Murviel-lès-Montpellier, France
Murviel-lès-Montpellier, France

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Vanscheidt W.,Paula Modersohn Platz 3 | Harding K.,University of Cardiff | Teot L.,Hopital Lapeyronie | Siebert J.,Schulke and Mayr GmbH
International Wound Journal | Year: 2012

The aim of this study was to evaluate the cytotoxic effect of octenidine dihydrochloride/phenoxyethanol (OHP) found in vitro by conducting a randomized, double-blind controlled clinical study focusing on its safe and effective use in chronic venous leg ulcers. In total, 126 male and female patients were treated with either OHP (n = 60) or Ringer solution (n = 66). The treatment lasted over a period of maximum 12 weeks. For the assessment of the wound-healing process, clinical outcome parameters were employed, that is, time span until 100% epithelization, wound status and the wound surface area were analysed. Side effects were recorded during the study period. The median time to complete ulcer healing was comparable between the OHP and Ringer solution groups (92 versus 87 days; P = 0·952), without being influenced by wound size or duration of the target ulcer (P-values: 0·947/0·978). In patients treated with OHP, fewer adverse events (AEs) were observed compared with the Ringer group (17% versus 29% of patients reported 20 versus 38 AEs). OHP is well suitable for the treatment of chronic wounds without cytotoxic effects. Furthermore, OHP does not impair the wound healing in chronic venous ulcers. © 2011 The Authors. © 2011 Blackwell Publishing Ltd and Medicalhelplines.com Inc.


Lauwerys B.R.,Catholic University of Louvain | Hachulla E.,Hopital Claude Huriez | Spertini F.,CHU Vaudois | Lazaro E.,Bordeaux University Hospital Center | And 8 more authors.
Arthritis and Rheumatism | Year: 2013

Objective We developed interferon-α-kinoid (IFN-K), a drug composed of inactivated IFNα coupled to a carrier protein, keyhole limpet hemocyanin. In human IFNα-transgenic mice, IFN-K induces polyclonal antibodies that neutralize all 13 subtypes of human IFNα. We also previously demonstrated that IFN-K slows disease progression in a mouse model of systemic lupus erythematosus (SLE). This study was undertaken to examine the safety, immunogenicity, and biologic effects of active immunization with IFN-K in patients with SLE. Methods We performed a randomized, double-blind, placebo-controlled, phase I/II dose-escalation study comparing 3 or 4 doses of 30 μg, 60 μg, 120 μg, or 240 μg of IFN-K or placebo in 28 women with mild to moderate SLE. Results IFN-K was well tolerated. Two SLE flares were reported as serious adverse events, one in the placebo group and the other in a patient who concomitantly stopped corticosteroids 2 days after the first IFN-K dose, due to mild fever not related to infection. Transcriptome analysis was used to separate patients at baseline into IFN signature-positive and -negative groups, based on the spontaneous expression of IFN-induced genes. IFN-K induced anti-IFNα antibodies in all immunized patients. Notably, significantly higher anti-IFNα titers were found in signature-positive patients than in signature-negative patients. In IFN signature-positive patients, IFN-K significantly reduced the expression of IFN-induced genes. The decrease in IFN score correlated with the anti-IFNα antibody titer. Serum complement C3 levels were significantly increased in patients with high anti-IFNα antibody titers. Conclusion These results show that IFN-K is well tolerated, immunogenic, and significantly improves disease biomarkers in SLE patients, indicating that further studies of its clinical efficacy are warranted. Copyright © 2013 by the American College of Rheumatology.


Maimoun L.,Montpellier University | Georgopoulos N.A.,University of Patras | Sultan C.,Hopital Lapeyronie
Journal of Clinical Endocrinology and Metabolism | Year: 2014

