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Senat M.-V.,Center for Research in Epidemiology and Population Health | Porcher R.,French Institute of Health and Medical Research | Winer N.,Hopital Mere enfant | Vayssiere C.,Hopital Paul de Viguier | And 7 more authors.
American Journal of Obstetrics and Gynecology

Objective: The objective of the study was to evaluate the use of 17 alpha-hydroxyprogesterone caproate (17P) to reduce preterm delivery in women with a twin pregnancy and short cervix. Study Design: This open-label, multicenter, randomized controlled trial included women with a twin pregnancy between 24+0 and 31+6 weeks of gestation who were asymptomatic and had a cervical length of 25 mm or less measured by routine transvaginal ultrasound. Women were randomized to receive (or not) 500 mg of intramuscular 17P, repeated twice weekly until 36 weeks or preterm delivery. The primary outcome was time from randomization to delivery. Analysis was performed according to the intent-to-treat principle. Results: The 17P and control groups did not differ significantly for median [interquartile range] time to delivery: 45 (26-62) and 51 (36-66) days, respectively. However, treatment with 17P was associated with a significant increase in the rate of preterm delivery before 32 weeks. Conclusion: Twice-weekly injections of 17P did not prolong pregnancy significantly in asymptomatic women with a twin pregnancy and short cervix. © 2013 Mosby, Inc. Source

Bonnet F.,University of Rennes 1 | Disse E.,French Institute of Health and Medical Research | Laville M.,French Institute of Health and Medical Research | Mari A.,Institute of Biomedical Engineering | And 6 more authors.

Aims/hypothesis Moderate alcohol consumption is associated with a reduced risk of type 2 diabetes with a stronger effect in women. As the underlying mechanisms remain poorly characterised, we investigated its relationship with insulin resistance, insulin secretion, clearance of insulin and glucagon concentration. Methods One-thousand two-hundred and seventy-six non-diabetic individuals from the RISC (relationship between insulin sensitivity and cardiovascular disease) study without high alcohol consumption were studied; all had a euglycaemic-hyperinsulinaemic clamp and an OGTT with assessment of insulin sensitivity, secretion and clearance.Results Alcohol consumption was positively associated with insulin sensitivity in women (β=0.15, p trend=0.005) and in men (β=0.07, ptrend=0.07) after controlling for age, centre, waist, smoking and physical activity. In women, this association persisted after adjustment for adiponectin but was attenuated after controlling for HDL-cholesterol, suggesting that part of the protection is related to a higher HDL-cholesterol concentration. Higher alcohol consumption was associated with lower basal insulin secretion in women only (β=-0.10, ptrend=0.004) and this association persisted after adjustment for insulin sensitivity. In men, increasing alcohol consumption was associated with enhanced insulin clearance and increased fasting NEFA concentrations, independently of insulin sensitivity. Fasting glucagon decreased with increasing alcohol in women only (abstainers 9.2±4.4; >28 g/week 8.6±4.0; 28-64 g/week 8.1±3.7; <64 g/week 7.5±3.1 pmol/l; p trend=0.01). Conclusions/interpretation Light-to-moderate alcohol consumption was associated in healthy women with enhanced insulin sensitivity, reduced basal insulin secretion rate and lower fasting plasma glucagon concentration, providing consistent mechanisms for the reduced risk of diabetes. © Springer-Verlag 2012. Source

Maitrot-Mantelet L.,University of Paris Descartes | Horellou M.H.,University of Paris Descartes | Massiou H.,Unit of Neurology | Conard J.,University of Paris Descartes | And 3 more authors.
Thrombosis Research

