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Marseille, France

Marotte H.,Hopital NORD | Cimaz R.,University of Florence
Expert Opinion on Biological Therapy | Year: 2014

TNF blockers have been available to treat various inflammatory disorders since more than a decade. T cells and macrophages mainly express TNF and activate many cells through two types of receptors. Pharmaceutical companies developed two types of TNF blockers: soluble receptors and monoclonal antibodies. Understanding of differences of structure and function can explain divergence of efficacy or side effects. Etanercept has the best retention rate in rheumatic diseases, but is less or not effective in granulomatous diseases, such as inflammatory bowel diseases or uveitis. However, etanercept induces less tuberculosis infections than anti-TNF blocker monoclonal antibodies. © 2014 Informa UK, Ltd.

Boleslawski E.,University of Lille Nord de France | Vibert E.,Center Hepato Biliaire | Pruvot F.-R.,University of Lille Nord de France | Le Treut Y.-P.,Hopital de la Conception | And 4 more authors.
Annals of Surgery | Year: 2014

Objectives: Determine whether inflow occlusion is correlated with peakpostoperative serum-transaminases (PSTs) and whether PST is predictive of outcome after liver resections. Background: PST is used as the surrogate of ischemia reperfusion and as the main endpoint in prospective trials of inflow occlusion. This assumption has, however, not been validated. Furthermore, the impact of PST on the postoperative course is unknown. Methods: This prospectively designed registered study included consecutive adult patients undergoing elective hepatectomy in 9 HPB centers. Primary outcome was PST of aspartate-amino-transferase (AST) and alanine-aminotransferase (ALT). Secondary outcome was 90-day morbidity (Dindo-Clavien grades) and length of stay. Explanatory variables were preoperative (including age, sex, body mass index, comorbidities, cirrhosis, and chemotherapy), and intraoperative variables (including procedure performed, inflow occlusion and its duration, length of surgery, vasoactive drugs used, blood loss, and transfusion) were collected prospectively on a dedicated Web site. Multivariable regression models were used to identify independent predictors of PST and of morbidity. Results: Between January 2013 and September 2013, 651 hepatectomieswere included. Inflowocclusionwas performed in 58% (intermittent in 32%, continuous in 24%) andwas not performed in 42%. PST-AST (336 IU/L; interquartile range: 204-573) and PST-ALT (336 IU/L; interquartile range: 205-557) occurred on postoperative day 1. PST was not correlated with the duration of inflow occlusion (ρ-AST = 0.20, P < 0.01; ρ-ALT = 0.18, P < 0.01). PST was not independently associated with morbidity. Receiver operating characteristic curve identified a cutoff of 450 IU/L but this prediction's accuracy was low: Area under the receiver operating characteristic curve for PST-AST: 0.61, confidence interval: 0.56-0.66, P < 0.01, and area under the receiver operating characteristic curve for PST-ALT: 0.57, confidence interval: 0.52-0.62, P = 0.01. Conclusions: PST is not correlated with ischemia time and should not be used as a surrogate of postoperative outcome. Copyright © 2014 by Lippincott Williams & Wilkins.

Hill C.,Institute Gustave Roussy | Dubois G.,Hopital NORD
Presse Medicale | Year: 2012

Screening for prostate cancer has been widely promoted since the early 1990s despite the lack of evidence of its efficacy. The US Preventive Services Task Force recommended against PSA screening because there is sufficient evidence that the harms of screening outweigh its benefits. Yet more than half of French doctors are in favor of screening and the use of PSA assays continue to grow, by 4.6% between 2009 and 2010.The sale of a rapid immunological test for PSA, intended for home use, can only aggravate a situation already out of control. The role of the French authorities in the present situation cannot be ignored. © 2012 Elsevier Masson SAS.

Ranchet M.,INRETS | Paire-Ficout L.,INRETS | Marin-Lamellet C.,INRETS | Laurent B.,Hopital NORD | And 3 more authors.
Journal of Neurology, Neurosurgery and Psychiatry | Year: 2011

Objective: Driving activity requires major involvement of executive functions. The main objective of our study was to determine whether mental flexibility and the updating of information in working memory are affected in drivers with mild to moderate Parkinson's disease (PD). Methods: The study included 25 patients, aged 58-76, with mild to moderate PD and 25 healthy controls matched for age, sex and education, with an average mileage of over 3000 km/year. Neuropsychological tests were conducted to assess global cognitive abilities, to evaluate updating (via the n-back task), flexibility (via the plus-minus task) and information-processing speed (via the Stroop test). Three different scenarios were developed on a driving simulator. Participants were asked to recall road signs (updating task), indicate the shape or colour of road signs according to road side (flexibility task) and to brake at the same time as the car ahead (information-processing speed task) while driving. Results: An updating impairment was found in PD patients in the n-back and simulator tasks; patients recalled significantly fewer road signs. No notable differences were observed between groups in the plus-minus task or in the simulator task evaluating flexibility. There was no significant difference between patients and controls in information-processing speed tasks. Regression analysis showed that the Trail-Making test (B-A) accounted for 40.7% of the variation in PD drivers' simulator task updating score. Conclusion: The updating function is clearly impaired in drivers with mild to moderate PD, while mental flexibility remains unaffected. This study demonstrates the interest of using the Trail Making Test and simulator tasks to assess PD drivers.

Gautret P.,Hopital NORD | Lim,Tan Tock Seng Hospital | Shaw M.,Worldwise Travellers Health and Vaccination Center | Shaw M.,James Cook University | Leder K.,Royal Melbourne Hospital
Clinical Microbiology and Infection | Year: 2011

Since 2008, when the outbreak of rabies in Bali began, 45 patients have attended GeoSentinel or EuroTravNet sites for rabies post-exposure prophylaxis (PEP), representing 12.6% of all travellers seen for PEP in all network clinics during the same time period. This suggests that Bali is emerging as a commonly visited destination among travellers presenting for rabies PEP. The data demonstrate that the majority of animal-related injuries in travellers returning from Bali are associated with exposure to monkeys, and not dog bites/scratches. The clinical implications of this are discussed. © 2010 The Authors. Clinical Microbiology and Infection © 2010 European Society of Clinical Microbiology and Infectious Diseases.

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