Context: Puberty is a crucial period of dramatic hormonal changes, accelerated growth, attainment of reproductive capacity, and acquisition of peak bone mass. Participation in recreational physical activity is widely acknowledged to provide significant health benefits in this period. Conversely, intense training imposes several constraints, such as training stress and maintenance of very low body fat to maximizeperformance. Adolescentfemaleathletesarethereforeatriskofovertrainingand/orpoordietary intake, which may have several consequences for endocrine function. The "adaptive" changes in the hypothalamic-pituitary-gonadal, -adrenal, andsomatotropic axesandthe secretory role of the adipose tissue are reviewed, as are their effects on growth, menstrual cycles, and bone mass acquisition.Design: Asystematic searchonMedline between 1990 and 2013 was conducted using the following terms: "intense training," "physical activity," or "exercise" combined with "hormone," "endocrine," and "girls," "women," or "elite female athletes." All articles reporting on the endocrine changes related to intense training and their potential implications for growth, menstrual cycles, and bone mass acquisition were considered.Results and Conclusion: Young female athletes present a high prevalence of menstrual disorders, including delayed menarche, oligomenorrhea, and amenorrhea, characterized by a high degree of variability according to the type of sport. Exercise-related reproductive dysfunction may have consequences for growth velocity and peak bone mass acquisition. Recent findings highlight the endocrine role of adipose tissue and energy balance in the regulation of homeostasis and reproductive function. A better understanding of the mechanisms whereby intense training affects the endocrine system may orient research to develop innovative strategies (ie, based on nutritional or pharmacological approaches and individualized modalities of training and competition) to improve the medical care of these adolescentsandprotect their reproductive function. Copyright © 2014 by the Endocrine Society.


Soubrier M.,Hopital G Montpied | Lukas C.,Hopital Lapeyronie | Sibilia J.,Hopital Hautepierre | Fautrel B.,Hopital la Pitie Salpetriere | And 4 more authors.
Annals of the Rheumatic Diseases | Year: 2011

Objectives: To compare the efficacy of disease activity score in 28 joints (DAS28ESR)-driven therapy with antitumour necrosis factor (patients from the GUEPARD trial) and routine care in patients with recent-onset rheumatoid arthritis (patients of the ESPOIR cohort). Results: After matching GUEPARD and ESPOIR patients on the basis of a propensity score and a 1:2 ratio, at baseline all patients had comparable demographic characteristics, rheumatoid factor, anticyclic citrullinated peptide antibody positivity and clinical disease activity parameters: erythrocyte sedimentation rate, C-reactive protein, mean DAS (6.26±0.87), Sharp/van der Heijde radiographic score (SHS), health assessment questionnaire (HAQ). Disease duration was longer in GUEPARD patients (5.6±4.6 vs 3.5±2.0 months, p<0.001). After 1 year, the percentage of patients in remission with an HAQ (<0.5) and an absence of radiological progression was higher in the tight control group (32.3% vs 10.2%, p=0.011) as well as the percentage of patients in low DAS with an HAQ (<0.5) and an absence of radiological progression (36.1% vs 18.9%, p=0.045). However, there was no difference in the decrease in DAS, nor in the percentage of EULAR (good and moderate), ACR20, ACR50 and ACR70 responses. More patients in the tight control group had an HAQ below 0.5 (70.2% vs 45.2%, p=0.005). Overall, pain, patient and physician assessment and fatigue decreased more in the tight control group. The mean SHS progression was similar in the two groups as was the percentage of patients without progression. Conclusions: In patients with recent onset active rheumatoid arthritis, a tight control of disease activity allows more patients to achieve remission without disability and radiographic progression.


Dechanet C.,Hopital Arnaud de Villeneuve | Anahory T.,Hopital Arnaud de Villeneuve | Mathieu Daude J.C.,Hopital Lapeyronie | Quantin X.,Hopital Arnaud de Villeneuve | And 4 more authors.
Human Reproduction Update | Year: 2011

