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Tours, France

Swallowing disorders are in many cases serious and complex. Their management needs to be considered from several perspectives. Multidisciplinary daytime hospitalisation (MDH) for swallowing disorders is an appropriate solution for many patients: A single day is sufficient for a complete checkup and the initiation of a therapeutic programme. A Ministerial Direction (15 June 2010), the content of which is discussed in this article, lays out the conditions of this approach. Our institution (Regional University Hospital of Tours) has substantial experience of MDH for swallowing disorders and here we take a look at the organisational, human, medical, and financial aspects of this activity. Source


Homan C.C.,University of Adelaide | Kumar R.,Womens and Childrens Health Research Institute | Kumar R.,University of Adelaide | Nguyen L.S.,University of Adelaide | And 10 more authors.
American Journal of Human Genetics | Year: 2014

With a wealth of disease-associated DNA variants being recently reported, the challenges of providing their functional characterization are mounting. Previously, as part of a large systematic resequencing of the X chromosome in 208 unrelated families with nonsyndromic X-linked intellectual disability, we identified three unique variants (two missense and one protein truncating) in USP9X. To assess the functional significance of these variants, we took advantage of the Usp9x knockout mouse we generated. Loss of Usp9x causes reduction in both axonal growth and neuronal cell migration. Although overexpression of wild-type human USP9X rescued these defects, all three USP9X variants failed to rescue axonal growth, caused reduced USP9X protein localization in axonal growth cones, and (in 2/3 variants) failed to rescue neuronal cell migration. Interestingly, in one of these families, the proband was subsequently identified to have a microdeletion encompassing ARID1B, a known ID gene. Given our findings it is plausible that loss of function of both genes contributes to the individual's phenotype. This case highlights the complexity of the interpretations of genetic findings from genome-wide investigations. We also performed proteomics analysis of neurons from both the wild-type and Usp9x knockout embryos and identified disruption of the cytoskeleton as the main underlying consequence of the loss of Usp9x. Detailed clinical assessment of all three families with USP9X variants identified hypotonia and behavioral and morphological defects as common features in addition to ID. Together our data support involvement of all three USP9X variants in ID in these families and provide likely cellular and molecular mechanisms involved. © 2014 The American Society of Human Genetics. Source


Mateo T.,University of Tours | Chang A.,University of Tours | Mofid Y.,University of Tours | Pisella P.-J.,CHRU de Tours | Ossant F.,University of Tours
IEEE Transactions on Medical Imaging | Year: 2014

In ophthalmic ultrasonography the crystalline lens is known to be the main source of phase aberration, causing a significant decrease in resolution and distortion effects on axial B-scans. This paper proposes a computationally efficient method to correct the phase aberration arising from the crystalline lens, including refraction effects using a bending ray tracing approach based on Fermat's principle. This method is used as a basis to perform eye-adapted beamforming (BF), with appropriate focusing delays for a 128-element 20-MHz linear array in both emission and reception. Implementation was achieved on an in-house developed experimental ultrasound scanning device, the ECODERM. The proposed BF was tested in vitro by imaging a wire phantom through an eye phantom consisting of a synthetic gelatin lens anatomically set up in an appropriate liquid (turpentine) to approach the in vivo velocity ratio. Both extremes of accommodation shapes of the human crystalline lens were investigated. The performance of the developed BF was evaluated in relation to that in homogeneous medium and compared to a conventional delay-and-sum (DAS) BF and a second adapted BF which was simplified to ignore the lens refraction. Global expectations provided by our method with the transducer array are reviewed by an analysis quantifying both image quality and spatial fidelity, as well as the detrimental effects of a crystalline lens in conventional reconstruction. Compared to conventional array imaging, the results indicated a two-fold improvement in the lateral resolution, greater sensitivity and a considerable reduction of spatial distortions that were sufficient to envisage reliable biometry directly in B-mode, especially phakometry. © 2014 IEEE. Source


