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Nantes, France

Cadranel J.,Service de Pneumologie et Reanimation | Cadranel J.,University Pierre and Marie Curie | Philippe B.,CEA DAM Ile-de-France | Hennequin C.,French Institute of Health and Medical Research | And 11 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2012

Early evidence suggests the efficacy of voriconazole for chronic pulmonary aspergillosis (CPA). We conducted a prospective, open, multicenter trial to evaluate the efficacy and safety of voriconazole for proven CPA in minimally or non-immunocompromised patients. Patients had CPA confirmed by chest computed tomography (CT) and/or endoscopy, positive Aspergillus culture from a respiratory sample, and positive serologic test for Aspergillus precipitins. Patients received voriconazole (200 mg twice daily) for a period of 6-12 months and were followed for 6 months after the end of therapy (EOT). The primary endpoint was global success at 6 months, defined as complete or partial (≥50 % improvement) radiological response and mycological eradication. Forty-one patients with confirmed CPA were enrolled. All patients had A. fumigatus as the etiologic agent. By EOT, five patients had died from comorbidities and seven had discontinued voriconazole due to toxicity. The global success rate at 6 months was 13/41 (32 %): 10/19 (53 %) for chronic necrotizing aspergillosis and 3/22 (14 %) for chronic cavitary aspergillosis (p=0.01). The respective success rates at EOT were 58 and 32 %. Clinical symptoms and quality of life also improved during treatment. Voriconazole is effective for CPA, with acceptable toxicity. The response rate is higher and obtained more rapidly in necrotizing than cavitary forms. © 2012 Springer-Verlag.

Guerin P.,Institute du Thorax | Bigot E.,Biochemistry | Patrice T.,Photobiologie des Cancers
Journal of Thrombosis and Thrombolysis | Year: 2013

Blood flow arrest and reperfusion during myocardial infarction (MI) cause myocyte and endothelium injury through oxidative stress and inflammation, both of which involve Reactive Oxygen Species (ROS) and peroxides that consume antioxidant defenses. The aim of this study was to determine whether serum from the occluded coronary vessel has impaired anti-oxidative defenses as compared to serum from aortic blood or from the periphery of healthy controls. Forty-seven patients (44 men) were included for study. Inclusion criteria were chest pain, ST elevation, and cardiac troponin increase. A photoreaction producing a standardized amount of singlet oxygen (1O2), an excited form of oxygen, was performed in serum samples obtained during primary percutaneous coronary intervention (PCI). Immediately after laser light delivery to 5 % sera containing 5 μg/mL rose bengal, dichloro-dihydro-fluorescein (DCFH) was added and its post-oxidation transformation into the fluorescent DCF, was recorded. At least 5 h after the start of symptoms, the mean secondary ROS production after 1O2 delivery was increased in coronary sera (p < 0.001), but in aortic blood remained similar to that of healthy controls. The peak troponin value correlated with DCF fluorescence throughout the interval between symptoms onset and PCI. A high fluorescence was associated with a higher risk of MACE. These results show that oxidants secondary to 1O2 are increased in occluded vessels during AMI in parallel to c-troponin, demonstrating that antioxidants are consumed. A O 2 increase during reperfusion would thus extend the damage resulting from IDM necrosis. The effect of conditioning during PCI could be studied using the described method. © 2012 Springer Science+Business Media, LLC.

The Saxagliptin assessment of vascular outcomes recorded in patients with diabetes mellitus-thrombolysis in myocardial infarction (SAVOR-TIMI 53) trial was designed to test the effect of saxagliptin, a DPP-4 inhibitor, on the prevention of the occurrence of cardiovascular events in patients with type 2 diabetes (T2D). It is a 5-year, randomized, double-blind trial, conducted against placebo in 27 countries on 16,496 T2D patients. They received either a placebo or the saxagliptin 5 mg, or 2,5 mg in patients with renal failure (creatinine clearance <50 ml/minute). The treatment was given in addition to the usual treatment but gliptins or GLP-1 analogues were excluded. Patients were in secondary (80%) or primary cardiovascular prevention but with an additional risk factor (20%). The primary endpoint was a combined endpoint of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. The trial was built to test a hypothesis from a non-inferiority to suggest the cardiovascular safety of the saxagliptin but also an assumption of superiority in cardiovascular prevention with a goal to reduce the relative risk of major cardiovascular events (primary endpoint) by 17%. The number of patients enrolled allowed testing these hypotheses with a good statistical power when 1040 events were observed. Patients were included in 27 countries with a large majority in North America and Western Europe. At inclusion the average age was 65.0 years with predominantly male (67%) patients. The average duration of diabetes was 11.9 years and mean HbA1c at baseline was 8.0+1.4%. Almost 12% of patients had retinopathy, 18% nephropathy and 2.5% amputation. Only 5% had no diabetes treatment and ~41% received insulin ± oral antidiabetics. The vast majority of patients (80%) received treatment with statins, antihypertensive and antiplatelet agents. Patients with cardiovascular history had more microvascular complications and were more often treated with insulin. The overall incidence of the primary endpoint was 2%/year. Investigators were asked to minimize the drop out of the patients less than 2,8%/year. The results of this study are expected in September 2013. © 2013 - Elsevier Masson SAS - Tous droits réservés.

