase Inhibitors). While these therapies are initially effective, acquired resistance invariably emerges. Importantly, the majority of these tumors continue to depend on ERα for growth and survival. The emerging evidence that ERα can signal in both a ligand-dependent and ligand-independent manner supports the development of agents that are not only competitive ERα antagonists but also reduce steady state levels of the receptor and thus limit both modes of signaling.
We have identified novel, non-steroidal ERα antagonists that induce degradation of ERα in breast cancer cell lines at picomolar concentrations resulting in significant reduction in steady state ERα protein levels. Using peptide-based conformational profiling, we show that these Selective Estrogen Receptor Degraders (SERDs) induce estrogen receptor conformations that are distinct from both fulvestrant and tamoxifen indicating a unique mechanism of action. This unique biological profile coupled with good oral pharmacokinetics produces tumor regressions in both tamoxifen-sensitive and -resistant models of breast cancer in vivo. Recent pre-clinical and clinical data indicate that PI3K pathway signaling can contribute to the endocrine resistant state. In a preclinical model of tamoxifen resistant breast cancer in which SERD monotherapy only produces tumor growth inhibition, SERD therapy in combination with torc1/2 inhibition results in frank tumor regressions. These orally bioavailable SERDs hold promise as a next generation therapy for the treatment of ER+ breast cancer as monotherapy, as well as in combination with agents that target other pathways involved in both intrinsic and acquired endocrine resistance.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-04-12.
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Affiliation(s)
- JH Hager
- Aragon Pharmaceuticals, San Diego, CA
| | | | - J Joseph
- Aragon Pharmaceuticals, San Diego, CA
| | - S Govek
- Aragon Pharmaceuticals, San Diego, CA
| | - K Grillot
- Aragon Pharmaceuticals, San Diego, CA
| | | | | | | | - J Kaufman
- Aragon Pharmaceuticals, San Diego, CA
| | - A Lai
- Aragon Pharmaceuticals, San Diego, CA
| | - K-J Lee
- Aragon Pharmaceuticals, San Diego, CA
| | - N Lu
- Aragon Pharmaceuticals, San Diego, CA
| | | | | | - J Qian
- Aragon Pharmaceuticals, San Diego, CA
| | | | - G Shao
- Aragon Pharmaceuticals, San Diego, CA
| | - R Heyman
- Aragon Pharmaceuticals, San Diego, CA
| | - P Rix
- Aragon Pharmaceuticals, San Diego, CA
| | - ND Smith
- Aragon Pharmaceuticals, San Diego, CA
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6
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Robert G, Heyman R, Curt M, Rauscent H, Bonan I. Syndromes douloureux chroniques rhumatologiques inexpliquées (SdCRI) chez l’enfant : prise en charge multidisciplinaire au sein du service de médecine physique et réadaptation. Arch Pediatr 2012. [DOI: 10.1016/j.arcped.2012.03.044] [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: 11/30/2022]
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7
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Lyakhovitsky A, Barzilai A, Heyman R, Baum S, Amichai B, Solomon M, Shpiro D, Trau H. Low-dose methotrexate treatment for moderate-to-severe atopic dermatitis in adults. J Eur Acad Dermatol Venereol 2009; 24:43-9. [PMID: 19552716 DOI: 10.1111/j.1468-3083.2009.03351.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a common inflammatory skin disease. Methotrexate (MTX) was suggested as an effective treatment option in cases of moderate-to-severe atopic dermatitis. This study assessed the efficacy and safety of treatment with low weekly doses of methotrexate for moderate-to-severe AD in adults. METHODS Twenty adult patients with moderate-to-severe AD were included in this retrospective study. Those patients were unresponsive to topical treatments, antihistamines and at least one of the second-line treatments. MTX in low weekly doses of 10-25 mg was administered orally or intramuscularly with folic acid supplementation 5 mg per week for at least 8-12 weeks. The response to treatment was evaluated by change in SCORAD (SCORing Atopic Dermatitis), DLQI (Dermatology Quality of Life Index) and the global assessment of the clinical response score. RESULTS After 8-12 weeks of treatment, we observed an objective response in most patients. There were 16 responders and 4 non-responders. The mean SCORAD and DLQI decreased by 28.65 units (44.3%) and 10.15 units (43.5%), respectively. The first improvement was observed after a period ranging from 2 weeks to 3 months (mean 9.95 w +/- 3.17). Treatment was more effective in adult onset AD than in childhood onset. Tolerance of treatment was good. However, nausea and an increase of liver enzymes were observed in 5 patients and 3 of them required a transient discontinuation of MTX. One patient developed peripheral neuropathy, which was resolved several weeks after the discontinuation of MTX. CONCLUSION MTX seems to be an effective and safe second-line treatment for patients with moderate-to-severe atopic dermatitis. A randomized, controlled study is warranted.
