Lawitz E.,Alamo Medical Research |
Jacobson I.,New York Medical College |
Bourliere M.,Fondation Hopital Saint Joseph |
Hezode C.,University Paris Est Creteil |
And 13 more authors.
Clinical Gastroenterology and Hepatology
Background and Aims: The addition of boceprevir to therapy with peginterferon alfa-2b and ribavirin results in significantly higher rates of sustained virologic response (SVR) in previously treated patients with chronic hepatitis C virus (HCV) genotype-1 infection, compared with peginterferon alfa-2b and ribavirin alone. We assessed SVR with boceprevir plus peginterferon alfa-2-ribavirin (PEG2a/R) in patients with identical study entry criteria. Methods: In a double-blind, placebo-controlled trial, 201 patients with HCV genotype-1 who had relapsed or not responded to previous therapy were assigned to groups (1:2) and given a 4-week lead-in phase of PEG2a/R, followed by placebo plus PEG2a/R for 44 weeks (PEG2a/R) or boceprevir plus PEG2a/R for 44 weeks (BOC/PEG2a/R). The primary end point was SVR 24 weeks after therapy ended. Results: The addition of boceprevir after 4 weeks of lead-in therapy with PEG2a/R significantly increased the rate of SVR from 21% in the PEG2a/R group to 64% in the BOC/PEG2a/R group (P< .0001). Among patients with poor response to interferon therapy (<1-log 10 decline in HCV RNA at week 4), 39% in the BOC/PEG2a/R group had SVRs, compared with none of the patients in the PEG2a/R group. Among patients with good response to interferon (≥1-log 10 decline), 71% in the BOC/PEG2a/R group had SVRs, compared with 25% in the PEG2a/R group. A ≥1-log 10 decline in HCV RNA at treatment week 4 was the strongest independent predictor of SVR, exceeding that of IL-28Bgenotype. Among 8 patients who began the study with HCV amino acid variants associated with boceprevir resistance, 3 (38%) achieved SVRs. Fifty percent of patients in the BOC/PEG2a/R group developed anemia (hemoglobin <10.0 g/dL), compared with 27% in the PEG2a/R group; 43% vs 21%, respectively, developed neutropenia (neutrophil count <750/mm 3). © 2013 AGA Institute. Source
Poor prognosis of pregnancy in women with autoimmune type 1 diabetes mellitus masquerading as gestational diabetes [Le pronostic de la grossesse est péjoratif chez les femmes ayant un diabète de type 1 auto-immun initialement considéré comme un diabète gestationnel]
Wucher H.,University of Paris Descartes |
Lepercq J.,University of Paris Descartes |
Carette C.,University of Paris Descartes |
Colas C.,Hotel Dieu |
And 11 more authors.
Diabetes and Metabolism
Aim: To describe the clinical presentation and the prognosis of autoimmune type 1 diabetes (T1D) that was first revealed during pregnancy masquerading as gestational diabetes mellitus (GDM). Methods: We reviewed the files of 21 women in whom diabetes was revealed during a pregnancy (" index pregnancy" ) and progressed to T1D after delivery, and in whom GAD and/or IA-2 autoantibodies were found. Results: The median age and BMI of the women were 31 years and 19.8kg/m2. Eleven women had at least one risk factor for GDM. Eight of the 12 multiparous women had had an abnormal outcome of previous pregnancy, including GDM in five. GDM was diagnosed at week 26 (range: 4-38) of gestation by screening in 18, because of macrosomia in two and during hyperglycaemic crises in three. All were treated with insulin, from the time of diabetes diagnosis in 10 and after 4 weeks (range: 2-15) in 11. Term of delivery was 38 (range: 26-41) weeks. Abnormal outcomes occured in 14 pregnancies, including two fetal deaths, four preterm deliveries and eight macrosomic infants. No congenital malformations were reported. After delivery, insulin therapy was stopped in 18 women for 6 months (range: 2-48). The diagnosis of the autoimmune origin of diabetes was established during the index pregnancy in only eight cases. Conclusion: T1D may reveal as GDM in women with or without risk factors for GDM and is associated with a poor prognosis, partly because the correct diagnosis and treatment are delayed. Whether screening for autoimmune markers of T1D should be performed more systematically in women with GDM deserves to be studied. © 2010. Source
Kauv P.,Fondation Hopital Saint Joseph |
Benadjaoud S.,Fondation Hopital Saint Joseph |
Curis E.,University of Paris Descartes |
Boulay-Coletta I.,Fondation Hopital Saint Joseph |
And 2 more authors.
