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Le Touquet – Paris-Plage, France

Correas J.-M.,Groupe Hospitalier Necker Enfants Malades | Low G.,University of Alberta | Low G.,Royal Infirmary | Needleman L.,University of Alabama at Birmingham | And 11 more authors.
European Radiology

Objective To conduct a dose testing analysis of perfluorobutane microbubble (NC100100) contrast-enhanced ultrasound (CEUS) to determine the optimal dose for detection of liver metastases in patients with extra-hepatic primary malignancy. Methods 157 patients were investigated with conventional US and CEUS. CEUS was performed following intravenous administration of perfluorobutane microbubbles (using one dose of either 0.008, 0.08, 0.12 or 0.36 μL/kg body weight). Three blinded off-site readers recorded the number and locations of metastatic lesions detected by US and CEUS. Contrast enhanced CT and MRI were used as the "Standard Of Reference" (SOR). Sensitivity, specificity and accuracy of liver metastasis detection with US versus CEUS, for each dose group were obtained. Dose group analysis was performed using the Chi-square test. Results 165 metastases were present in 92 patients who each had 1-7 lesions present on the SOR. Sensitivity of US versus CEUS (for all doses combined) was 38% and 67% (p=0.0001). The 0.12 dose group with CEUS (78%) had significantly higher sensitivity and accuracy (70%) compared to other dose groups (p<0.05). Conclusion The diagnostic performance of CEUS is dose dependent with the 0.12 μL/kg NC100100 dose group showing the greatest sensitivity and accuracy in detection of liver metastases. © European Society of Radiology 2011. Source

Coulibaly M.,University of Ouagadougou | Meda N.,University of Ouagadougou | Meda N.,Center Muraz | Yonaba C.,Service de pediatrie | And 11 more authors.

Objective: The World Health Organization (WHO) has recommended a universal antiretroviral therapy (ART) for all HIV-infected children before the age of two since 2010, but this implies an early identification of these infants. We described the Prevention of Mother-to-Child HIV Transmission (PMTCT) cascade, the staffing and the quality of infrastructures in pediatric HIV care facilities, in Ouagadougou, Burkina Faso. Methods: We conducted a cross-sectional survey in 2011 in all health care facilities involved in PMTCT and pediatric HIV care in Ouagadougou. We assessed them according to their coverage in pediatric HIV care and WHO standards, through a desk review of medical registers and a semi-structured questionnaire administered to health-care workers (HCW). Results: In 2011, there was no offer of care in primary health care facilities for HIV-infected children in Ouagadougou. Six district hospitals and two university hospitals provided pediatric HIV care. Among the 67 592 pregnant women attending antenatal clinics in 2011, 85.9% were tested for HIV. The prevalence of HIV was 1.8% (95% Confidence Interval: 1.7%-1.9%). Among the 1 064 HIV-infected pregnant women attending antenatal clinics, 41.4% received a mother-to-child HIV transmission prevention intervention. Among the HIV-exposed infants, 313 (29.4%) had an early infant HIV test, and 306 (97.8%) of these infants tested received their result within a four-month period. Among the 40 children initially tested HIV-infected, 33 (82.5%) were referred to a health care facility, 3 (9.0%) were false positive, and 27 (90.0%) were initiated on ART. Although health care facilities were adequately supplied with HIV drugs, they were hindered by operational challenges such as shortage of infrastructures, laboratory reagents, and trained HCW. Conclusions: The PMTCT cascade revealed bottle necks in PMTCT intervention and HIV early infant diagnosis. The staffing in HIV care and quality of health care infrastructures were also insufficient in 2011 in Ouagadougou. © 2014 Coulibaly et al. Source

Dhedin N.,Paris West University Nanterre La Defense | Prebet T.,Medullaire Institute Paoli Calmettes | De Latour R.P.,Service de Greffe de Moelle | Katsahian S.,Unite de Biostatistique | And 16 more authors.
Bone Marrow Transplantation