Introduction Migraine, particularly migraine with aura (MA), is associated with a higher risk for ischemic stroke (IS). A procoagulant state may predispose to IS. Whether inherited biological thrombophilia are associated with migraine risk remains controversial. Objective To assess the risk of migraine without or with aura related to inherited biological thrombophilia adjusted for the main potential confounders. Material and Methods A cross-sectional study was conducted in 1456 French women aged 18 to 56 years, referred for biological coagulation check-up because of personal or familial venous thrombosis history. Between April 2007 and December 2008, all women answered a self-administered questionnaire to determine whether they had headache. Results There were 294 (20%) migrainous sufferers (including 71 [5%] with MA), 975 (67%) non migrainous women and 187 (13%) non migrainous headache women. Inherited thrombophilia were detected in 576 (40%) women, including 389 (40%) non migrainous women, 90 (40%) migraine without aura (MWA), 33 (46%) MA women and 64 (34%) non migrainous headache women. Factor V Leiden (FVL) i.e. F5rs6025 or Factor II G20210A (FIIL) i.e. F2rs1799963 mutation was detected in 296 (30%) non migrainous women and in 100 (34%) migrainous women of which 27 had MA. There was a significant association between MA and FVL or FIIL mutations (adjusted OR = 1.76 [95% CI 1.02-3.06] p = 0.04) whereas this association in MWA and in non migrainous headache women was not significant. There was no significant association between migraine and other biological thrombophilia. Conclusion FVL or FIIL mutations were more likely among patients suffering from MA. Whether biological thrombophilia screening should be systematically performed in women suffering from MA remains to be determined. © 2014 Elsevier Ltd. All rights reserved. Source

Jeebhay M.F.,University of Cape Town | Ngajilo D.,University of Cape Town | Le Moual N.,Center for Research in Epidemiology and Population Health | Le Moual N.,University Paris - Sud
Current Opinion in Allergy and Clinical Immunology

PURPOSE OF REVIEW: To identify the similarities and differences between nonwork-related adult-onset and occupational asthma from various literature sources published between 2010 and 2013, with respect to the epidemiology, phenotypic manifestations, and risk factors for the disease. RECENT FINDINGS: The incidence of adult-onset asthma from pooled population studies is estimated to be 3.6 per 1000 person-years in men and 4.6 cases per 1000 person-years in women. In adults with new-onset asthma, occupational asthma is a common asthma phenotype. Work-related factors are estimated to account for up to 25% of adult cases of asthma and occupational asthma comprising about 16% of adult-onset asthma cases. The review finds that nonwork-related adult-onset asthma is a heterogenous entity and that environmental exposure factors (aside from occupational exposures) appear to have a lesser role than host factors when compared with occupational asthma. SUMMARY: Large-scale general population studies are needed to identify the similarities and differences between nonwork-related adult-onset and occupational asthma, which may enable a better understanding of these entities and promote efforts towards holistic management approaches for these asthma phenotypes. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Canonico M.,Center for Research in Epidemiology and Population Health | Canonico M.,University Paris - Sud

Objective: Postmenopausal hormone therapy (HT), which consists of exogenous estrogens with or without combined progestogens, remains the most effective treatment of climacteric symptoms. Depending on its characteristics, it may nevertheless increase the risk of venous thromboembolism, and its effects on hemostasis have been studied for several decades. The aim of this review was to summarize current knowledge on the effects of HT on hemostasis, taking into account the route of estrogen administration, the daily dose and chemical structure of estrogens, and the pharmacologic class of progestogens. Methods: Data from randomized controlled trials that included a control group (either placebo or no treatment) were selected, and analysis was conducted on different generations of biomarkers. Results: Overall, studies showed a hemostasis imbalance among oral estrogen users with a decrease in coagulation inhibitors and an increase in markers of activation coagulation, leading to global enhanced thrombin generation. By contrast, transdermal estrogen use was associated with less change in hemostasis variables and did not activate coagulation and fibrinolysis. No clear difference in HT effects on hemostasis was highlighted between daily doses of estrogens, between estrogen compounds, and between pharmacologic classes of progestogens. Conclusions: Changes in hemostasis are in accordance with clinical results showing an increased thrombotic risk with oral - but not transdermal - estrogen use. © 2014 by The North American Menopause Society. Source

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