Background: Cigarette smoking is associated with lower fecundity rates, adverse reproductive outcomes and a higher risk of IVF failures. Over the last few decades, prevalence of smoking among women of reproductive age has increased. This review focuses on current knowledge of the potential effects of smoke toxicants on all reproductive stages and the consequences of smoke exposure on reproductive functions. Methods: We conducted a systematic review of the scientific literature on the impact of cigarette smoking and smoke constituents on the different stages of reproductive function, including epidemiological, clinical and experimental studies. We attempted to create hypotheses and find explanations for the deleterious effects of cigarette smoke observed in experimental studies. Results: Cigarette smoke contains several thousand components (e.g. nicotine, polycyclic aromatic hydrocarbons and cadmium) with diverse effects. Each stage of reproductive function, folliculogenesis, steroidogenesis, embryo transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and uterine myometrium is a target for cigarette smoke components. The effects of cigarette smoke are dose-dependent and are influenced by the presence of other toxic substances and hormonal status. Individual sensitivity, dose, time and type of exposure also play a role in the impact of smoke constituents on human fertility. Conclusions: All stages of reproductive functions are targets of cigarette smoke toxicants. Further studies are necessary to better understand the deleterious effects of cigarette smoke compounds on the reproductive system in order to improve health care, help to reduce cigarette smoking and provide a better knowledge of the molecular mechanisms involved in reproductive toxicology. © The Author 2010. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.


Mubarak S.J.,Rady Childrens Hospital and Health Center | Dimeglio A.,Hopital Lapeyronie
Journal of Pediatric Orthopaedics | Year: 2011

BACKGROUND: The goals of cavus foot correction are to obtain a plantigrade foot with the heel in slight valgus position and to hopefully preserve joint motion in both the tarsal and metatarsal joints. The apex of many cavus deformities is near Chopart joint. We are reporting on a new technique involving navicular excision and cuboid osteotomy to correct severe stiff cavus feet. METHODS: A retrospective review of patients who underwent navicular excision and a cuboid dorsal closing wedge osteotomy to correct a rigid cavus foot deformity was performed. A total of 11 children and 16 feet were treated during the past 8 years at 2 centers. RESULTS: All feet had navicular excision and a cuboid dorsal closing wedge osteotomy to correct a rigid cavus foot deformity. The etiology of the deformity was as follows: multiply operated congenital clubfoot (5 feet), arthrogryposis (6 feet), and neurological deficits (5 feet). At a mean follow-up of 4.9 years, all had a plantigrade foot. CONCLUSIONS: This salvage procedure offers an alternative method to correct a severe stiff cavus deformity. The procedure is performed at the apex of the deformity and thus maximum correction can be obtained by this "wedge resection." The curved articular surfaces of the cuneiforms articulate with the head of the talus post navicular excision if no fusion is desired. Navicular excision has been used to correct children with vertical talus, but not previously reported as a method to handle severe cavus. It is a salvage procedure that should be considered to address severe rigid cavus. LEVEL OF EVIDENCE: Level IV © 2011 Lippincott Williams & Wilkins, Inc.


Allegaert K.,University Hospital | Rochette A.,Hopital Lapeyronie | Veyckemans F.,Cliniques Universitaires St Luc
Paediatric Anaesthesia | Year: 2011

Aims and objectives: To illustrate the complex interaction between ontogeny, i.e., age-dependent maturation, genetic polymorphisms and renal elimination clearance during infancy, based on developmental disposition of intravenous tramadol during infancy. Background: Tramadol (M) is metabolized by O-demethylation (cytochrome P450 [CYP] 2D6) to the pharmacodynamic active metabolite O-demethyl tramadol (M1). This metabolite is subsequently eliminated by renal route while M1 formation will in part depend on ontogeny, i.e., age-dependent activity and CYP2D6 polymorphisms. However, these pathways do not mature simultaneously. Methods: A pooled pharmacokinetic analysis of earlier reported time-concentration profiles in neonates and infants was performed with subsequent simulation of the impact of ontogeny, polymorphisms and renal elimination clearance during infancy. Results: Tramadol plasma time-concentration profile changes with postmenstrual age. The highest metabolite concentrations occur in the 52-week infant, where M1 formation clearance (hepatic, CYP2D6) is already mature but metabolite elimination clearance (through glomerular filtration rate) is immature. Discussion: The phenotypic observations might in part explain unanticipated (side-)effects of tramadol. In addition to the compound-specific clinical implications, it is important to stress that the maturational trends in the elimination processes described can be considered for other compounds (e.g., codeine) that undergo similar elimination routes. © 2010 Blackwell Publishing Ltd.