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Affiliation(s)
- A Lyakhovitsky
- Sheba Medical Center - Dermatology Department, Tel-Hashomer, Ramat-Gan, Israel.
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8
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9
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Abstract
Abstract
OBJECTIVE:
Epidural hematoma (EDH) in newborn infants is rare. We have described the history of 15 newborns with EDH to provide a better understanding of this pathology.
METHODS:
This is a descriptive case series study using a retrospective review of the medical records of newborns who were admitted to the Pediatric Intensive Care Unit and Neurosurgery Department with the diagnosis of birth EDH over a 24-year period (1979–2002).
RESULTS:
There was no sex predominance, and most of the mothers were young, nulliparous women. The time latency from birth to the first signs varied from 0 to 24 hours. Clinical presentation was nonspecific: seizures and hypotonia were the main symptoms. The parietal area was the most frequent location. Surgical drainage was required in nine patients, and no deaths were reported.
CONCLUSION:
This report highlights the clinicoradiological characteristics of newborn EDH, which occurs more frequently in newborns that experienced difficult delivery from a nulliparous mother. Surgery is not a rule; some patients can be managed with conservative treatment. The outcome is generally good.
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Affiliation(s)
- Rachel Heyman
- Department of Pediatrics, CHRU Pontchaillou, Rennes, France
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Heyman R, Minjolle S, Lefrançois C, Colimon R, Le Gall E. P71 Néonatologie Transmission materno-fœtale et pathogenicite du virus HHV-6 en periode neo-natale. Arch Pediatr 2003. [DOI: 10.1016/s0929-693x(03)90583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Abstract
A 53-year-old man presented with optic neuritis, followed within 10 weeks by a subacute progression of weakness, ataxia, and multiple cranial nerve palsies. Cranial magnetic resonance imaging demonstrated multiple T2-hyperintense lesions extending from the ponto-medullary junction to the thalamus and internal capsule. Cerebrospinal fluid analysis showed lymphocytic pleocytosis with elevated protein content. A brain biopsy revealed inflammatory changes. After a month long period of inexorable worsening, the patient was treated with intravenous immunoglobulins (2 g/kg). He responded to treatment, and recovered over the subsequent 3 months. The patient's response to treatment suggests that intravenous immunoglobulins should be considered in patients with inflammatory brain disorders.