The correlation between the incidence of GVHD and the number of infused CD34+cells remains controversial for PBSC transplantation after a reduced-intensity-conditioning (RIC) regimen. We evaluated 99 patients transplanted with an HLA-identical sibling after the same RIC (2-Gy-TBI/fludarabine). Donor and recipient characteristics, donors blood G-CSF-mobilized CD34+cell count, and number of infused CD34 +and CD3+ cells were analyzed as risk factors for acute and chronic GVHD There was a trend for an increased incidence of extensive chronic GVHD in the quartile of patients receiving more than 10 × 10 6 CD34+cells/kg (P=0.05). Interestingly, the number of donor's blood CD34+cells at day 5 of G-CSF mobilization was closely associated with the incidence of extensive chronic GVHD, that is, 48% (95% CI: 28-68) at 24-months in the quartile of patients whose donors had the highest CD34+cell counts versus 24.3% (95% CI: 14-34) in the other patients (P=0.007). In multivariate analysis, the only factor correlating with extensive chronic GVHD (cGVHD) was the donors blood CD34+cell count after G-CSF (HR 2.49; 95% CI: 1.16-5.35, P=0.019). This study shows that the incidence of cGVHD is more strongly associated with the donor's ability to mobilize CD34 +cells than with the number of infused CD34+cells. © 2012 Macmillan Publishers Limited. Source

Bani-Sadr F.,University of Monastir | Bani-Sadr F.,French Institute of Health and Medical Research | Loko M.-A.,French Institute of Health and Medical Research | Pambrun E.,French Institute of Health and Medical Research | And 8 more authors.

Background: The impact of hepatitis C virus (HCV)-related characteristics such as genotype, viral load or liver fibrosis on the chances of achieving sustained HIV suppression in coinfected patients is not fully documented. Method: We examined the relationship between both HIV/HCV-related and sociobehavioural characteristics and HIV sustained viral suppression (SVS) in 897 patients included in the ANRS CO13 HEPAVIH cohort. Results: The main outcome variable was HIV SVS, defined as at least two consecutive undetectable HIV viral loads. Among the 897 HIV/HCV-coinfected patients, 419 (47%) had receivedHCV therapy at least once, and 103 patients (25%) had experienced anHCV sustained virologic response (SVR). In multivariate analysis, older age [odds ratio (OR) 1.23 for each period of 5 years of age, 95%confidence interval (CI) 1.02-1.49; P=0.03], a higher level of school education (OR 1.92, 95% CI 1.04-3.56; P=0.04), good adherence to HIV therapy (OR 2.05, 95% CI 1.23-3.43; P=0.006) and HCV SVR (OR 1.81, 95%CI 1.01-3.26; P=0.04) remained significantly associated with HIV SVS. In contrast, triple nucleoside reverse transcriptase inhibitor (NRTI) regimens were associated with failure to achieve HIVSVS(OR0.50, 95%CI 0.27-0.94; P=0.03).Our results show that HCV SVR is associated with a higher likelihood of achieving HIV SVS. Conclusion: With the advent of direct-acting anti-HCV drugs, a marked increase in the rate of virologic response is observed in coinfected patients. So, further research is needed to determine whether suppression of HCV replication could be associated with a higher efficacy of antiretroviral therapy. © 2014 Wolters Kluwer Health - Lippincott Williams & Wilkins. Source

Piram M.,Groupe Hospitalier Necker Enfants Malades | Le Merrer M.,Groupe Hospitalier Necker Enfants Malades | Le Merrer M.,Reference Center for Genetic Bone Diseases | Bughin V.,National Reference Center for Genodermatoses | And 7 more authors.
Journal of the American Academy of Dermatology

Background: Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder characterized by progressive ossification of soft tissues. Clinical diagnosis is important because trauma from lesional biopsies can exacerbate the disease. Objective: We sought to evaluate the frequency of scalp nodules as the presenting manifestation of FOP. Methods: We describe 3 infants with FOP who presented with multiple neonatal scalp nodules. We reviewed all 43 cases of this disorder in the French FOP registry. Results: Scalp nodules were found in 40% of cases and usually represented the first manifestation of the disease. All 43 patients had characteristic skeletal malformations involving the great toes (n = 43), fingers (n = 12), and vertebrae (n = 3). Other abnormalities were cerebral malformations (n = 1) and alopecia (n = 2). Histopathologic analysis did not contribute to the differential diagnosis and was interpreted as cranial fasciitis in two patients. Limitations: Our study was retrospective, and the presence or absence of scalp nodules was not always recorded. Conclusion: Neonatal scalp nodules associated with a characteristic malformation of the great toes are a common presentation of FOP. Physicians should be aware that lesional biopsies can exacerbate the disease and must therefore be avoided. A diagnosis of classic FOP can be confirmed by molecular genetic studies. © 2009 by the American Academy of Dermatology, Inc. Source

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