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Terrasson-Lavilledieu, France

Rocchetti V.,Center Hospitalier Of Versailles gnot | Viard J.P.,Hotel Dieu
Medecine et Maladies Infectieuses | Year: 2015

Background: We assessed how family physicians screened for HIV infection in Paris, in 2013 and whether their practice had changed after publication of the HAS (French National Authority for Health) recommendation for systematic screening. Method: Family practitioners (FPs) in Paris answered a questionnaire by e-mail or regular mail from January to April 2013. The statistical analysis was performed with the Chi2 test. Results: Four hundred and seven FPs answered (77.8% response rate). FPs did not always identify risk cases: 78% in case of sexually transmitted infection, but 32% for partner change, 39% for patients from a highly HIV endemic country, and 21% for sexually active teenagers or adults. Practices differed according to districts. FPs in the 1st and in the Northeastern Paris districts detected risk cases for HIV more often than their colleagues, and they used screening more often, with, consequently, more frequently positive results. The screening strategies also differed according to the FPs' demographic characteristics and their type of practice: young (P=0.0002) female (P=0.02) FPs working in "sector 1 (patients fully reimbursed)" (P=8.10-5) prescribed more HIV blood tests. Surprisingly, only 45% of FPs was aware of the recent recommendation for systematic screening of HIV. Conclusion: The Paris FP screening practices differ according to demographic characteristics, place, and type of practice. Screening practices have not changed since the publication of the new screening strategy. © 2015 Elsevier Masson SAS.

Dupouy S.,French Institute of Health and Medical Research | Mourra N.,Service danatomopathologie | Doan V.K.,French Institute of Health and Medical Research | Gompel A.,UF de Gynecologie Hotel Dieu | And 2 more authors.
Biochimie | Year: 2011

A growing challenge in medicine today, is the need to improve the suitability of drug treatments for cancer patients. In this field, biomarkers have become the "flags" to provide additional information in tumor biology. They are a relay between the patient and practitioner and consequently, aid in the diagnosis, providing information for prognosis, or in some cases predicting the response to specific therapies. In addition to being markers, these tumor "flags" can also be major participants in the process of carcinogenesis. Neurotensin receptor 1 (NTSR1) was recently identified as a prognosis marker in breast, lung, and head and neck squamous carcinomas. Neurotensin (NTS) was also shown to exert numerous oncogenic effects involved in tumor growth and metastatic spread. These effects were mostly mediated by NTSR1, making the NTS/NTSR1 complex an actor in cancer progression. In this review, we gather information on the oncogenic effects of the NTS/NTSR1 complex and its associated signaling pathways in order to illuminate its significant role in tumor progression and its potential as a biomarker and a therapeutic target in some tumors. © 2011 Elsevier Masson SAS. All rights reserved.

Frija-Orvoen E.,Hotel Dieu
Medecine du Sommeil | Year: 2015

Pulse oximetry is currently used in many clinical applications. Usually reliable and accurate, a good knowledge of the limitations in measurement is necessary before use. This paper describes technical principles and limitations of pulse oximetry.

Vitamin K antagonists (VKA) and heparins are the commonly used therapeutics in the prevention of venous and arterial thromboembolic episodes. They have numerous advantages and few flaws: iatrogenicity and compulsory biological monitoring for the VKA, and activity limited to the parenteral way for heparins. Three new oral anticoagulants, direct inhibitors of factor Xa (Rivaroxaban, Apixaban) or of factor IIa or thrombin (Dabigatran Etexilate), do not need coagulation monitoring. The diet does not influence the activity of these 3 new molecules. A small number of drugs can modify their anticoagulant activity. The thromboprophylaxis in major orthopedic surgery and the non valvular atrial fibrillation are registered by the Health Authorities. Their use in the treatment of venous thromboembolic episodes and the prevention of recurrence or secondary prevention has not been yet validated by the Health Authorities. The physician's information and the patient's education are strongly recommended for the success of this therapeutic revolution. © 2011 Springer Verlag France.

Frampas E.,Hotel Dieu | Lassau N.,University Paris - Sud | Zappa M.,APHP Assistance Publique Hopitaux de Paris | Vullierme M.-P.,APHP Assistance Publique Hopitaux de Paris | And 3 more authors.
European Journal of Radiology | Year: 2013

Purpose: To investigate whether there is any correlation between standard endpoints and tumor perfusion measurements with Perfusion CT and Dynamic Contrast-Enhanced Ultrasonography (DCE-US) in patients with advanced Hepatocellular Carcinoma (HCC) treated with targeted therapy. Materials and methods: Nineteen patients were evaluated during targeted therapy (sorafenib n = 16, sunitinib n = 3). Changes in tumor perfusion measurements between baseline and month 1 were assessed and compared using RECIST progression criteria at month 2. Results: Median time to progression according to RECIST was 117 days and median time to death was 208 days. Perfusion CT values before treatment were significantly increased in HCC compared to the surrounding liver (n = 17, P <.02). Eleven patients received complete examinations with both techniques at baseline and month 1. A non-significant decrease was found in all Perfusion CT values between RECIST nonprogressors (n = 7) and progressors (n = 4): mean Blood Volume: -27.9 vs. -11.1% and mean Blood Flow: -25.0 vs. -11.7% respectively. With DCE-US, opposite changes were found (mean Area Under the Curve AUC: -38.3 vs. 436.3%). RECIST progression at month 2 was significantly correlated with a threshold 40% decrease in AUC (P =.015). None of the patients with a decrease in AUC ≥ 40% was a progressor at month 2. Conclusion: Despite perfusion changes with both Perfusion CT and DCE-US in patients receiving treatment, only DCE-US at month 1 (with a decrease in the AUC of more than 40%) predicted non-progression at month 2 and may be a potential surrogate marker of tumor response during targeted therapy. © 2012 Elsevier Ireland Ltd.

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