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Sainte-Foy-lès-Lyon, France

Rullier A.,Bordeaux University Hospital Center | Gourgou-Bourgade S.,Center Val dAurelle | Jarlier M.,Center Val dAurelle | Bibeau F.,Center Val dAurelle | And 18 more authors.
European Journal of Cancer

Circumferential resection margin (CRM) appears as a new powerful prognostic factor of survival after surgery for rectal cancer. We aimed to evaluate predictive factors of positive CRM following preoperative radiochemotherapy in a French trial. Patients with rectal cancer were randomised in long course preoperative radiotherapy 45 Gy plus capecitabine versus 50 Gy plus capecitabine and oxaliplatin. Mesorectal excision was performed 6 weeks after treatment. Impact of clinical, pathological and surgical variables on positive CRM (≤1 mm) were analysed by multivariate analysis. Of 565 randomised patients, CRM was recorded in 390 cases and was positive in 8% (30/390). Patients with 50 Gy plus capecitabine and oxaliplatin had a 6% rate of positive CRM while those treated by 45 Gy plus capecitabine had a 10% rate (p = 0.128). Three independent predictive factors of positive CRM were identified: abdominoperineal resection (APR) (odds ratio OR = 3.24; p = 0.004), vascular tumour invasion (OR = 2.78; p = 0.026) and poor histological response (modified Dworak 0-2) (OR = 9.01; p = 0.003). Significant predictive factors of positive CRM are related to type of surgery, especially APR, and poor histological prognostic factors. Intensification of neoadjuvant radiochemotherapy does not seem to have a major role in this study. © 2012 Elsevier Ltd. All rights reserved. Source

Oster J.-P.,Center hospitalier Louis Pasteur | Lavaud F.,Reims University Hospital Center | Bentaleb A.,Clinique Victor Pauchet | Bourrain J.-L.,Service de Pneumologie et Allergologie | And 5 more authors.
Revue Francaise d'Allergologie

Our aim was to assess the eventual impact of pretreatment with omalizumab on the tolerance and efficacy of specific immunotherapy (SIT). Based on a collection of experiences, we report observations on 10groups of patients who have received that therapeutic combination. Six of these observations involved patients sensitized to bees; their SIT was stopped because of problems with tolerance. In these six observations, different sorts of pretreatment with omalizumab was considered effective, which allowed bee venom SIT to be started and then maintained. While no randomized clinical trial has evaluated the effect of omalizumab treatment on tolerance to hymenoptera venoms, a number of published reports emphasize the efficacy of this pretreatment in improving tolerance to this SIT. Four observations concerned patients with severe allergic asthma due to sensitization to mites. In three of these observations, the association of omalizumab and mite SIT was considered effective in terms of control of the asthma and tolerance to the SIT; the combination was not considered effective in the fourth case. This collection of observations and an analysis of the literature have allowed us to emphasize the role of pretreatment with omalizumab in improving tolerance to SIT with hymenoptera venom. In the context of respiratory allergies, there are arguments for the combination of these two therapeutic modes in spite of the difficulty of applying it, especially in the case of severe asthma. © 2014 Elsevier Masson SAS. Source

Mahe A.,Center hospitalier Louis Pasteur

In this review we present a synthesis of the current knowledge of leprosy based on the epidemiological studies and the latest data obtained in basic research and the strategies undertaken to fight out this pathology. The significant progress in the genomic study of the leprosy bacillus, and in understanding the basic mechanisms governing the individual susceptibility to the disease, together with the stagnation in the incidence of the new cases observed for ten years, represent focus of interest. If the efficiency of the recommended treatments is actually confirmed by a low relapse rate, however the drying up of new cases, which could be expected by reducing the infectiousness of the treated cases, is nonetheless slow in coming. Recent studies support the effectiveness of prophylaxis based on a single dose of rifampicin and/or a BCG vaccination of patient contacts. This could allow an increased reduction of the incidence of the disease. However, no official position validates such strategies. Because of an ambiguity in the expression of the objectives for managing the disease, i.e. « elimination of a disease considered as a public health problem », which should not to be confused with « eradication of the disease », which, in fact, has no relevance today, demobilization in fighting against leprosy is to be feared. © 2015 médecine/sciences - Inserm. Source

Beliard S.,Center hospitalier Louis Pasteur | Beliard S.,University of Franche Comte | Chauveau M.,Laboratoires Innothera | Moscatiello T.,Laboratoires Innothera | And 3 more authors.
Journal of Sports Science and Medicine

Compression garments on the lower limbs are increasingly popular among athletes who wish to improve performance, reduce exercise-induced discomfort, and reduce the risk of injury. However, the beneficial effects of compression garments have not been clearly established. We performed a review of the literature for prospective, randomized, controlled studies, using quantified lower limb compression in order to (1) describe the beneficial effects that have been identified with compression garments, and in which conditions; and (2) investigate whether there is a relation between the pressure applied and the reported effects. The pressure delivered were measured either in laboratory conditions on garments identical to those used in the studies, or derived from publication data. Twenty three original articles were selected for inclusion in this review. The effects of wearing compression garments during exercise are controversial, as most studies failed to demonstrate a beneficial effect on immediate or performance recovery, or on delayed onset of muscle soreness. There was a trend towards a beneficial effect of compression garments worn during recovery, with performance recovery found to be improved in the five studies in which this was investigated, and delayed-onset muscle soreness was reportedly reduced in three of these five studies. There is no apparent relation between the effects of compression garments worn during or after exercise and the pressures applied, since beneficial effects were obtained with both low and high pressures. Wearing compression garments during recovery from exercise seems to be beneficial for performance recovery and delayed-onset muscle soreness, but the factors explaining this efficacy remain to be elucidated. © 2014, Journal of Sports Science and Medicine. Source

Kalfon P.,Center hospitalier Louis Pasteur | Mimoz O.,University of Poitiers | Loundou A.,Aix - Marseille University | Geantot M.-A.,CHU Dijon Bourgogne | And 9 more authors.

Background: It is now well documented that critically ill patients are exposed to stressful conditions and experience discomforts from multiple sources. Improved identification of the discomforts of patients in intensive care units (ICUs) may have implications for managing their care, including consideration of ethical issues, and may assist clinicians in choosing the most appropriate interventions. The primary objective of this study was to assess the effectiveness of a multicomponent program of discomfort reduction in critically ill patients. The secondary objectives were to assess the sustainability of the impact of the program and the potential seasonality effect. Methods/design: We conducted a multicenter, cluster-randomized, controlled, single (patient)-blind study involving 34 French adult ICUs. The experimental intervention was a 6-month period during which the multicomponent program was implemented in the ICU and included the following steps: identification of discomforts, immediate feedback to the healthcare team, and implementation of targeted interventions. The control intervention was a 6-month period during which any program was implemented. The primary endpoint was the monthly overall score of self-reported discomfort from the French questionnaire on discomforts in ICU patients (IPREA). The secondary endpoints were the scores of the discomfort items of IPREA. The sample size was 660 individuals to obtain 80 % power to detect a 25 % difference in the overall discomfort score of IPREA between the two groups (design effect: 2.9). Discussion: The results of this cluster-randomized controlled study are expected to confirm that a multicomponent program of discomfort reduction may be a new strategy in the management of care for critically ill patients. Trial registration: ClinicalTrials.gov NCT02442934, registered 11 May 2015. © 2016 Kalfon et al. Source

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