Clermont-Ferrand, France
Clermont-Ferrand, France

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Borel P.,French Institute of Health and Medical Research | Borel P.,French National Institute for Agricultural Research | Borel P.,Aix - Marseille University | Caillaud D.,CHU de Clermont Ferrand | And 3 more authors.
Critical Reviews in Food Science and Nutrition | Year: 2015

There has been renewed interest in vitamin D since numerous recent studies have suggested that besides its well-established roles in bone metabolism and immunity, vitamin D status is inversely associated with the incidence of several diseases, e.g., cancers, cardio-vascular diseases, and neurodegenerative diseases. Surprisingly, there is very little data on factors that affect absorption of this fat-soluble vitamin, although it is acknowledged that dietary vitamin D could help to fight against the subdeficient vitamin D status that is common in several populations. This review describes the state of the art concerning the fate of vitamin D in the human upper gastrointestinal tract and on the factors assumed to affect its absorption efficiency. The main conclusions are: (i) ergocalciferol (vitamin D2), the form mostly used in supplements and fortified foods, is apparently absorbed with similar efficiency to cholecalciferol (vitamin D3, the main dietary form), (ii) 25-hydroxyvitamin D (25OHD), the metabolite produced in the liver, and which can be found in foods, is better absorbed than the nonhydroxy vitamin D forms cholecalciferol and ergocalciferol, (iii) the amount of fat with which vitamin D is ingested does not seem to significantly modify the bioavailability of vitamin D3, (iv) the food matrix has apparently little effect on vitamin D bioavailability, (v) sucrose polyesters (Olestra) and tetrahydrolipstatin (orlistat) probably diminish vitamin D absorption, and (vi) there is apparently no effect of aging on vitamin D absorption efficiency. We also find that there is insufficient, or even no data on the following factors suspected of affecting vitamin D bioavailability: (i) effect of type and amount of dietary fiber, (ii) effect of vitamin D status, and (iii) effect of genetic variation in proteins involved in its intestinal absorption. In conclusion, further studies are needed to improve our knowledge of factors affecting vitamin D absorption efficiency. Clinical studies with labeled vitamin D, e.g., deuterated or 13C, are needed to accurately and definitively assess the effect of various factors on its bioavailability. © 2015, Taylor and Francis Group, LLC.


Collet J.-P.,University Pierre and Marie Curie | Cuisset T.,Marseille University Hospital Center | Range G.,Les Hopitaux de Chartres | Cayla G.,Nimes University Hospital Center | And 21 more authors.
New England Journal of Medicine | Year: 2012

BACKGROUND: Patients' responses to oral antiplatelet therapy are subject to variation. Bedside monitoring offers the opportunity to improve outcomes after coronary stenting by individualizing therapy. METHODS: We randomly assigned 2440 patients scheduled for coronary stenting at 38 centers to a strategy of platelet-function monitoring, with drug adjustment in patients who had a poor response to antiplatelet therapy, or to a conventional strategy without monitoring and drug adjustment. The primary end point was the composite of death, myocardial infarction, stent thrombosis, stroke, or urgent revascularization 1 year after stent implantation. For patients in the monitoring group, the VerifyNow P2Y12 and aspirin point-of-care assays were used in the catheterization laboratory before stent implantation and in the outpatient clinic 2 to 4 weeks later. RESULTS: In the monitoring group, high platelet reactivity in patients taking clopidogrel (34.5% of patients) or aspirin (7.6%) led to the administration of an additional bolus of clopidogrel, prasugrel, or aspirin along with glycoprotein IIb/IIIa inhibitors during the procedure. The primary end point occurred in 34.6% of the patients in the monitoring group, as compared with 31.1% of those in the conventional-treatment group (hazard ratio, 1.13; 95% confidence interval [CI], 0.98 to 1.29; P = 0.10). The main secondary end point, stent thrombosis or any urgent revascularization, occurred in 4.9% of the patients in the monitoring group and 4.6% of those in the conventional-treatment group (hazard ratio, 1.06; 95% CI, 0.74 to 1.52; P = 0.77). The rate of major bleeding events did not differ significantly between groups. CONCLUSIONS: This study showed no significant improvements in clinical outcomes with platelet-function monitoring and treatment adjustment for coronary stenting, as compared with standard antiplatelet therapy without monitoring. (Funded by Allies in Cardiovascular Trials Initiatives and Organized Networks and others; ARCTIC ClinicalTrials.gov number, NCT00827411.) Copyright © 2012 Massachusetts Medical Society.


