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Carrier M.,Ottawa Health Research Institute | Le Gal G.,Brest University Hospital Center | Wells P.S.,Ottawa Hospital | Rodger M.A.,Ottawa Health Research Institute
Annals of Internal Medicine | Year: 2010

Background: Case-fatality rates are important for assessing the risks and benefits of anticoagulation in patients with venous thromboembolism (VTE). Purpose: To summarize case-fatality rates of recurrent VTE and major bleeding events during anticoagulation and recurrent VTE after anticoagulation. Data Sources: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and all evidence-based medicine reviews in the Ovid interface through the second quarter of 2008. Study Selection: 69 articles (13 prospective cohort studies and 56 randomized, controlled trials) that reported on patients with symptomatic VTE who received anticoagulation therapy for at least 3 months and on the rate of fatal recurrent VTE and fatal major bleeding. Data Extraction: Two reviewers independently extracted data onto standardized forms. Data Synthesis: During the initial 3 months of anticoagulation, the rate of recurrent fatal VTE was 0.4% (95% CI, 0.3% to 0.6%), with a case-fatality rate of 11.3% (CI, 8.0% to 15.2%). The rate of fatal major bleeding events was 0.2% (CI, 0.1% to 0.3%), with a case-fatality rate of 11.3% (CI, 7.5% to 15.9%). After anticoagulation, the rate of fatal recurrent VTE was 0.3 per 100 patient-years (CI, 0.1% to 0.4%), with a case-fatality rate of 3.6% (CI, 1.9% to 5.7%). Limitations: Estimates come from heterogeneous trial and cohort populations and are not derived from patient-level longitudinal data. Differences in case-fatality rates during and after anticoagulation may be attributable to unmeasured patient characteristics. Conclusion: The case-fatality rates of recurrent VTE and major bleeding events are similar during the initial period of VTE treatment. The case-fatality rate of recurrent VTE decreases after completion of the initial period of anticoagulation. When combined with absolute rates of recurrent VTE and major bleeding events, case-fatality rates provide clinicians with a surrogate measure of mortality to balance the risks and benefits of anticoagulant therapy in patients with VTE. © 2010 American College of Physicians.


Marcorelles P.,Brest University Hospital Center | Laquerriere A.,University of Rouen
American Journal of Medical Genetics, Part C: Seminars in Medical Genetics | Year: 2010

Holoprosencephaly (HPE) is a brain malformation which results from a primary defect in induction and patterning of the rostral neural tube during early embryogenesis and usually considered as an impaired cleavage of the prosencephalon. The review of neuropathologic findings highlights a complex malformation involving not only the prosencephalon but also the whole brain, the eyes, and the cerebral vascularization. The classical form of HPE is divided in three sub-types according to DeMyer classification, although the spectrum is far wider, ranging from the most severe, aprosencephaly/atelencephaly, to milder forms such as syntelencephaly and to the less severe ends of the spectrum. Macroscopy and microscopy abnormality patterns are described extensively, allowing a comparison of the anatomic features between each form. Disturbances observed in the main cerebral structures including the basal ganglia, the commissures, the hippocampus, the brainstem, the cerebellum, and spinal cord are reviewed. Macroscopic and microscopic features of the ophthalmic anomalies are described, as well as brain vascular and associated central nervous system malformations. © 2010 Wiley-Liss, Inc.


The overall research objective of the SPICES project is to implement and evaluate a comprehensive CVD prevention and control program in five settings: a rural & semi-urban community in a low-income country (Uganda), middle income (South Africa) and vulnerable groups in three high-income countries (Belgium, France and United Kingdom) as well as to identify and compare the barriers and facilitators across study contexts. The project will be evaluated using a mix of formative assessments; pre/post and trial designs. At the beginning of the project, we will conduct baseline assessments including literature reviews, formative studies, household surveys (where feasible) and learn lessons from other projects to understand healthcare and lifestyle practices, barriers, and facilitators. A cost-effectiveness and cost benefit analysis will be included. In addition, the teams will conduct site exchanges visits to learn from each other and organise policy dialogues to ensure sustainability and maximise impact of the interventions. The implementation outcomesacceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability will be evaluated in order to understand the factors affecting the implementation, the processes, and the accruing results. The intervention of the SPICES project will aim to: (1) improve patients risk profiles (LDL-cholesterol, blood pressure, HbA1c (among patients with diabetes), modify lifestyles (diet and exercise and smoking cessation) and achieve recommended cholesterol, blood pressure and glycaemic control targets; (2) increase proportion of patients receiving appropriate BP, cholesterol and diabetes medication; (3) and mitigate the number of people developing complications such a stroke and myocardial infarction.


