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Saint-Léger-sur-Roanne, France

Szymanowicz A.,Center Hospitalier Of Roanne
Immuno-Analyse et Biologie Specialisee

Besides structural and physiological cortisol data, this paper points out the optimal conditions for immunoassay and interpretation of results. © 2011 Elsevier Masson SAS. Source

Hennequin C.,Ap Hp Et University Of Paris Vii | Bossard N.,University of Lyon | Bossard N.,French National Center for Scientific Research | Servagi-Vernat S.,Center Hospitalier University Of Besancon | And 12 more authors.
International Journal of Radiation Oncology Biology Physics

Purpose: To evaluate the efficacy of irradiation of internal mammary nodes (IMN) on 10-year overall survival in breast cancer patients after mastectomy. Methods and Patients: This multicenter phase 3 study enrolled patients with positive axillary nodes (pN+) or central/medial tumors with or without pN+. Other inclusion criteria were age <75 and a Karnofsky index ≥70. All patients received postoperative irradiation of the chest wall and supraclavicular nodes and were randomly assigned to receive IMN irradiation or not. Randomization was stratified by tumor location (medial/central or lateral), axillary lymph node status, and adjuvant therapy (chemotherapy vs no chemotherapy). The prescribed dose of irradiation to the target volumes was 50 Gy or equivalent. The first 5 intercostal spaces were included in the IMN target volume, and two-thirds of the dose (31.5 Gy) was given by electrons. The primary outcome was overall survival at 10 years. Disease-free survival and toxicity were secondary outcomes. Results: T total of 1334 patients were analyzed after a median follow-up of 11.3 years among the survivors. No benefit of IMN irradiation on the overall survival could be demonstrated: the 10-year overall survival was 59.3% in the IMN-nonirradiated group versus 62.6% in the IMN-irradiated group (P=.8). According to stratification factors, we defined 6 subgroups (medial/central or lateral tumor, pN0 [only for medial/central] or pN+, and chemotherapy or not). In all these subgroups, IMN irradiation did not significantly improve overall survival. Conclusions: In patients treated with 2-dimensional techniques, we failed to demonstrate a survival benefit for IMN irradiation. This study cannot rule out a moderate benefit, especially with more modern, conformal techniques applied to a higher risk population. © 2013 Elsevier Inc. Source

Frat J.-P.,University of Poitiers | Thille A.W.,University of Poitiers | Mercat A.,Center hospitalier regional dOrleans | Girault C.,University of Rouen | And 30 more authors.
New England Journal of Medicine

BACKGROUND: Whether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated. Therapy with high-flow oxygen through a nasal cannula may offer an alternative in patients with hypoxemia. METHODS: We performed a multicenter, open-label trial in which we randomly assigned patients without hypercapnia who had acute hypoxemic respiratory failure and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 300 mm Hg or less to high-flow oxygen therapy, standard oxygen therapy delivered through a face mask, or noninvasive positive-pressure ventilation. The primary outcome was the proportion of patients intubated at day 28; secondary outcomes included all-cause mortality in the intensive care unit and at 90 days and the number of ventilator-free days at day 28. RESULTS: A total of 310 patients were included in the analyses. The intubation rate (primary outcome) was 38% (40 of 106 patients) in the high-flow-oxygen group, 47% (44 of 94) in the standard group, and 50% (55 of 110) in the noninvasive-ventilation group (P = 0.18 for all comparisons). The number of ventilator-free days at day 28 was significantly higher in the high-flow-oxygen group (24±8 days, vs. 22±10 in the standard-oxygen group and 19±12 in the noninvasive-ventilation group; P = 0.02 for all comparisons). The hazard ratio for death at 90 days was 2.01 (95% confidence interval [CI], 1.01 to 3.99) with standard oxygen versus high-flow oxygen (P = 0.046) and 2.50 (95% CI, 1.31 to 4.78) with noninvasive ventilation versus high-flow oxygen (P = 0.006). CONCLUSIONS: In patients with nonhypercapnic acute hypoxemic respiratory failure, treatment with high-flow oxygen, standard oxygen, or noninvasive ventilation did not result in significantly different intubation rates. There was a significant difference in favor of high-flow oxygen in 90-day mortality. (Funded by the Programme Hospitalier de Recherche Clinique Interrégional 2010 of the French Ministry of Health; FLORALI ClinicalTrials.gov number, NCT01320384.) Copyright © 2015 Massachusetts Medical Society. All rights reserved. Source