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Affiliation(s)
- S A Zivković
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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12
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Emilsson V, O'Dowd J, Wang S, Liu YL, Sennitt M, Heyman R, Cawthorne MA. The effects of rexinoids and rosiglitazone on body weight and uncoupling protein isoform expression in the Zucker fa/fa rat. Metabolism 2000; 49:1610-5. [PMID: 11145125 DOI: 10.1053/meta.2000.18692] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Agonists for the retinoid X receptor (RXR), the rexinoids, and the peroxisome proliferator-activated receptor gamma (PPARgamma), the thiazolidinediones, are effective in the treatment of insulin resistance in rodent models by enhancing insulin action and improving glycemic control. In the present study, we compared the effects of rexinoids and a thiazolidinedione on body weight and mitochondrial uncoupling protein (UCP) isoform mRNA expression in the obese Zucker fa/fa rat. Long-term (2 weeks) oral treatment with the rexinoids LG100268 and LG100324 reduced food intake and body weight gain, whereas rosiglitazone (BRL49653) tended to increase both food intake and weight gain. LG100268 and LG100324 increased brown adipose tissue (BAT) UCP-1 mRNA content by 2.7-fold (P < .002) and 3.1-fold (P < .001), respectively, while BRL49653 had no effect on BAT UCP-1 mRNA content. Neither the rexinoids nor the thiazolidinedione had any effect on the level of mRNA encoding UCP-2 and the recently described PPARgamma coactivator-1 (PGC-1). LG100324 increased UCP-3 mRNA content by 3.6-fold (P < .0005) in muscle and 4.3-fold (P < .0002) in white adipose tissue (WAT). LG100268 increased UCP-3 mRNA content in WAT by 2-fold (P < .005) but was without any effect on muscle UCP-3. BRL49653 increased UCP-3 mRNA content by 2.1-fold (P < .005) in muscle and 2.7-fold (P < .003) in WAT. Thus, the rexinoids, but not the thiazolidinedione, have an antiobesity action by reducing food intake, and the increase in UCP-1 mRNA content in BAT may reflect a stimulation of BAT UCP-1 activity.
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Affiliation(s)
- V Emilsson
- Clore Laboratory, Buckingham University, UK
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13
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Sartain SA, Clarke CL, Heyman R. Hearing the voices of children with chronic illness. J Adv Nurs 2000; 32:913-21. [PMID: 11095230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
This qualitative study has aimed to explore children's, parents' and health professionals' experience of childhood chronic illness. Seven families and their professional carers participated in semistrucured interviews. The children's interviews were augmented with a 'drawing' technique. A grounded theory approach facilitated data collection and analysis. This paper debates the perceived passivity of the voice of children in health care and research and illustrates data collection methods that seek to give children and other disadvantaged groups a voice. The children who participated in this study are described as competent interpreters of their world.
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Affiliation(s)
- S A Sartain
- Faculty of Health, Social Work and Education, University of Northumbria at Newcastle, England
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14
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Niranjan A, Kondziolka D, Baser S, Heyman R, Lunsford LD. Functional outcomes after gamma knife thalamotomy for essential tremor and MS-related tremor. Neurology 2000; 55:443-6. [PMID: 10932286 DOI: 10.1212/wnl.55.3.443] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [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: 11/15/2022] Open
Abstract
Twelve patients with a median age of 75 years underwent gamma knife thalamotomy for essential tremor (ET) (n = 9) or MS-related tremor (n = 3). All 11 evaluable patients noted improvement in action tremor. Six of eight ET patients had complete tremor arrest, and the violent action tremor in all three patients with MS was improved. One patient developed transient arm weakness. Stereotactic radiosurgery for ET and MS-related tremor is safe and effective for patients who may be poor candidates for other procedures.
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Affiliation(s)
- A Niranjan
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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15
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Lefebvre AM, Chen I, Desreumaux P, Najib J, Fruchart JC, Geboes K, Briggs M, Heyman R, Auwerx J. Activation of the peroxisome proliferator-activated receptor gamma promotes the development of colon tumors in C57BL/6J-APCMin/+ mice. Nat Med 1998; 4:1053-7. [PMID: 9734399 DOI: 10.1038/2036] [Citation(s) in RCA: 484] [Impact Index Per Article: 18.6] [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: 12/18/2022]
Abstract
The development of colorectal cancer, one of the most frequent cancers, is influenced by prostaglandins and fatty acids. Decreased prostaglandin production, seen in mice with mutations in the cyclooxygenase 2 gene or in animals and humans treated with cyclooxygenase inhibitors, prevents or attenuates colon cancer development. There is also a strong correlation between the intake of fatty acids from animal origin and colon cancer. Therefore, the peroxisome proliferator-activated receptor gamma (PPARgamma), a downstream transcriptional mediator for prostaglandins and fatty acids which is highly expressed in the colon may be involved in this process. Activation of PPARgamma by two different synthetic agonists increased the frequency and size of colon tumors in C57BL/6J-APCMin/+ mice, an animal model susceptible to intestinal neoplasia. Tumor frequency was only increased in the colon, and did not change in the small intestine, coinciding with the colon-restricted expression of PPARgamma. Treatment with PPARgamma agonists increased beta-catenin levels both in the colon of C57BL/61-APCMin/+ mice and in HT-29 colon carcinoma cells. Genetic abnormalities in the Wnt/wingless/APC pathway, which enhance the transcriptional activity of the beta-catenin-T-cell factor/lymphoid enhancer factor 1 transcription complex, often underly the development of colon tumors. Our data indicate that PPARgamma activation modifies the development of colon tumors in C57BL/61-APCMin/+ mice.
