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Gleicher N.,Center for Human Reproduction | Gleicher N.,Foundation Medicine | Gleicher N.,CHR Metals Limited | Kim A.,Center for Human Reproduction | And 7 more authors.
Journal of Assisted Reproduction and Genetics | Year: 2013

Purpose: To investigate whether androgen conversion rates after supplementation with dehydroepiandrosterone (DHEA) differ, and whether differences between patients with diminished ovarian reserve (DOR) are predictive of pregnancy chances in association with in vitro fertilization (IVF). Methods: In a prospective cohort study we investigated 213 women with DOR, stratified for age (≤38 or >38 years) and ovarian FMR1 genotypes/sub-genotypes. All women were for at least 6 weeks supplemented with 75 mg of DHEA daily prior to IVF, between initial presentation and start of 1st IVF cycles. Levels of DHEA, DHEA-sulfate (DHEAS), total T (TT) and free T (FT) at baseline (BL) and IVF cycle start (CS) were then compared between conception and non-conception cycles. Results: Mean age for the study population was 41.5 ± 4.4 years. Forty-seven IVF cycles (22.1 %) resulted in clinical pregnancy. Benefits of DHEA on pregnancy rates were statistically associated with efficiency of androgen conversion from DHEA to T and amplitude of T gain. Younger women converted significantly more efficiently than older females, and selected FMR1 genotypes/sub-genotypes converted better than others. FSH/androgen and AMH/androgen ratios represent promising new predictors of IVF pregnancy chances in women with DOR. Conclusions: DOR at all ages appears to represent an androgen-deficient state, benefitting from androgen supplementation. Efficacy of androgen supplementation with DHEA, however, varies depending on female age and FMR1 genotype/sub-genotype. Further clarification of FMR1 effects should lead to better individualization of androgen supplementation, whether via DHEA or other androgenic compounds. © 2012 Springer Science+Business Media New York.

Collet J.-P.,Institut Universitaire de France | Silvain J.,Institut Universitaire de France | Barthelemy O.,Institut Universitaire de France | Range G.,Les Hopitaux de Chartres | And 20 more authors.
The Lancet | Year: 2014

Background: Optimum duration of dual antiplatelet treatment (DAPT) after coronary stenting remains uncertain, with an unknown efficacy to safety ratio of extended treatment leading to discrepancies between international guidelines and clinical practice. We assessed whether DAPT continuation beyond 1 year after coronary stenting is beneficial. Methods: This analysis was a planned extension of the previously published ARCTIC-Monitoring trial, in which we randomly allocated 2440 patients to a strategy of platelet function testing with antiplatelet treatment adjustment or a conventional strategy after coronary stenting with drug-eluting stent (DES). We recruited patients (aged 18 years or older) scheduled for planned DES implantation at 38 centres in France. After 1 year of follow-up, patients without contraindication to interruption of DAPT were eligible for a second randomisation to this second phase of the study (ARCTIC-Interruption). Using a computer-generated randomisation sequence (1:1; stratified by centre), we allocated patients to a strategy of interruption of DAPT where the thienopyridine was interrupted and single aspirin antiplatelet treatment was maintained (interruption group) or a strategy of DAPT continuation for 6-18 months (continuation group). The primary endpoint was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularisation, analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00827411. Findings: Between Jan 4, 2011, and March 3, 2012, 1259 eligible patients were randomly allocated to treatment in ARCTIC-Interruption: 624 to the interruption group and 635 to the continuation group. After a median follow-up of 17 months (IQR 15-18), the primary endpoint occurred in 27 (4%) patients in the interruption group and 24 (4%) patients in the continuation group (hazard ratio [HR] 1·17 [95% CI 0.68-2.03]; p=0.58). STEEPLE major bleeding events occurred more often in the continuation group (seven [1%] patients) compared with the interruption group (one [<0.5%] patient; HR 0.15 [0.02-1.20]; p=0.073). Major or minor bleedings were also more common in the continuation group compared with the interruption group (12 [2%] patients vs three [1%] patients; HR 0.26 [0.07-0.91]; p=0.04). Interpretation: Our finding suggests no apparent benefit but instead harm with extension of DAPT beyond 1 year after stenting with DES when no event has occurred within the first year after stenting. No conclusion can be drawn for high-risk patients who could not be randomised. The consistency between findings from all trials of such interruption suggests the need for a reappraisal of guidelines for DAPT after coronary stenting towards shorter duration of treatment. Funding: Allies in Cardiovascular Trials Initiatives and Organized Networks (ACTION Study Group), Fondation de France, Sanofi-Aventis, Cordis, Medtronic, Boston Scientific, Fondation SGAM.