Szymanowicz A.,Center Hospitalier Of Roanne
Immuno-Analyse et Biologie Specialisee

The C-peptide is a polypeptide of connection that is generated during the proteolytic cleavage of proinsulin in pancreatic beta cells. It is secreted in equimolar amounts with insulin. Unlike insulin, C-peptide is not metabolized by the liver but filtered by the kidneys and excreted in the urine. Because of its longer half-life (compared with insulin), the C-peptide value is better suited to control the secretion of β cells. The C-peptide plays an important role in the structural conformation of A and B chains of insulin and the formation of two disulfide bonds present in the proinsulin molecule that are conserved in the active insulin. The main indications of its assay are: evaluating the residual function of β cells in diabetic patients and in case of exogenous insulin substitution, the evaluation of secretory capacity of β cells in the early stage of diabetes mellitus, control of patients with symptoms of hypoglycemia. Less frequently, the assay may be useful in patients suffering from polycystic ovarian syndrome, the diagnosis of insulinoma, the diagnosis of factitious hypoglycemia, the evaluation of β-cell transplantation and monitoring of patients after pancreatectomy. The urinary assay facilitates the monitoring of gestational diabetes and the follow-up of patients with unstable glycemic status. Besides structural and physiological C-peptide data, this paper points out the optimal conditions for immunoassay and interpretation of results. © 2011 Elsevier Masson SAS. Source

Legriel S.,Center Hospitalier Of Versailles Andre Mignot Hospital | Azoulay E.,CHU Saint Louis | Resche-Rigon M.,CHU Saint Louis | Lemiale V.,CHU Saint Louis | And 14 more authors.
Critical Care Medicine

Objectives: Few outcome data are available about convulsive status epilepticus managed in the intensive care unit. We studied 90-day functional outcomes and their determinants in patients with convulsive status epilepticus. Design: Two hundred forty-eight convulsive status epilepticus patients admitted to 18 intensive care units in 2005-2007 were included in a prospective observational cohort study. The main outcome measure was a Glasgow Outcome Scale score of 5 (good recovery) on day 90. Main results: Convulsive status epilepticus occurred out of hospital in 177 (67%) patients, and all but 15 patients were still seizing at medical team arrival. The median time from convulsive status epilepticus onset to anticonvulsant drug initiation was 40 mins (interquartile range, 5-80). Total seizure duration was 85 mins (interquartile range, 46.5-180). Convulsive status epilepticus was refractory in 49 (20%) patients. The most common causes of convulsive status epilepticus were anticonvulsive agent withdrawal (36.4%) in patients with previous epilepsy and stroke (27.7%) in inaugural convulsive status epilepticus. Mechanical ventilation was needed in 210 (85%) patients. On day 90, 42 (18.8%) patients were dead, 87 (38.8%) had marked functional impairments (Glasgow Outcome Scale score, 2-4), and 95 (42.4%) had a good recovery (Glasgow Outcome Scale score, 5). Factors showing independent positive associations with poor outcome (Glasgow Outcome Scale score, <5) were older age (odds ratio, 1.04/year; 95% confidence interval, 1.02-1.05; p = .0005), cerebral insult (odds ratio, 2.70; 95% confidence interval, 1.37-5.26; p = .007), longer seizure duration (odds ratio, 1.72/120 min; 95% confidence interval, 1.05-2.86; p = .03), on-scene focal neurologic signs (odds ratio, 2.08; 95% confidence interval, 1.03-4.16; p = .04), and refractory convulsive status epilepticus (odds ratio, 2.70; 95% confidence interval, 1.02-7.14; p = .045). Conclusions: Ninety days after intensive care unit admission for convulsive status epilepticus, half the survivors had severe functional impairments. Longer seizure duration, cerebral insult, and refractory convulsive status epilepticus were strongly associated with poor outcomes, suggesting a role for early neuroprotective strategies. © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. Source

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