PubMed | Center Hospitalier Of Vichy, CHU de Clermont Ferrand, Center Jean Perrin and Center hospitalier dAmbert
Type: Journal Article | Journal: Bulletin du cancer | Year: 2016

The anticancer drug technical commission (COTECH) of the Auvergne OMEDIT has set up a region-wide professional practice evaluation (PPE) with regards to antiemetic prescription practices in chemotherapy-induced nausea and vomiting (CINV), in order to evaluate their compliance with OMEDITs guidelines. Are not included pediatric and hematologic protocols. A prospective survey was carried from November 2013to January 2014out in 14medical centers in Auvergne. This clinical audit was based on the HAS (national healthcare authority) framework and used as a reference regional standards based on the MASCC Antiemetic Guidelines. Altogether, 346antiemetic prescriptions were compared to guidelines. We observed respectively 81% and 42% conformity rates in acute and delayed emesis for high emesis risk chemotherapy (HE); 86% and 35% conformity rates in acute and delayed emesis for moderate emesis risk chemotherapy (ME); 66% and 85% conformity rates in acute and delayed emesis for low emesis risk chemotherapy (LE). These results highlight deficiencies in compliance with guidelines, especially in the management of delayed CINV in HE and ME chemotherapy. The COTECH identified three priority improvement areas: under-prescribe NK1antagonists in HE cure; under-prescribe corticosteroid; over-prescribe 5HT3antagonists for delayed emesis. The COTECH is publicizing these results all over the Auvergne region, together with a reminder of recommendations.


PubMed | Center Hospitalier Of Riom and CHU de Clermont Ferrand
Type: Journal Article | Journal: Revue des maladies respiratoires | Year: 2016

Smoking is a factor associated with premature death, including in older people. Stopping smoking reduces related mortality even after the age of 60. The aim of this study, conducted in a smoking cessation clinic, was to describe the characteristics of these older smokers and their quit attempts.A retrospective study was performed from the patient files of a smoking cessation clinic between 1999/01/01 and 2009/12/31; older smokers (60 years; n=181) were compared to young smokers (<60 years; n=1425).Compared to young smokers, older smokers had a higher frequency of cardio-pulmonary diseases (82.3 % vs. 46.7 %; P<0.0001) and current depressions (45.3% vs. 35.7%; P=0.012); their abstinence rate at 12 months was higher (44.2% vs. 32.9%; P=0.0025). An age over 60 years was associated with a higher success rate (OR=1.83; CI 95%: 1.29-2.59).Cessation smoking attempts are as likely to be successful in older smokers as in younger smokers. Physicians should advise and assist older smokers to quit and if necessary refer them to smoking cessation clinics. Smoking cessation guidelines therefore will apply without reserve in seniors.


Bazin J.-E.,CHU de Clermont Ferrand | Delaunay L.,Clinique generale Annecy
Praticien en Anesthesie Reanimation | Year: 2016

Advantages and drawbacks of transferring medical anaesthetic practice to nurses are discussed considering the quality of care, the responsibility of healthcare providers, the bylaws and the economics in different countries. © 2016 Elsevier Masson SAS


Penard-Morand C.,French Institute of Health and Medical Research | Penard-Morand C.,University Pierre and Marie Curie | Penard-Morand C.,Agro ParisTech | Raherison C.,Center Francois Magendie | And 7 more authors.
European Respiratory Journal | Year: 2010