Jacobi D.,CHRU de Tours | Ciangura C.,University Pierre and Marie Curie | Couet C.,CHRU de Tours | Oppert J.-M.,University Pierre and Marie Curie | Oppert J.-M.,French Institute of Health and Medical Research
Obesity Reviews | Year: 2011

Physical activity is a cornerstone in the medical management of obesity and could be important for weight loss following bariatric surgery. This review aims to describe the evolution of physical activity following massive weight loss induced by bariatric surgery, and to identify the relationship between physical activity and amount of weight loss. A literature search identified 20 publications (19 studies) reporting physical activity data in relation to bariatric surgery. All studies were observational. Self-assessment of physical activity was used in all the studies. Objective measures (pedometry) were used in two studies. The time frame for physical activity assessment varied: before surgery in two publications, after surgery in nine, and longitudinal pre- to post-operative evolution in nine. The latter nine publications found an increase in physical activity after bariatric surgery. In 10/13 studies where it was described, there was a positive relationship between physical activity level and amount of weight loss. In conclusion, observational evidence of self-reported physical activity suggests that physical activity increases after bariatric surgery and that physical activity is associated with surgically induced weight loss. However, these findings warrant further evaluation using objective measures of physical activity and testing in controlled trials. © 2010 The Authors. obesity reviews © 2010 International Association for the Study of Obesity. Source


Zhu A.X.,Harvard University | Kudo M.,Kinki University | Assenat E.,ICM Val DAurelle | Cattan S.,University of Lille Nord de France | And 18 more authors.
JAMA - Journal of the American Medical Association | Year: 2014

IMPORTANCE: Aside from the multikinase inhibitor sorafenib, there are no effective systemic therapies for the treatment of advanced hepatocellular carcinoma. OBJECTIVE: To assess the efficacy of everolimus in patients with advanced hepatocellular carcinoma for whom sorafenib treatment failed. DESIGN, SETTING, AND PARTICIPANTS: EVOLVE-1was a randomized, double-blind, phase 3 study conducted among 546 adults with Barcelona Clinic Liver Cancer stage B or C hepatocellular carcinoma and Child-Pugh A liver function whose disease progressed during or after sorafenib or who were intolerant of sorafenib. Patients were enrolled from 17 countries between May 2010 and March 2012. Randomization was stratified by region (Asia vs rest of world) and macrovascular invasion (present vs absent). INTERVENTIONS: Everolimus, 7.5mg/d, or matching placebo, both given in combination with best supportive care and continued until disease progression or intolerable toxicity. Per the 2:1 randomization scheme, 362 patients were randomized to the everolimus group and 184 patients to the placebo group. MAIN OUTCOMES AND MEASURES: The primary end pointwas overall survival. Secondary end points included time to progression and the disease control rate (the percentage of patients with a best overall response of complete or partial response or stable disease). RESULTS: No significant difference in overall survival was seen between treatment groups, with 303 deaths (83.7%) in the everolimus group and 151 deaths (82.1%) in the placebo group (hazard ratio [HR], 1.05; 95% CI, 0.86-1.27; P = .68; median overall survival, 7.6 months with everolimus, 7.3 months with placebo). Median time to progression with everolimus and placebo was 3.0 months and 2.6 months, respectively (HR, 0.93; 95%CI, 0.75-1.15), and disease control rate was 56.1% and 45.1%, respectively (P = .01). The most common grade 3/4 adverse events for everolimus vs placebo were anemia (7.8%vs 3.3%, respectively), asthenia (7.8%vs 5.5%, respectively), and decreased appetite (6.1%vs 0.5%, respectively). No patients experienced hepatitis C viral flare. Based on central laboratory results, hepatitis B viral reactivation was experienced by 39 patients (29 everolimus, 10 placebo); all cases were asymptomatic, but 3 everolimus recipients discontinued therapy. CONCLUSIONS AND RELEVANCE: Everolimus did not improve overall survival in patients with advanced hepatocellular carcinoma whose disease progressed during or after receiving sorafenib or who were intolerant of sorafenib. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01035229 Copyright 2014 American Medical Association. All rights reserved. Source

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