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Affiliation(s)
- A M Lefebvre
- LBRE, U.325 INSERM, Département d'Athérosclérose, Institut Pasteur, Lille, France
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Abstract
OBJECTIVE We administered an acute psychological stressor to multiple sclerosis (MS) patients and normal controls to determine whether differences in subjective and physiological responses to stress may underlie the susceptibility of MS patients to stress-related exacerbations. METHOD Twenty-five MS patients (18 female, 7 male) and 25 age- and gender-matched controls participated in the study. They were asked to give a 5-minute videotaped speech defending themselves in a hypothetical scenario in which they were wrongly accused of stealing. Subjective and autonomic responses were monitored, and blood was sampled at baseline, 5, 20, and 60 minutes after the stressor to assess mitogen-stimulated production of interleukin-1beta(IL-1beta), interleukin-4 (IL-4), tumor necrosis factor-alpha (TNF-alpha), and interferon-gamma (IFN-gamma). RESULTS MS patients and controls demonstrated similar subjective and physiological responses to the stressor that were independent of gender, mood, and disability status. The macrophage-derived cytokines IL-1beta and TNF-alpha were increased during the stressor, and remained elevated through 60 minutes. Th1 lymphocyte-derived IFN-gamma production also was increased at 5 and 60 minutes relative to baseline; however, there was no change in the Th2 lymphocyte-derived cytokine IL-4. CONCLUSIONS These results favor the hypothesis that MS patients do not differ in stress response from normal controls; however, psychological stress may enhance cellular immune responses that would be potentially harmful to MS patients.
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Affiliation(s)
- K D Ackerman
- The Brain, Behavior and Immunity Center, Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA
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17
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Byrne G, Heyman R. Patient anxiety in the accident and emergency department. J Clin Nurs 1997; 6:289-95. [PMID: 9274230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Structured interviews were carried out with a sample of 96 patients to identify the sources of anxiety for patients in the accident and emergency (A & E) department. Only two patients reported that they were not at all anxious about any aspect of being in A & E. The average number of anxieties reported was 6.9. The most frequently reported anxieties were 'not being able to carry on your usual activities', 'not knowing what will happen to you in the department', 'having to undergo an uncomfortable procedure', 'feeling pain' and 'not knowing what is wrong'. The findings indicate that patients were as concerned with psychological and social aspects associated with admission as they were about physical factors. The authors suggest that it is essential for nurses in A & E to assess patients holistically and consider their psychological state and social circumstances as well as their physical condition. There is also a need for closer links to be developed between accident and emergency departments and other community health agencies and for more emphasis to be placed on referral to other bodies.
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Affiliation(s)
- G Byrne
- University & Herbfordshire Hatfield Campus, Hatfield Herts, UK
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18
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Abstract
Much research has examined the nature and duration of nurse-patient communication. However, few studies sufficiently acknowledge the extent to which communication is influenced by the meanings and perceptions of those involved or the social context in which it occurs. This paper reports on a study which used in-depth interviews with 21 nurses in two accident and emergency departments to explore how their perceptions of their work and patients influenced communication and the way in which patients' anxieties were addressed. A grounded theory approach was used to guide the process of data collection and analysis, and interpretation of findings discussed with reference to a symbolic interactionist perspective. The core category was identified as 'Defining the role of the accident and emergency department nurse'. This category illuminates the nurses' perception of their role and purpose as being primarily concerned with dealing with emergencies and providing urgent physical care. Two other categories, 'Nurses' priorities and patients' anxieties' and 'Keeping the department running smoothly', delineate the impact this view had on the organization and delivery of nursing care in accident and emergency departments and its effect on nurse-patient communication.