The aim of this study was to evaluate the impact of urban air pollution, assessed through reliable indicators of exposure, on asthma and allergies in schoolchildren. A validated dispersion model combining data on traffic conditions, topography, meteorology and background pollution was used to relate 3-yrs averaged concentrations of major urban pollutants at the sites of schools to skin prick tests, exercise-induced asthma and reported asthma and allergies in 6,683 children (9-11 yrs) attending 108 schools randomly selected in six French communities. For the 4,907 children who had resided at their current address for the past 3 yrs, asthma (exercise induced, past year and lifetime) was significantly positively associated with benzene, SO2, particles with a 50% cut-off aerodynamic diameter of 10 μm (PM10), nitrogen oxides (NOx) and CO. In the same children, eczema (lifetime and past year) was significantly positively associated with benzene, PM10, NO2, NOx and CO, lifetime allergic rhinitis with PM10 and sensitisation to pollens with benzene and PM10. Among the 2,213 children residing at their current address since birth, the associations persisted for lifetime asthma with benzene (adjusted OR per interquartile range (95% CI) 1.3 (1.0-1.9)) and PM10 (1.4 (1.0-2.0)), and for sensitisation to pollens with volatile organic compounds (1.3 (1.0-1.9)) and PM10 (1.2 (1.0-1.9)). Accurately modelled urban air pollution was associated with some measures of childhood asthma and allergies. Copyright©ERS 2010.


Viala M.,Institute Gustave Roussy | Brosseau S.,CHU de Clermont Ferrand | Planchard D.,Caen University Hospital Center | Besse B.,University Paris - Sud | Soria J.-C.,Institute Gustave Roussy
Bulletin du Cancer | Year: 2015

The identification of the EML4-ALK rearrangement in 5% of NSCLC enhanced the development of 1st generation ALK inhibitors such as crizotinib. Two phase III trials demonstrated crizotinib efficacy in second line metastatic (PROFILE 1007) and more recently first line metastatic (PROFILE 1014) NSCLC in terms of progression-free survival and also objective response. However, within 12 to 16 months, patients will progress due to the emergence of acquired resistance mechanisms such as mutation (L1196M) or amplification of the ALK gene, as well as activation of alternative signaling pathways (EGFR, KRAS). Second generation ALK inhibitors have been developed such as ceritinib, alectinib, and AP26113. This review will present those new drugs, summarize the results of their ongoing trials, and discuss the best way to treat ALK+ NSCLC patients. © 2015 Société Francaise du Cancer. Publié par Elsevier Masson SAS. Tous droits réservés.


Bouteloup C.,CHU de Clermont Ferrand | Bouteloup C.,Clermont University
Cahiers de Nutrition et de Dietetique | Year: 2016

Since 2009-2010, gluten is controversial: athletes, movie actresses, and other famous people suppress it from their diet to improve performance, to lose weight or for their welfare. For these reasons given, nothing is proven but there are clearly identified genuine pathologies for which the gluten free (wheat free) diet is justified: wheat allergy and celiac disease. Non celiac gluten sensitivity is another indication although its existence remains controversial. This review aims to provide an update on the epidemiology, pathophysiology and clinical presentation of these three diseases and to emphasize the diagnostic difficulties in clinical practice. © 2016 Société française de nutrition.


The parasympathetic nervous system is activated during rest or digestion. Its neurotransmitter is acetylcholine, and its main effects on the heart and lungs are bradycardia and bronchoconstriction. Acetylcholinesterase inhibitors are indirect stimulants of the parasympathetic tone which can play a role in myasthenia, the slowing down of bowel function, as well as constitute powerful toxins. Cholinergic antagonists can be used to treat sinus bradycardia, hypersalivation or bronchospasm. © 2014 Elsevier Masson SAS.


Bazin J.-E.,CHU de Clermont Ferrand
Oxymag | Year: 2015

Vasovagal attacks are very common and usually not serious. Another form of fainting or a serious cause must be ruled out. Caused by hypertonia of the parasympathetic system, such an attack leads to bradycardia and various unpleasant manifestations. Nonmedical treatment consists in laying the person down, reassuring them and raising their legs. If the condition persists or occurs during the perioperative period, it is treated by an intravenous injection of atropine. © 2014 Elsevier Masson SAS.

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