Objectives: To evaluate the diagnostic accuracy of CT in postoperative colorectal anastomotic leakage (AL). Methods: Two independent blinded radiologists reviewed 153 CTs performed for suspected AL within 60 days after surgery in 131 consecutive patients, with (n = 58) or without (n = 95) retrograde contrast enema (RCE). Results were compared to original interpretations. The reference standard was reoperation or consensus (a radiologist and a surgeon) regarding clinical, laboratory, radiological, and follow-up data after medical treatment. Results: AL was confirmed in 34/131 patients. For the two reviewers and original interpretation, sensitivity of CT was 82 %, 87 %, and 71 %, respectively; specificity was 84 %, 84 %, and 92 %. RCE significantly increased the positive predictive value (from 40 % to 88 %, P = 0.0009; 41 % to 92 %, P = 0.0016; and 40 % to 100 %, P = 0.0006). Contrast extravasation was the most sensitive (reviewers, 83 % and 83 %) and specific (97 % and 97 %) sign and was significantly associated with AL by univariate analysis (P < 0.0001 and P < 0.0001). By multivariate analysis with recursive partitioning, CT with RCE was accurate to confirm or rule out AL with contrast extravasation. Conclusions: CT with RCE is accurate for diagnosing postoperative colorectal AL. Contrast extravasation is the most reliable sign. RCE should be performed during CT for suspected AL. Key Points: • CT accurately diagnosed clinically suspected colorectal AL and showed good interobserver agreement • Contrast extravasation was the most sensitive and specific CT sign • Retrograde contrast enema during CT improved positive predictive value • Retrograde contrast enema decreased false-negative or indeterminate original CT interpretations © 2015, European Society of Radiology. Source
Agency: Cordis | Branch: FP7 | Program: CP-FP | Phase: HEALTH-2009-2.3.1-2 | Award Amount: 7.82M | Year: 2010
Many results drawn from previous studies of the effect of antibiotic use on emergence, selection and spread of antimicrobial resistance (AMR) have lacked a holistic view combining all aspects into one study. The SATURN project aims to study the impact of antibiotic exposure on AMR with a multidisciplinary approach that bridges molecular, epidemiological, clinical and pharmacological research. Two types of clinical studies will be conducted: First, a randomized trial will be performed to resolve an issue of high controversy (antibiotic cycling vs. mixing). Second, 3 observational studies will be conducted to rigorously study issues surrounding the effect of antibiotic use on AMR that are not easily assessable through randomized trials. These clinical studies will serve as a platform to 2 complementary workpackages (microbiology & pharmacology) that will perform important investigations relevant to this call. The work package focusing on molecular studies will generate new evidence about the changes effected by antibiotic therapy on commensal organisms or opportunistic pathogens in the oropharyngeal, nasal and gastro-intestinal flora and study AMR mechanisms and the dissemination of successful clones of fluoroquinolone-resistant, carbapenem-resistant or extended-spectrum beta-lactamase harboring Gram-negative bacteria, MRSA and fluoroquinolone-resistant viridans streptococci. The purpose of the pharmacodynamic study is to model the relationships between antibiotic exposure and AMR emergence over time for various classes of agents. In summary, the overarching rationale of SATURN is to improve methodological standards and conduct research that will help to better understand the impact of antibiotic use on acquisition, selection and transmission of AMR in different environments, by combining analyses of molecular, individual patient-level and ecologic data. The anticipated results may guide clinical and policy decisions to ultimately reduce the burden of AMR in Europe.
Moreau P.-E.,Fondation Hopital Saint Joseph |
Ferrero E.,Hopital Europeen Georges Pompidou |
Riouallon G.,Fondation Hopital Saint Joseph |
Lenoir T.,Hopital Europeen Georges Pompidou |
Guigui P.,Hopital Europeen Georges Pompidou
Orthopaedics and Traumatology: Surgery and Research
Introduction: Lumbar fusion is now a currently accepted treatment for degenerative lumbar spondylolisthesis (DLSP), but may induce adjacent segment degeneration (ASD). The present study hypothesis was that there are radiological parameters associated with ASD. The study objective was to determine predictive factors of ASD. Material and methods: A single-center retrospective study included patients operated on between 2006 and 2013 for DLSP. Radiological parameters were analyzed on preoperative, immediate postoperative and final follow-up lateral X-ray. ASD was defined by the following adjacent segment criteria:. >. 3. mm anteroposterior translation,. >. 10° segmental kyphosis, or. >. 50% loss of disc height. Results: One hundred and seven patients were included: 79% female; mean age, 67. ±. 10.2 years. Fusion involved 1 level in 67% of cases and 2 or more in 33%, with transforaminal lumbar interbody fusion (TLIF) in 27% of cases. There was overall significant gain in lumbar lordosis (mean, 3.1°; P = 0.04). At a mean 27.8 months' follow-up, 29% of cases showed ASD and 10% required surgical reintervention. Preoperative anterior imbalance and long fusion (>. 2 levels) were significantly associated with ASD (OR = 2.81, 95% CI [1.17-6.74] versus OR = 2.76, 95% CI [1.15-6.63]). There were no significant differences according to postoperative radiological parameters, or to TLIF (OR = 1.8, 95% CI [0.7-4.4]). Conclusion: Twenty-nine percent of patients developed ASD, with a surgical revision rate of 10%. ASD risk factors comprised high number of instrumented levels and preoperative sagittal imbalance. Level of evidence: IV, retrospective cohort. © 2016 Elsevier Masson SAS. Source