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Tchetche D.,University Paul Sabatier | Farah B.,University Paul Sabatier | Misuraca L.,University Paul Sabatier | Pierri A.,University Paul Sabatier | And 15 more authors.
JACC: Cardiovascular Interventions | Year: 2014

Objectives The aim of this study was to analyze the incidence, impact, and predictors of cerebrovascular events (CVEs) in patients undergoing transcatheter aortic valve replacement (TAVR).Background Several issues remain unresolved post-TAVR, including CVEs.Methods The FRANCE-2 (French Aortic Nation CoreValve and Edwards-2) registry prospectively included all patients who underwent TAVR in France and Monaco from January 2010 to October 2011. A total of 3,191 patients were analyzed. Six-month follow-up data were obtained. Events were adjudicated according to Valve Academic Research Consortium (VARC)-1 definition.Results Of the cohort, 3.98% experienced a CVE: 55% were major strokes, 14.5% minor strokes, and 30.5% transient ischemic attacks. The mean delay for CVE occurrence was 2 days (interquartile range: 0 to 7 days) with 48.5% of CVEs occurring within 2 days. There was no statistically significant difference in CVE rate with regard to the type of valve (p = 0.899) and the access route (p = 0.128). Patients with a CVE more frequently had new-onset paroxysmal atrial fibrillation (13.6% vs. 7.6%; p = 0.015). During follow-up, the unadjusted mortality rate was higher in patients with a CVE (26% vs. 16.5%; p = 0.002). By multivariate analysis, only advanced age (odds ratio: 1.05; 95% confidence interval: 1.02 to 1.08; p = 0.02) and having 2 valves implanted (odds ratio: 3.13; 95 confidence interval: 1.40 to 7.05; p = 0.006) were associated with a significant risk of CVEs.Conclusions CVEs occur frequently after TAVR and are associated with an increased mortality rate. No difference exists in the CVE rate when exploring the type of valve or the access route. Advanced age and multiple valves implanted during the same procedure are predictors of CVE. © 2014 American College of Cardiology Foundation Published by Elsevier Inc.


Lambert A.-S.,University Paris - Sud | Lambert A.-S.,University of Limoges | Grybek V.,University Paris - Sud | Francou B.,University Paris - Sud | And 12 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Background: Except after neck surgery, hypoparathyroidism is a rare disease caused by defects in genes involved in parathyroid gland development (TBX1/22q11.2 del, GCMB, GATA3, TBCE) or function [calcium sensing receptor (CASR), GNA11, PTH], or the autoimmune polyglandular syndrome type 1 (AIRE). Approximately 90% of sporadic cases and 30% of familial cases of isolated hypoparathyroidism remain unexplained. Recurrent missense mutations in AP2S1, a calcium-sensing receptor regulator, have been recently identified in familial hyperparathyroidism. Aim: Theaimof the studywasto investigate AP2S1 as a putative hypoparathyroidism-causing gene. Methods: Sequencing analysis and quantitative genomic PCR of the AP2S1 gene in a large cohort of 10 index cases (from nine families) and 50 sporadic cases affected with isolated hypoparathyroidism were investigated. Results and Conclusions: None of the 60 patients presented with nucleotidic changes or copy number variation in the AP2S1 gene, thereby excluding AP2S1 defects as a frequent cause of isolated hypoparathyroidism. Copyright © 2014 by the Endocrine Society.


PubMed | University of Limoges, Center Hospitalier University Bichat, University of Lyon, Clinique Pasteur and 7 more.
Type: Journal Article | Journal: JACC. Cardiovascular interventions | Year: 2014

The aim of this study was to analyze the incidence, impact, and predictors of cerebrovascular events (CVEs) in patients undergoing transcatheter aortic valve replacement (TAVR).Several issues remain unresolved post-TAVR, including CVEs.The FRANCE-2 (French Aortic Nation CoreValve and Edwards-2) registry prospectively included all patients who underwent TAVR in France and Monaco from January 2010 to October 2011. A total of 3,191 patients were analyzed. Six-month follow-up data were obtained. Events were adjudicated according to Valve Academic Research Consortium (VARC)-1definition.Of the cohort, 3.98% experienced a CVE: 55% were major strokes, 14.5% minor strokes, and 30.5% transient ischemic attacks. The mean delay for CVE occurrence was 2 days (interquartile range: 0 to 7 days) with 48.5% of CVEs occurring within 2 days. There was no statistically significant difference in CVE rate with regard to the type of valve (p=0.899) and the access route (p= 0.128). Patients with a CVE more frequently had new-onset paroxysmal atrial fibrillation (13.6% vs. 7.6%; p= 0.015). During follow-up, the unadjusted mortality rate was higher in patients with a CVE (26% vs. 16.5%; p= 0.002). By multivariate analysis, only advanced age (odds ratio: 1.05; 95% confidence interval: 1.02 to 1.08; p= 0.02) and having 2 valves implanted (odds ratio: 3.13; 95 confidence interval: 1.40 to 7.05; p= 0.006) were associated with a significant risk of CVEs.CVEs occur frequently after TAVR and are associated with an increased mortality rate. No difference exists in the CVE rate when exploring the type of valve or the access route. Advanced age and multiple valves implanted during the same procedure are predictors of CVE.


