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Gerardin P.,French Institute of Health and Medical Research | Gerardin P.,Center Hospitalier Regional | Fianu A.,French Institute of Health and Medical Research | Mussard C.,French Institute of Health and Medical Research | And 6 more authors.
BMC Medicine | Year: 2011

Background: Persistent disabilities are key manifestations of Chikungunya virus (CHIKV) infection, especially incapacitating polyarthralgia and fatigue. So far, little is known about their impact on health status. The present study aimed at describing the burden of CHIKV prolonged or late-onset symptoms on the self-perceived health of La Réunion islanders.Methods: At 18 months after an outbreak of Chikungunya virus, we implemented the TELECHIK survey; a retrospective cohort study conducted on a random sample of the representative SEROCHIK population-based survey. A total of 1,094 subjects sampled for CHIKV-specific IgG antibodies in the setting of La Réunion island in the Indian Ocean, between August 2006 and October 2006, were interviewed about current symptoms divided into musculoskeletal/rheumatic, fatigue, cerebral, sensorineural, digestive and dermatological categories.Results: At the time of interview, 43% of seropositive (CHIK+) subjects reported musculoskeletal pain (vs 17% of seronegative (CHIK-) subjects, P < 0.001), 54% fatigue (vs 46%, P = 0.04), 75% cerebral disorders (vs 57%, P < 0.001), 49% sensorineural impairments (vs 37%, P = 0.001), 18% digestive complaints (vs 15%, P = 0.21), and 36% skin involvement (vs 34%, P = 0.20) on average 2 years after infection (range: 15-34 months). After controlling for confounders such as age, gender, body mass index or major comorbidities in different Poisson regression models, 33% of joint pains were attributable to CHIKV, 10% of cerebral disorders and 7.5% of sensorineural impairments, while Chikungunya did not enhance fatigue states, digestive and skin disorders.Conclusions: On average, 2 years after infection 43% to 75% of infected people reported prolonged or late-onset symptoms highly attributable to CHIKV. These manifestations carry a significant burden in the community in the fields of rheumatology, neurology and sensorineural health. © 2011 Gérardin et al; licensee BioMed Central Ltd.

Deye N.,French Institute of Health and Medical Research | Cariou A.,Reanimation Medicale | Girardie P.,Lille University Hospital Center | Pichon N.,Limoges University Hospital Center | And 22 more authors.
Circulation | Year: 2015

Background - Targeted temperature management is recommended after out-of-hospital cardiac arrest. Whether advanced internal cooling is superior to basic external cooling remains unknown. The aim of this multicenter, controlled trial was to evaluate the benefit of endovascular versus basic surface cooling. Methods and Results - Inclusion criteria were the following: age of 18 to 79 years, out-of-hospital cardiac arrest related to a presumed cardiac cause, time to return of spontaneous circulation <60 minutes, delay between return of spontaneous circulation and inclusion <240 minutes, and unconscious patient after return of spontaneous circulation and before the start of cooling. Exclusion criteria were terminal disease, pregnancy, known coagulopathy, uncontrolled bleeding, temperature on admission <30°C, in-hospital cardiac arrest, immediate need for extracorporeal life support or hemodialysis. Patients were randomized between 2 cooling strategies: endovascular femoral devices (Icy catheter, Coolgard, Zoll, formerly Alsius; n=203) or basic external cooling using fans, a homemade tent, and ice packs (n=197). The primary end point, that is, favorable outcome evaluated by survival without major neurological damage (Cerebral Performance Categories 1-2) at day 28, was not significantly different between groups (odds ratio, 1.41; 95% confidence interval, 0.93-2.16; P=0.107). Improvement in favorable outcome at day 90 in favor of the endovascular group did not reach significance (odds ratio, 1.51; 95% confidence interval, 0.96-2.35; P=0.07). Time to target temperature (33°C) was significantly shorter and target hypothermia was more strictly maintained in the endovascular than in the surface group (P<0.001). Minor side effects directly related to the cooling method were observed more frequently in the endovascular group (P=0.009). Conclusion - Despite better hypothermia induction and maintenance, endovascular cooling was not significantly superior to basic external cooling in terms of favorable outcome. © 2015 American Heart Association, Inc.

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.

Cassuto N.G.,Art Unit | Hazout A.,Art Unit | Hammoud I.,CHR Metals Limited | Balet R.,Hopital des Bluets | And 7 more authors.
Reproductive BioMedicine Online | Year: 2012

The utility of sperm DNA testing remains controversial. However, it may be helpful in couples with unexplained failures of multiple assisted reproductive techniques and/or recurrent abortions. This study analysed 10,400 spermatozoa of 26 patients for sperm-head morphology with high-magnification microscopy, DNA fragmentation and sperm chromatin decondensation. A significant negative correlation was demonstrated between sperm-parameters and abnormal sperm-head morphology as assessed by high magnification (score 0 according to this study's classification): concentration (r = -0.41; P = 0.03), motility (r = -0.42; P = 0.03), morphology (r = -0.63; P = 0.0008). No correlation was found with DNA fragmentation. However, the sperm chromatin-decondensation rate of score-0 spermatozoa was twice as high as the controls (19.5% versus 10.1%; P < 0.0001). This observation suggests that score-0 spermatozoa should not be selected for intracytoplasmic sperm injection. We analysed 10,400 spermatozoa of 26 patients for sperm head morphology at high magnification, DNA fragmentation and sperm chromatin decondensation. We demonstrated a significant negative correlation between sperm parameters: concentration (r = -0.41; P = 0.03), motility (r = -0.42; P = 0.03), morphology (r = -0.63; P = 0.0008) and abnormal sperm head morphology as assessed by high magnification (score 0 according our classification). No correlation was found with DNA fragmentation. The sperm chromatin decondensation rate of score-0 spermatozoa was twice as high as than in controls (19.5% versus 10.1%; P < 0.0001). No significant relationship with sperm DNA fragmentation was observed. We suggest that high-magnification sperm selection could be an important step and a new tool for the clinician, who could decide to discard score-0 spermatozoa with a high risk of abnormal chromatin and select the best sperm cells for intracytoplasmic sperm injection. © 2011, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Bonsante F.,University of Burgundy | Bonsante F.,CHR Metals Limited | Bonsante F.,Center Detudes Perinatales Of Locean Indien | Iacobelli S.,University of Burgundy | And 4 more authors.
American Journal of Perinatology | Year: 2013