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Affiliation(s)
- G Byrne
- Adult Nursing (South) Division, University of Hertfordshire, Hatfield, England
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19
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Miller VA, Benedetti FM, Rigas JR, Verret AL, Pfister DG, Straus D, Kris MG, Crisp M, Heyman R, Loewen GR, Truglia JA, Warrell RP. Initial clinical trial of a selective retinoid X receptor ligand, LGD1069. J Clin Oncol 1997; 15:790-5. [PMID: 9053506 DOI: 10.1200/jco.1997.15.2.790] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.2] [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: 02/03/2023] Open
Abstract
PURPOSE The retinoid response is mediated by nuclear receptors, including retinoic acid receptors (RARs) and retinoid "X" receptors (RXRs). All-trans retinoic acid (RA) binds only RARs, while 9-cis RA is an agonist for both RARs and RXRs. Recently, LGD1069 was identified as a highly selective RXR agonist with low affinity for RARs. We undertook a dose-ranging study to examine the safety, clinical tolerance, and pharmacokinetics of LGD1069 in patients with advanced cancer. PATIENTS AND METHODS Fifty-two patients received. LGD1069 administered orally once daily at doses that ranged from 5 to 500 mg/m2 for 1 to 41 weeks. Treatment proceeded from a starting dose of 5 mg/m2. Pharmacokinetic sampling was performed on selected patients on days 1, 15, and 29. RESULTS Reversible, asymptomatic increases in liver biochemical tests were the most common dose-limiting adverse effect. Less prominent reactions included leukopenia, hypertriglyceridemia, and hypercalcemia. Characteristic retinoid toxicities, such as cheilitis, headache, and myalgias/arthralgias, were mild or absent. Two patients with cutaneous T-cell lymphoma experienced major antitumor responses. Pharmacokinetic studies obtained in 27 patients at eight dose levels showed that the day 1 area under the plasma concentration-times-time curves (AUCs) were proportional to dose. At all doses studied, the day 1 AUCs were similar to those on days 15 and 29, indicating a lack of induced metabolism. CONCLUSION LGD1069 is a unique compound that exploits a newly identified pathway of retinoid receptor biology that may be relevant to tumor-cell proliferation and apoptosis. Further investigation of this drug is warranted. Based on the results of this study, a dose of 300 mg/m2 is recommended for single-agent trials.
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Affiliation(s)
- V A Miller
- Department of Medicine, Memorial Sloan-Kettering Cancer Center and Cornell University Medical College, New York, NY 10021, USA.
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20
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Mukherjee R, Jow L, Strasser J, Syka P, Rosen J, Heyman R. Synergistic activation of the hydratase but not the ApoA1 gene by gemfibrozil and retinoids. Ann N Y Acad Sci 1996; 804:734-5. [PMID: 8993608 DOI: 10.1111/j.1749-6632.1996.tb18684.x] [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] [Indexed: 02/03/2023]
Affiliation(s)
- R Mukherjee
- Ligand Pharmaceuticals Inc., San Diego, California 92121, USA
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21
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Abstract
To determine whether MS patients differ from healthy subjects in stress-related immune changes, we examined immunologic alterations following a public speaking task in 25 MS patients and 25 healthy controls. Both groups demonstrated similar autonomic, neuroendocrine and immunologic responses to acute stress. Neutrophils, monocytes, CD8+ suppressor/cytotoxic T-lymphocytes and NK-cells transiently increased, with parallel changes in NK-cell activity. T-cell proliferation declined at 20 min, followed by increased reactivity at 60 min relative to baseline. This data suggests that stress-induced immune alterations remain intact in MS patients, and may contribute to immune changes associated with disease exacerbation.