Bessede T.,Center Hospitalier University Henri Mondor | Soulie M.,Toulouse University Hospital Center | Mottet N.,Clinique Mutualiste Saint Etienne | Rebillard X.,Clinique Beausoleil | And 3 more authors.
Journal of Urology | Year: 2010

Purpose: We analyzed preoperative data, pathological results and followup of pT0 tumors after radical prostatectomy for prostate cancer diagnosed on previous positive biopsy. Materials and Methods: At 6 centers a total of 30 of 7,693 radical prostatectomy specimens were classified as pT0 despite prior biopsy proven prostate cancer. No patients were diagnosed after transurethral prostate resection or received neoadjuvant hormonal treatment. All biopsy cores and radical prostatectomy specimens were reanalyzed by a second pathologist. Followup comprised clinical examination and postoperative prostate specific antigen assay at 1 and 3 months, and every 6 months thereafter. Results: Median patient age was 63 years (range 46 to 73). Median preoperative prostate specific antigen was 7.4 ng/ml (range 1.3 to 23). Of the cases 24 were T1c and 6 were T2a. The median number of biopsy cores was 10 (range 6 to 21) with 1 positive (range 1 to 4). On biopsies median tumor length was 1 mm (range 0.3 to 18) and there was tumor in 11.1% (range 3.4% to 64%). In 25 cases (83.3%) there was only 1 positive biopsy. Gleason score was 3 + 3 in 23 cases and less than 6 in 5 with grade 4 in 2. Only 9 cases filled all nonsignificant tumor criteria. Median specimen weight was 61 gm (range 40 to 160). At a median 82-month followup (range 14 to 226) there was no biochemical progression. Conclusions: After biopsy proven cancer pT0 prostate cancer is an unpredictable pathological finding. Despite its excellent prognosis it has medicolegal repercussions that justify DNA based tissue analysis. There is no evidence that finding focal cancer after extensive prostate resection changes patient prognosis and postoperative treatment. © 2010 American Urological Association Education and Research, Inc.


Mammadova-Bach E.,French Institute of Health and Medical Research | Mammadova-Bach E.,University of Strasbourg | Ollivier V.,French Institute of Health and Medical Research | Ollivier V.,University Paris Diderot | And 20 more authors.
Blood | Year: 2015

Fibrin, the coagulation end product, consolidates the platelet plug at sites of vascular injury and supports the recruitment of circulating platelets. In addition to integrin αIIbβ3, another as-yet-unidentified receptor is thought to mediate platelet interaction with fibrin. Platelet glycoprotein VI (GPVI) interacts with collagen and several other adhesive macromolecules. We evaluated the hypothesis that GPVI could be a functional platelet receptor for fibrin. Calibrated thrombin assays using platelet-rich plasma (PRP) showed that tissue factor-triggered thrombin generation was impaired in GPVI-deficient patients and reduced by the anti-GPVI Fab 9O12. Assays on reconstituted PRP and PRP from fibrinogen-deficient patients revealed a fibrinogen-dependent enhancement of thrombin generation, which relied on functional GPVI. The effect of GPVI was found to depend on fibrin polymerization. A binding assay showed a specific interaction between GPVI-Fc and fibrin, inhibited by the Fab 9O12. This Fab also reduced platelet adhesion to fibrin at low (300 s-1) and high (1500 s-1) wall shear rates. Platelets adherent to fibrin displayed shape change, exposure of procoagulant phospholipids, and the formation of small clots. When hirudinated blood was perfused at 1500 s-1 over preformed fibrin-rich clots, the Fab 9O12 decreased the recruitment of platelets by up to 85%. This study identifies GPVI as a platelet receptor for polymerized fibrin with 2 major functions: (1) amplification of thrombin generation and (2) recruitment of circulating platelets to clots. These so-far-unrecognized properties of GPVI confer on it a key role in thrombus growth and stabilization. © 2015 by The American Society of Hematology.


Lilamand M.,Toulouse 1 University Capitole | Lilamand M.,Center Hospitalier University Bichat | Kelaiditi E.,Toulouse 1 University Capitole | Guyonnet S.,Toulouse 1 University Capitole | And 9 more authors.
Nutrition, Metabolism and Cardiovascular Diseases | Year: 2014

Background and aims: Flavonoids are a group of polyphenol compounds, ubiquitously found in plants. Great emphasis has been given to their possible benefits for cardiovascular health. These beneficial effects may be mediated by a specific action on arterial walls. Arterial stiffness is a marker of vascular aging, increasingly used in the clinical setting and assessed by pulse wave velocity. It has shown to be a robust predictor of cardiovascular events and mortality. This review aims at providing a comprehensive evaluation of available intervention and observational studies examining the relationship between flavonoid consumption and arterial stiffness. Data synthesis: A Medline® literature search was performed using the keywords "arterial stiffness" and "flavonoids". As a result, 2 cross-sectional and 16 intervention studies assessing the relationship between flavonoids intake and arterial stiffness were retained. Four intervention trials reported a significant decrease of arterial stiffness after a flavonoid-based intervention, independently from blood pressure changes. The two observational studies reported significant associations between a higher flavonoid consumption and a lower arterial stiffness. In this review, isoflavones, anthocyanins and to a lesser extent cocoa flavan-3-ols appeared to be the more efficient to improve vascular function. Conclusions: Despite their heterogeneity, preliminary data seem to support an improvement of the arterial stiffness related to flavonoid intake. However, further research on absorption and dose-response effects of the specific flavonoid subclasses on arterial structure is warranted. © 2014 Elsevier B.V.