Fesler P.,Hopital Lapeyronie | Mimran A.,Hopital Lapeyronie
Current Hypertension Reports | Year: 2011

Because of the high prevalence of chronic kidney disease, estimation of the glomerular filtration rate (GFR) is necessary to diagnose, stage, and follow the progression of renal impairment, and to adjust the dosage of medications with predominantly renal excretion. The main pitfall of using 24-h urinary creatinine clearance is the inaccuracy of urine collection. Multiple formulas based on serum creatinine have been proposed for the estimation of renal function in daily clinical practice and in large-scale studies. The two most widely used formulas are Cockcroft-Gault (CG) for the estimation of creatinine clearance and MDRD (Modification of Diet in Renal Disease) for the estimation ofGFR. However, the performance of these formulas is satisfactory only in individuals with a GFR level less than 60 mL/min/1.73 m2, and the presence of determinants of serum creatinine that are not dependent on GFR, such as gender, age, body weight, or chronic illness, should also be considered. Because of the need for an accurate and reproducible measurement of serum creatinine, uniform creatinine assay calibration is now available. The utility in daily practice of new markers of GFR, such as cystatin C, remains to be demonstrated. © Springer Science+Business Media, LLC 2011.


Lefebvre P.,Hopital Lapeyronie | Letois F.,French Institute of Health and Medical Research | Sultan A.,Hopital Lapeyronie | Nocca D.,Hopital St Eloi | And 2 more authors.
Surgery for Obesity and Related Diseases | Year: 2014

Background Nutritional deficiencies are common after bariatric surgery, but few studies have examined them preoperatively. The objective of this study was to evaluate several vitamins, nutrients, and nutritional markers and their determinants in patients with obesity considering bariatric surgery. Methods Preoperative values of fasting plasma glucose, insulin, lipid profile, 25-hydroxyvitamin D (25(OH)D), parathyroid hormone, thyroid-stimulating hormone, calcium, phosphate, albumin, magnesium, total proteins, liver function tests, iron, ferritin, folate, vitamin A, vitamin B12, selenium, and zinc were evaluated in 267 Caucasian outpatients (74.2% women, aged 40.5±12.6 years) who were considering bariatric surgery. The determinants of nutrient variability were analyzed by linear regression for nutrients with a prevalence of deficiency>10%, i.e., serum 25(OH)D, iron, phosphate, magnesium, and vitamin A. Results Prevalence of inadequate concentrations was high for 25(OH)D (67.9% with values 20 ng/mL), magnesium (35.4%), phosphate (21.6%), iron (18.8%), and vitamin A (16.9%). Multiple deficiencies were common; 28.5%, 12.1%, and 6.3% of patients had 2, 3, and 4 deficiencies, respectively. In multivariate analyses, metabolic characteristics had an important impact on deficiencies, with lower values of 25(OH)D and vitamin A with increasing body mass index, lower values of 25(OH)D and magnesium with increasing fasting plasma glucose, and a positive correlation between vitamin A and triglycerides. Elevated TSH was associated with low iron concentrations. Conclusion At all ages, micronutrient deficiencies were common, with high prevalence of concentration inadequacies for 25(OH)D, magnesium, phosphate, iron, and vitamin A. High body mass index and high fasting plasma glucose increased the risk of deficiencies, particularly for 25(OH)D. Preoperative screening and correction of deficiencies should be advised. © 2014 American Society for Bariatric Surgery.


Cyteval C.,Hopital Lapeyronie | Bourdon A.,Hopital Lapeyronie
Diagnostic and Interventional Imaging | Year: 2012

The diagnosis of infections associated with orthopedic implants is based on a combination of clinical signs, laboratory findings and imaging studies. There is no gold standard imaging technique: conventional radiography is indispensable, although 50% of the time the radiograph is normal. Computed tomography (CT), magnetic resonance imaging (MRI) and ultrasonography are valuable to detect soft tissue abnormalities. Bone scintigraphy (BS) rules out active infection. For infections involving the peripheral skeleton, labeled white blood cell (WBC) scintigraphy coupled with colloid scintigraphy is the reference technique, whereas a gallium scan is always necessary for imaging the spine or pelvis. To confirm or rule out infection, needle aspiration with analysis of aspirated fluid is the cornerstone of the diagnostic algorithm. © 2012 Published by Elsevier Masson SAS on behalf of the Éditions françaises de radiologie.

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