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Evrard S.,University of Liege | Delanaye P.,University of Liege | Kamel S.,Laboratoire Of Biochimie | Kamel S.,University of Picardie Jules Verne | And 23 more authors.
Clinica Chimica Acta | Year: 2014

The link between vascular calcification (VC) and increased mortality is now well established. Over time, as clinical importance of this phenomenon has begun to be fully considered, scientists have highlighted more and more physiopathological mechanisms and signaling pathways that underlie VC. Several conditions such as diabetes, dyslipidemia and renal diseases are undoubtedly identified as predisposing factors. But even if the process is better understood, many questions still remain unanswered. This review briefly develops the various theories that attempt to explain mineralization genesis. Nonetheless, the main purpose of the article is to provide a profile of the various existing biomarkers of VC. Indeed, in the past years, a lot of inhibitors and promoters, which form a dense and interconnected network, were identified. Given importance to assess and control mineralization process, a focusing on accumulated knowledge of each marker seemed to be necessary. Therefore, we tried to define their respective role in the physiopathology and how they can contribute to calcification risk assessment. Among these, Klotho/fibroblast growth factor-23, fetuin-A, Matrix Gla protein, Bone morphogenetic protein-2, osteoprotegerin, osteopontin, osteonectin, osteocalcin, pyrophosphate and sclerostin are specifically discussed. © 2014 Elsevier B.V. Source

Farhat S.,Endoscopy Unit | Chaussade S.,Endoscopy Unit | Chaussade S.,University of Paris Descartes | Coumaros D.,CHU Strasbourg | And 17 more authors.
Endoscopy | Year: 2011

Background and study aims: Endoscopic submucosal dissection (ESD) is a technique for en bloc resection of superficial tumors of the gastrointestinal tract. In France, experience with this technique is still limited. We wanted to assess the development of ESD in France, with special attention to short term outcomes. Patients and methods: Members of the Société Française d'Endoscopie Digestive (SFED) who declared performing ESD reported their cases prospectively on a voluntary basis. Demographic, clinical, and technical data, and the results of immediate complications were collected. Case reports were completed prospectively by each investigator before pooled analysis. Results: A total of 188 consecutive case reports were collected from 16 centers. The median case mix per center was 6 patients (range 143). The lesion sites treated by ESD were the stomach (n=75), esophagus (n=27), duodenum (n=1), cecum (n=2), right colon (n=3), transverse colon (n=5), sigmoid (n=3), and rectum (n=72). The median size of the lesions was 26mm (range 2150mm). En bloc resection was achieved in 77.1% of cases, with complete R0 resection in 72.9%. Histopathology results showed high grade dysplasia or superficial cancer in 71.2%. The median duration of ESD was 105 minutes (range 20450 minutes). The short term morbidity was 29.2% including 34 cases of perforation (18.1%), and 21 hemorrhages (11.2%) during the 24 hours following ESD, 89% of which were managed conservatively or endoscopically. Conclusion: In this early experience, the feasibility of ESD appeared to be good but R0 resection and complication rates did not match those reported by Japanese authors and must be improved by an extended practice. © Georg Thieme Verlag KG Stuttgart New York. Source

Aparicio T.,University of Paris 13 | Lavau-Denes S.,Limoges University Hospital Center | Phelip J.M.,CHU Saint Etienne Hopital Nord | Maillard E.,Data Center | And 84 more authors.
Annals of Oncology | Year: 2016

Background: Metastatic colorectal cancer (mCRC) frequently occurs in elderly patients. However, data from a geriatric tailored randomized trial about tolerance to and the efficacy of doublet chemotherapy (CT) with irinotecan in the elderly are lacking. The benefit of first-line CT intensification remains an issue in elderly patients. Patients and methods: Elderly patients (75+) with previously untreated mCRC were randomly assigned in a 2 × 2 factorial design (four arms) to receive 5-FU (5-fluorouracil)-based CT, either alone (FU: LV5FU2 or simplified LV5FU2) or in combination with irinotecan [IRI: LV5FU2-irinotecan or simplified LV5FU2-irinotecan (FOLFIRI)]. The CLASSIC arm was defined as LV5FU2 or LV5FU2-irinotecan and the SIMPLIFIED arm as simplified LV5FU2 or FOLFIRI. The primary end point was progression- free survival (PFS). Secondary end points were overall survival (OS), safety and objective response rate (ORR). Results: From June 2003 to May 2010, 71 patients were randomly assigned to LV5FU2, 71 to simplified LV5FU2, 70 to LV5FU2-irinotecan and 70 to FOLFIRI. The median age was 80 years (range 75-92 years). No significant difference was observed for the median PFS: FU 5.2 months versus IRI 7.3 months, hazard ratio (HR) = 0.84 (0.66-1.07), P =0.15 and CLASSIC 6.5 months versus SIMPLIFIED 6.0 months, HR = 0.85 (0.67-1.09), P =0.19. The ORR was superior in IRI (P = 0.0003): FU 21.1% versus IRI 41.7% and in CLASSIC (P = 0.04): CLASSIC 37.1% versus SIMPLIFIED 25.6%. Median OS was 14.2 months in FU versus 13.3 months in IRI, HR = 0.96 (0.75-1.24) and 15.2 months in CLASSIC versus 11.4 months in SIMPLIFIED, HR = 0.71 (0.55-0.92). More patients presented grade 3-4 toxicities in IRI (52.2% versus 76.3%). Conclusion: In this elderly population, adding irinotecan to an infusional 5-FU-based CT did not significantly increase either PFS or OS. Classic LV5FU2 was associated with an improved OS compared with simplified LV5FU2. © The Author 2015. Source

Pelletier S.,University of Lyon | Fouque D.,University of Lyon | Fouque D.,Lyon University Hospital Center | Arnaud J.,Grenoble University Hospital Center | And 20 more authors.
Annales de Biologie Clinique | Year: 2015

Sclerostin is an osteocyte-specific glycoprotein secreted by the osteocyte and involved in the regulation of bone mass. High sclerostin levels are associated with osteoporosis, whereas low sclerostin levels are correlated with higher bone mineral density. It seems interesting to investigate a potential association between sclerostin levels and vascular calcifications since sclerostin is considered as a potent inhibitor of bone formation. In chronic kidney disease, serum sclerostin levels rise as renal function declines. Preliminary studies show a positive association between serum sclerostin and vascular calcification, but the link between sclerostin and survival of patients remains unclear in the absence of large-scale studies. © 2015, John Libbey Eurotext. All rights reserved. Source

Bargnoux A.-S.,Montpellier University | Arnaud J.,Grenoble University Hospital Center | Cavalier E.,University of Liege | Pieroni L.,Center Hospitalier dAvignon | And 26 more authors.
Annales de Biologie Clinique | Year: 2015

A better knowledge of physiopathologic mechanisms responsible for vascular calcification leads to emerging biological markers of calcifications. The use of these biomarkers in daily practice requires both clinical and analytical validation. This latter point is of particular importance to implement "researchgrade"diagnostic kits into daily practice. Data in the literature underline the lack of method standardization and the non-transferability of results. Depending on the method used, important biological associations might be hidden. © 2015, John Libbey Eurotext. All rights reserved. Source

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