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Affiliation(s)
- K D Ackerman
- Department of Psychiatry, University of Pittsburgh, PA 15213, USA. ackerman+@pitt.edu
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22
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Kizaki M, Dawson MI, Heyman R, Elster E, Morosetti R, Pakkala S, Chen DL, Ueno H, Chao W, Morikawa M, Ikeda Y, Heber D, Pfahl M, Koeffler HP. Effects of novel retinoid X receptor-selective ligands on myeloid leukemia differentiation and proliferation in vitro. Blood 1996; 87:1977-84. [PMID: 8634447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The biologic effects of retinoids such as all-trans-retinoic acid (ATRA) and 9-cis-retinoic acid on proliferation and differentiation of hematopoietic cells are mediated by binding and activating two distinct families of transcription factors: the retinoic acid receptors (RARs) and the retinoid X receptors (RXRs). The RARs require heterodimerization with RXRs; in addition, RXRs can form homodimers, which can bind to DNA response elements that are either distinct or the same as those bound by the RAR/RXR heterodimers. Therefore, the two retinoid pathways provide sequences that are specific for effective DNA binding and activation of target genes. We have developed several series of novel synthetic retinoids that selectively interact with RXR/RXR homodimers and RAR/RXR heterodimers. We show here that SR11236 and SR11246, which are RXR-selective analogs, had little ability to inhibit clonal growth and induce differentiation of leukemic cells (HL-60 cells and fresh acute myeloid leukemia cells). However, SR11249, SR11256, and LGD1069, which activated both RXR/RXR homodimers and RAR/RXR heterodimers, could inhibit clonal growth and induce differentiation of HL-60 cells as well as leukemic cells from patients, including those with acute promyelocytic leukemia (APL). This is similar to results observed with RAR/RXR-specific ligands. Interestingly, the combination of ATRA and either SR11249, SR11256, or LGD1069 showed synergistic effects in inducing differentiation of HL-60 cells. A retinoid (SR11238) with strong anti-AP-1 activity that did not activate the RARs and RXRs for gene transcription from the response element TREpal was inactive in our assay systems, suggesting that the antiproliferative effects of retinoids on leukemic cells is not mediated by inhibiting the AP-1 pathway. We conclude that the RAR/RXR pathway is more important than RXR/RXR pathway for differentiation and proliferation of acute myeloid leukemic cells, and certain retinoids or combination of retinoids with both RAR and RXR specificities may synergistically enhance the differentiation activity of ATRA, which may be relevant in several clinical situations.
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Affiliation(s)
- M Kizaki
- Division of Hematology, Keio University School of Medicine, Tokyo, Japan
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23
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Aarvold J, Heyman R. Health management training and qualifications. NonPC. Health Serv J 1993; 103:suppl 8, 11. [PMID: 10124155] [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: 02/11/2023]
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24
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Tsai S, Bartelmez S, Heyman R, Damm K, Evans R, Collins SJ. A mutated retinoic acid receptor-alpha exhibiting dominant-negative activity alters the lineage development of a multipotent hematopoietic cell line. Genes Dev 1992; 6:2258-69. [PMID: 1334022 DOI: 10.1101/gad.6.12a.2258] [Citation(s) in RCA: 126] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The retinoic acid receptor (RAR alpha) is expressed in virtually all hematopoietic lineages, but the role of this transcription factor in regulating the growth and differentiation of hematopoietic progenitors is unknown. We have constructed a mutant RAR alpha that both exhibits dominant-negative activity against the normal RAR alpha in transient expression assays in mouse fibroblasts and inhibits retinoic acid-induced neutrophilic differentiation of the HL-60 human promyelocytic leukemia cell line. When this dominant-negative RAR alpha construct is introduced into the multipotent interleukin-3-dependent FDCP mix A4 murine hematopoietic cell line, there is a rapid switch from spontaneous neutrophil/monocyte differentiation to basophil/mast cell development. Thus, in this multipotent hemopoietic cell line the normal RAR alpha transcription factor and/or related molecules appear to promote the differentiation of neutrophils and monocytes but suppress the development of basophils/mast cells.