Patent
Brest University Hospital Center and Aix - Marseille University | Date: 2011-01-13

A compound which inhibits the importation of chloride into neurons and a compound which improve the outflow of chloride from neurons for the use in treatment of autism, a pharmaceutical composition for use in the treatment of autism including such compound and a pharmaceutically acceptable carrier are described.


Saraux A.,Brest University Hospital Center
Rheumatology (Oxford, England) | Year: 2010

Modern treatment of RA includes the use of biologics. Their cost is high and comparison between different treatment strategies is needed. Direct medical costs of RA in France were evaluated based on expert opinion. Then, simulation-decision analytical models were developed to assess four biologic treatment sequences over 2 years in patients failing to respond to at least one anti-TNF agent. Effectiveness was expressed in theoretical expected number of days (TEND) in remission or low disease activity [low disease activity score (LDAS)] based on DAS-28 scores. Direct medical costs of RA in France (excluding the cost of biologics) were estimated at euro 905 (s.d. 263) for 6 months and euro 696 (s.d. 240) for each subsequent 6 months (P < 0.001) for patients achieving LDAS and euro 1215 for 6 months (s.d. 405) for patients not achieving LDAS. Based on LDAS criteria, using abatacept after an inadequate response to the first anti-TNF agent (etanercept) appeared significantly (P < 0.01) more efficacious over a 2-year period (102 TEND) compared with using rituximab at a 6-month re-treatment interval (82 TEND). Mean cost-effectiveness ratios showed significantly lower costs (P < 0.01) per TEND with abatacept as second biologic agent (euro 278) compared with rituximab (euro 303). After an inadequate response to two anti-TNF agents, using abatacept also appeared significantly more efficacious than an anti-TNF agent (P < 0.01). All comparisons were confirmed when using remission criteria instead of LDAS. Advanced simulation models based on clinical evidence and medical practice appear to be a promising approach for comparing cost-effectiveness of biologic strategies in RA.


Blanc J.-J.,Brest University Hospital Center | Le Dauphin C.,Brest University Hospital Center
Europace | Year: 2014

Aims: We sought to investigate in patients with syncope the relationship between documented paroxysmal atrioventricular block (AVB) of unknown mechanism and AVB induced by adenosine triphosphate (ATP) injection. Methods and results: We selected patients >45 years free of structural heart disease with syncope related to paroxysmal AVB documented by Holter or in-hospital monitoring, but without any trigger suggestive of vasovagal origin and with normal baseline electrocardiogram. Adenosine triphosphate test was performed according to the usual protocol. Nine patients (all females; mean age 66 ± 14.6 years; range: 48-81 years) matching the abovementioned criteria particularly documented spontaneous complete AVB with long ventricular pauses. Their mean QRS duration was 86.6 ± 14.1 ms and the mean PR interval was 161 ± 21.3 ms. In all patients, ATP induced a long ventricular pause related to AVB (mean duration 13.2 s; range from 7 to 56 s). After a mean follow-up duration of 42 ± 36 months, electrocardiogram (ECG) remained unchanged without progression to permanent AVB or appearance of intraventricular conduction disturbances. Conclusion: Some patients, predominantly older females, with 'normal' heart and ECG, have syncope associated with spontaneous AVB of unknown origin reproduced during the ATP test. They do not develop permanent AVB during follow-up. This unusual behaviour could be interpreted as an abnormal susceptibility to ATP and these patients could be considered to have 'ATP-sensitive AVB'. In this subgroup of syncope patients ATP test is useful. All rights reserved. © The Author 2013.


OBJECTIVES: The aims of the study were (a) to describe the characteristics of all incident cases of pancreatic adenocarcinoma diagnosed in the population of the Finistère area between 2002 and 2011, (b) to report on their therapeutic management, and (c) to analyze survival and prognostic factors. METHODS: All residents of the administrative region of Finistère who were diagnosed with pancreatic adenocarcinoma between January 2002 and December 2011 were registered in the digestive cancer registry. Survival data were analyzed using the Kaplan-Meier method and were compared using log-rank tests. Multivariate analysis was performed using a binary logistic regression model to identify prognostic factors. RESULTS: A total of 1002 patients with a pancreatic adenocarcinoma were registered, of whom 60% had metastases at diagnosis. Only 10% of patients underwent a potentially curative negative margin resection (R0); their median survival was 22.0 months. The median survival of the overall population was 4.1 months. The stages of the disease and the patientʼs age were independent prognostic factors in multivariate analysis. CONCLUSIONS: Our study confirms the dramatic prognosis of this cancer. Because the tumor stage is the main prognostic factor in pancreatic adenocarcinoma, efforts should focus on the earlier diagnosis of pancreatic cancer. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Cochener B.,Brest University Hospital Center
Journal of Refractive Surgery | Year: 2016