Objective Evidence supports the efficacy of probiotics in reducing necrotizing enterocolitis (NEC) in very low-birth-weight infants, although concerns remain with regard to their routine use. Since 2008 in our neonatal intensive care unit, a low dose of probiotics (unique strain) is administered as standard of care in all preterm babies born at 24 to 31 weeks' gestation. This study reports outcomes in infants receiving probiotic cohort (PC) compared with the historical cohort. Design Treatment with Lactobacillus rhamnosus Lcr35 (Lcr Restituo) (2 × 108 colony-forming units/12 h) was started early after birth and intention to treat was up to 36 weeks' gestation. The main outcome was definite NEC. Secondary outcomes were mortality, late-onset sepsis (LOS), cholestasis, isolated rectal bleeding (IRB), and time to reach full enteral feeding (FEF). Results A total of 1130 patients were included. No adverse effects were observed. Infants in PC presented a reduced rate of NEC (odds ratio [OR] 0.20; 95% confidence interval [CI] 0.07 to 0.58), mortality (OR 0.46; 95% CI 0.21 to 1.00), and LOS (OR 0.60; 95% CI 0.40 to 0.89) and achieved FEF significantly earlier. IRB was significantly reduced among infants receiving the complete scheduled treatment. Conclusion Administration of Lcr Restituo was well tolerated and associated with lower mortality and morbidities in this cohort. Our results provide evidence in support of the hypothesis that this probiotic may reduce IRB. Copyright © 2013 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

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.

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.

Hassall C.,CHR Metals Limited | Roberts H.,CHR Metals Limited
World of Metallurgy - ERZMETALL | Year: 2015

Lead and zinc are commonly found and exploited together in ore and it is relatively rare for lead or zinc be mined separately although there are some well-known examples where this occurs. The ratio between mined zinc and lead has altered significantly over recent decades. There is a number of reasons for this including technical advances in mining and process technology. However, changing price ratios reflecting market balances for the two metals have also been a factor in determining the nature and location of ore deposits. In 1960 the ratio of lead to zinc in global mine output was close to 0.7:1. By the end of the 1960s this ratio had fallen to 0.6:1 and it continued to decline at roughly 0.1 per decade hitting a low of a little over 0.3:1 in 2003. A key factor in the structural change in the relationship between lead and zinc prices was the rapid increase in lead recycling as a share of total refined output, especially post-1985. This reflected two developments. A significant decline in the consumption of lead in almost all of its end-use markets, apart from lead-acid batteries, and legislation in almost all mature economies which banned the disposal of used lead-acid batteries and/or mandated that they be recycled. Secondary zinc accounts for a rather small share of total refined zinc output, even today. These developments capture a key change in the dynamics of zinc and lead supply over the past three decades. The supply of lead is now largely satisfied by secondary production. Its main end use is in lead-acid batteries with almost all batteries being recycled after a relatively short life. In the case of zinc, mine production has to meet almost 90 % of refined zinc demand every year. The use of zinc continues to expand across a range of end-uses and there is little scope for the foreseeable future of a major increase in the share of secondary zinc recovery in meeting overall demand. Therefore there is a requirement for new zinc mines to be developed, not only to replace output that will be lost as a result of closures due to reserve depletion, but also to meet future growth in zinc demand. For lead the situation is less clear cut. There will be a requirement to replace output lost due to mine closures but, given changing dynamics in lead demand, it is less certain that there will be any need to increase primary lead output above current levels in order to meet incremental demand for lead in the future. Outside China demand for lead in concentrate has been on a steadily declining trend for many years. In contrast, China has witnessed an annual average rate of increase of 8.4 %. Therefore, were anything to change in China's market demand for lead this would have very negative consequences for global demand for mined lead. Reasons for rapid growth in China's lead demand include growth of vehicle sales and fleet but the most important development has been the emergence of electric bicycles (e-bikes), powered largely by lead-acid batteries. This market hardly existed in 2000 but, by 2010, production was almost 30 million units a year. However, in more recent years, growth in the production and sales of e-bikes has stalled and the market is reported to have contracted by 5 % in 2014. If global markets are to absorb higher lead mine output in the future then a significant new market for lead-acid batteries is needed. There may be opportunities in renewable energy storage although lead-acid battery technology faces competition. Although an absolute decline in total lead demand is not forecast most of the growth in overall supply to meet higher demand will come from recycling activities, with primary lead only needed to meet annual incremental demand, small metallurgical losses in the recycling process and those few uses where the lead will not be recovered. Given this assessment, what are the prospects for lead mine output? Will there be a tendency towards chronic surplus supplies of lead in concentrate as miners develop new projects principally to meet anticipated higher demand for zinc in concentrate?

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.

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