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Affiliation(s)
- S Tsai
- Program in Molecular Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington 98104
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25
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Abstract
We have developed a toxic, or suicide, vector whose action is based on the targeted expression of the herpes simplex virus 1 thymidine kinase gene product in cultured cells or transgenic animals. This protein is able to convert nucleoside analogs such as acyclovir and 1-(2-deoxy-2-fluoro-beta-D-arabino-furanosyl)-5-iodouracil (FIAU) to toxic intermediates. The activation of these compounds disrupts cellular DNA replication, leading to rapid cell death. Neither acyclovir, FIAU, nor the herpes thymidine kinase alone is harmful to cells. This approach is simple and should have widespread applicability in studying lineage formation in cultured cells and transgenic animals.
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Affiliation(s)
- E Borrelli
- Howard Hughes Medical Institute, Gene Expression Laboratory, Salk Institute, La Jolla, CA 92037
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26
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Affiliation(s)
- M G Rosenfeld
- Howard Hughes Medical Institute, School of Medicine, University of California at San Diego, La Jolla 92093
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27
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Gianutsos G, Cohen SD, Carlson G, Heyman R, Salva P, Morrow G, Hite GJ. Alteration of in vivo and in vitro effects of heroin by esterase inhibition. Toxicol Appl Pharmacol 1986; 82:14-8. [PMID: 3003965 DOI: 10.1016/0041-008x(86)90432-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Selective inhibition of peripheral esterases by tri-ortho-tolyl phosphate in the mouse resulted in an increase in the analgetic activity of heroin, without affecting the activity of morphine. In vitro inhibition of esterases by paraoxon reduced the affinity of heroin for the opiate receptor, while that of morphine was unaffected. These results suggest that both central and peripheral esterases are involved in the metabolism of heroin and that interference with critical esterases can alter its pharmacologic and toxicologic effects.
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Caroli A, Joosen E, Van Huyneghem L, Dourov N, Heyman R. [A case of sinus aspergillosis associated with peripheral facial paralysis]. Acta Stomatol Belg 1985; 82:167-74. [PMID: 3866487] [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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Froimowitz M, Salva P, Hite GJ, Gianutsos G, Suzdak P, Heyman R. Conformational properties of ?- and ?-azabicyclane opiates. The effect of conformation on pharmacological activity. J Comput Chem 1984. [DOI: 10.1002/jcc.540050403] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Abstract
This paper presents some findings of a longitudinal study of nursing trainees in two British general hospitals concerning changes in attitudes to their work conditions, and compares the results with those of a cross-sectional study of the attitudes of trainees and qualified staff in the same two hospitals. Supporting the findings of previous research, the longitudinal study suggested that trainees become less attracted to work conditions during the course of training, and the cross-sectional study suggested that these changes would probably be reversed if and when trainees were taken on as qualified nurses. Since the widest gaps in attitudes between qualified staff and trainees reflected trainees' more unfavourable attitudes towards their influence over work tasks, opportunities to voice criticisms and to voice opinions, the findings are seen as evidence of a status gap between trainees' expected and achieved work autonomy.
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Clinton M, O'Brien DB, Heyman R, Hagel A. Postbasic education: partners in Tyne. Nurs Mirror 1983; 157:26-7. [PMID: 6554798] [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: 04/05/2023]
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32
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Abstract
Student and pupil nurses (64), from an initial sample of 117, completed repertory grids questionnaires and interviews on the first day of training, at 4 and 18 months. Measures of identification attraction and ideal/actual congruence were derived from the grids. Trainees were found to become more identified with and attracted to medical roles during training and less identified with and attracted to lower-status non-medical roles such as factory worker. Ideal/actual congruence with medical roles other than trainee also increased. Some measures derived from the grids related to trainee 'wastage' and to satisfaction with the hospital.
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