PURPOSE: To compare the visual results and patient satisfaction after bilateral implantation between a bifocal and a trifocal intraocular lens (IOL). METHODS: This study is a prospective, randomized, controlled study involving bilateral implantation of one of two multifocal IOLs. Patients were assessed for uncorrected and distance-corrected near (33 cm), intermediate (66 cm), and distance visual acuity. Distance contrast sensitivity under photopic (85 cd/m2) conditions with and without glare was also measured. Using a subjective questionnaire, patient satisfaction, spectacle independence, and the perception of glare and halo phenomena were evaluated at the final follow-up; a defocus curve analysis was conducted. RESULTS: Fifteen patients (30 eyes) were implanted with the FineVision IOL (PhysIOL, Liége, Belgium) and 12 patients (24 eyes) received the Tecnis ZMB00 IOL (Abbott Medical Optics, Santa Ana, CA). The average follow-up was 6 months. The mean binocular uncorrected visual acuity was 0.02 ± 0.04 logMAR in the FineVision group and 0.04 ± 0.05 logMAR in the Tecnis group and the mean binocular uncorrected near visual acuity was 0.01 ± 0.00 logMAR in both groups. In the intermediate range of the defocus curve, there was a statistically significant difference between the two IOLs (P < .05). Contrast sensitivity was within normal limits under photopic conditions in both groups. CONCLUSIONS: Both the Tecnis and FineVision IOLs provide a satisfactory range of vision, including a high level of uncorrected distance, intermediate, and near acuity and improved contrast sensitivity under photopic conditions. Copyright © SLACK Incorporated.


Noel-Savina E.,Brest University Hospital Center | Descourt R.,Brest University Hospital Center
OncoTargets and Therapy | Year: 2013

Bronchial typical carcinoid tumors are neuroendocrine bronchopulmonary tumors with a low-grade malignancy, and an atypical carcinoid is an intermediate form of these tumors. There is a lack of knowledge on the optimal treatment for these tumors. The surgical treatment of choice consists of a lobectomy supplemented by dissection. The benefit of chemotherapy and radiotherapy is unclear. Targeted therapy could be used in this condition, but there is a lack of research recommending it. © 2013 Noel-Savina and Descourt.


Bruyere F.,Brest University Hospital Center
The Journal of urology | Year: 2015

PURPOSE: Prostate biopsy side effects have a role in the controversy over screening for prostate cancer. We measured the precise incidence of infection after prostate biopsy and determined risk factors.MATERIALS AND METHODS: We performed a prospective, multicenter study in France from April to June 2013. All prostate biopsies done during this period were included in study. A web based questionnaire was used to identify patient characteristics, biopsy methods and postoperative infectious episodes. External audit helped ensure data completeness. The primary outcome was the post-biopsy infection rate. We determined risk factors for infectious complications using univariate and multivariate analysis.RESULTS: The study included 2,718 patients, of whom 6% reported receiving antibiotics in the previous 6 months and 7.4% had a history of prostatitis. Recommended antibiotic prophylaxis consisting of 2 fluoroquinolone tablets 2 hours before examination for prostate biopsy was noted in 78.3% of cases. Post-biopsy sepsis was found in 76 subjects (2.8%). On multivariate analysis predictors of post-biopsy sepsis were noncompliance with antibiotic prophylaxis guidelines (OR 2.3, 95% CI 1.4-3.9, p = 0.001), antibiotic treatment in the previous 6 months (OR 2.1, 95% CI 1.1-3.9, p = 0.015) and a history of prostatitis (OR 1.7, 95% CI 1.2-2.4, p = 0.002).CONCLUSIONS: In this study the incidence of post-prostate biopsy sepsis was 2.8% and no deaths were reported. Risk factors identified on multivariate analysis were noncompliance with antibiotic prophylaxis according to guidelines, antibiotic treatment in the previous 6 months and a history of prostatitis. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

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