Jambou R.,Institute Pasteur Paris | Le Bras J.,Center Hospitalier University Bichat | Randrianarivelojosia M.,Institute Pasteur of Madagascar
Trends in Parasitology | Year: 2011

Artemisinin combination therapy (ACT) paves the way for new opportunities to eliminate malaria in the tropics. However, the huge increase of ACT consumption raises major concerns about their availability over the next few years. At the same time a decrease in their efficacy has already been reported. Alongside the deployment of multifocal control programs, the process ranging from artemisia crop production to accreditation of new ACT combinations urgently needs to be strengthened to supply sufficient quantities of high-quality drugs. New suppliers will have the opportunity to enter this market to develop new formulations, and bioequivalence studies are required to validate these new formulations. It is thus crucial for national malaria control teams to be able to better scrutinize the dossier of these new formulations. © 2010 Elsevier Ltd.


Hermieu J.-F.,Center Hospitalier University Bichat | Le Guilchet T.,Center Hospitalier University Bichat
Journal Medical Libanais | Year: 2013

Genital prolapse frequently coexists with lower urinary tract symptoms. The first difficulty is to detect occult incontinence masked by the prolapsed organs. Rates of detection are not the same with the different clinical maneuvers (manual, pessary, cotton swab, speculum, etc.). The second difficulty is to choose a management strategy. Through a recent analysis of the literature, this paper suggests recommendations.


Thubert T.,Center Hospitalier University Bichat | Hermieu J.-F.,Center Hospitalier University Bichat
Progres en Urologie - FMC | Year: 2011

Obesity, defined as a BMI over 30, is an increasing health problem all over the world. In most studies, a stronger association is observed between increasing weight, urinary incontinence and genital prolapse. Urinary incontinence (UI) prevalence is greater than 5 for women obviously obese. Specifically, stress UI management needs specificities in this population. Weight loss and pelvic floor muscles training are the first step of treatment. A 10% weight loss induces a 50% reduction of episodes of leakage. Unfortunately, weight reduction is usually non-lasting. In stress UI with urethral mobility, sub-urethral sling should be the second step. BMI < 35 seemed to be the best cutoff level. In that case, cure and complications rates are the same than in normal weight women. Above 35, there is a sharp decrease in cure rate (around 50%), and an increased risk of de novo urgencies and postoperative complications. For that obese women population, obesity surgery shows similar results than tension free vaginal tape. From a technical point of view, bladder injury is specific to retropubic access and should be avoided with transobturator access. On the other hand, retropubic access is likely to give longer lasting results on obese women whenever an intrinsic sphincter deficiency, a low urethral mobility and high intra-abdominal pressures are risk factors for failure. © 2011 - Elsevier Masson SAS - Tous droits réservés.


Calvert P.A.,Center Hospitalier University Bichat | Himbert D.,Center Hospitalier University Bichat | Brochet E.,Center Hospitalier University Bichat | Radu C.,Center Hospitalier University Bichat | And 6 more authors.
EuroIntervention | Year: 2012

Aims: We describe the first report of an Edwards SAPIEN valve implanted in a tricuspid bioprosthesis from the femoral vein. We highlight the feasibility of this previously avoided approach and the techniques involved. Methods and results: A 61-year-old woman with multiple valve replacements for rheumatic heart disease presented with NHYA IV dyspnoea secondary to a severely stenosed tricuspid bioprosthesis. After failed aggressive medical therapy and surgical turn down, an Edwards SAPIEN XT valve was deployed in the tricuspid bioprosthesis via the right femoral vein. Adaptations to the standard transfemoral transcatheter aortic valve implantation (TAVI) technique included: (1) crossing the tricuspid bioprosthesis with a balloon floatation catheter; (2) temporary pacing wire in the coronary sinus rather than the right ventricle; (3) mounting of the SAPIEN XT valve in the reverse orientation to transfemoral TAVI; and (4) fine positioning of the final valve position pre-deployment by 3D transoesophageal echocardiography (3D TOE) alone due to complete radiolucency of the tricuspid bioprosthesis. The procedure was completed without complication and resulted in significant symptomatic improvement. Conclusions: Deployment of an Edwards SAPIEN valve in a tricuspid bioprosthesis via the femoral vein is feasible and, with careful adaptations to established TAVI techniques, can be performed without complications and with good clinical response. © Europa Edition 2012. All rights reserved.

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