Study Objectives: Describe the pharmacy characteristics of patients receiving delivery of an elastic compression stockings (EC) and determinants its observance. Materials and Methods: Each pharmacist described the characteristics of the first 10 patients to whom he delivered a CE and conditions of issue. It handed the patient a self-administered questionnaire to term of 15 days described their opinion on patient education and compliance received from the port of compression spring. Results: 332 pharmacists followed 2223 patients aged 54.2 ± 17.4 years on average. The issue was about 50.1% in socks cases, low (37.8%) and tights (14.9%) of Class II (90.2%); Class III (7.9%) and Class I (1.9%). After 15 days, 68.5% have worn regularly EC. The reasons for the lack of regular wearing are: - "Difficult to bear" (23.8%); - "The difficulty of putting" (14.5%); - "The existence of a sufficient number of pairs in their disposition" (24.5%). The absence of relief is only mentioned by 9.1%. The regular port of EC increases from 56.0% to 73.5% (p < 0.0001) if information is given on the threading and 57.2% to 73.5% (p < 0.0001) in the case of information about its maintenance. The prescribed number of pairs plays a major role in the regularity of the port changes growing from 31.6% when insufficient to 78.0% (p < 0.0001), when it is considered as sufficient. Conclusion: The compliance of the EC appears to be significantly linked to the existence of a number of pairs suitable for needs of patients and to the quality of the information delivered by pharmacists. A synergistic action between phlebologist doctor and pharmacist is required to better care for patients.

Laquerriere A.,CHR Metals Limited
Medecine Therapeutique Medecine de la Reproduction, Gynecologie et Endocrinologie | Year: 2010

During embryo-fetal life, early responses to noxious stimuli consist in muscle contraction called spinal reflex, that is early detectable then obvious and appropriated after the 26th week of amenorrhea (WA). The way of thermic pain sensitivity, mediated through the spinothalamic way, is in place after 20 WA and becomes functional when it connects to different cortical areas involved in the integration of pain, i.e., after 24 weeks. It was at this time that the medullary relay become mature through the establishment of local neuromodulator circuits. The emotional dimension of pain experience would be functional after 30 weeks, when the vigilance states appear and when the memory circuits and interhemispheric callosal connections take place. It is accepted by most authors that the functional maturation of all these structures is necessary for conscious perception of pain whose presence would fall just after the start of the second half of pregnancy.

Joveniaux P.,Reims University Hospital Center | Ohl X.,Reims University Hospital Center | Harisboure A.,Reims University Hospital Center | Berrichi A.,Service DOrthopedie et de Traumatologie | And 5 more authors.
International Orthopaedics | Year: 2010

Distal tibia fractures are complex injuries with a high complication rate. In this retrospective and multicentre study we attempted to detail complications and outcomes of this type of injury in order to determine predictive factors of poor results. Between 2002 and 2004, 104 patients were admitted for 105 distal tibia fractures. One hundred patients (101 fractures) were reviewed with an average follow-up of 19 months (range, 12-46). Internal fixation, external fixation, limited internal fixation (K-wires or screws), intramedullary nailing and conservative treatment were used. Outcome parameters included occurrence of complications, radiographic analysis, evaluation of the American Orthopaedic Foot and Ankle Society (AOFAS) ankle score and measures of the ankle range of motion. The average functional score was 76 points (range, 30-100 points), and complications occurred in 30 patients. Predictive factors of poor results were fracture severity, complications, malunion and the use of external fixation. We believe that external fixation must be reserved for trauma with severe skin injury, as a temporary solution in a two-staged protocol. For other cases, we recommend ORIF with early mobilisation. © 2009 Springer-Verlag.

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