Charpentier G.,Center Detudes Et Of Recherche Pour Lintensification Du Traitement Du Diabete | Benhamou P.-Y.,University Hospital | Dardari D.,Center Detudes Et Of Recherche Pour Lintensification Du Traitement Du Diabete | Clergeot A.,University Hospital | And 8 more authors.
Diabetes Care | Year: 2011

OBJECTIVE - To demonstrate that Diabeo software enabling individualized insulin dose adjustments combined with telemedicine support significantly improves HbA1c in poorly controlled type 1 diabetic patients. RESEARCH DESIGN AND METHODS - In a six-month open-label parallel-group, multicenter study, adult patients (n = 180) with type 1 diabetes (>1 year), on a basal-bolus insulin regimen (>6 months), with HbA1c ≥8%, were randomized to usual quarterly follow-up (G1), home use of a smartphone recommending insulin doses with quarterly visits (G2), or use of the smartphone with short teleconsultations every 2 weeks but no visit until point end (G3). RESULTS - Six-month mean HbA1c in G3 (8.41 ± 1.04%) was lower than in G1 (9.10 ± 1.16%; P = 0.0019). G2 displayed intermediate results (8.63 ± 1.07%). The Diabeo system gave a 0.91% (0.60; 1.21) improvement in HbA1c over controls and a 0.67% (0.35; 0.99) reduction when used without teleconsultation. There was no difference in the frequency of hypoglycemic episodes or in medical time spent for hospital or telephone consultations. However, patients in G1 and G2 spent nearly 5 h more than G3 patients attending hospital visits. CONCLUSIONS - The Diabeo system gives a substantial improvement to metabolic control in chronic, poorly controlled type 1 diabetic patients without requiring more medical time and at a lower overall cost for the patient than usual care. © 2011 by the American Diabetes Association.

Gagnadoux F.,University of Angers | Gagnadoux F.,Angers University Hospital Center | Vaillant M.,French Institute of Health and Medical Research | Goupil F.,Center Hospitalier | And 7 more authors.
PLoS ONE | Year: 2011

Background: Long-term adherence is a major issue in patients receiving home continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea-hypopnea syndrome (OSAHS). In a multicenter prospective cohort (the Institut de Recherche en Santé Respiratoire des Pays de la Loire [IRSR] sleep cohort) of consecutive OSAHS patients in whom CPAP had been prescribed for at least 90 days, we studied the impact on long-term treatment adherence of socioeconomic factors, patients and disease characteristics prior to CPAP initiation. Methods and Principal Findings: Among 1,141 patients in whom CPAP had been prescribed for an average of 504±251 days (range: 91 to 1035), 674 (59%) were adherent with a mean daily use of CPAP≥4 h (mean: 6.42±1.35 h). Stepwise regression analysis identified 4 independent factors of CPAP adherence including apnea-hypopnea index (AHI) (OR: 1.549, 95%CI 1.163 to 2.062 for AHI≥30 vs. AHI<30; p = 0.003), body mass index (BMI) (OR: 1.786, 95%CI 1.131 to 2.822 for BMI≥25 and <30 kg/m 2, p = 0.01; OR: 1.768, 95%CI 1.145-2.731 for BMI≥30 kg/m 2, p = 0.01 vs. BMI<25 kg/m 2), employment status (OR: 1.414, 95%CI 1.097-1.821 for retired vs. employed; p = 0.007) and marital status (OR: 1.482, 95%CI 1.088-2.019 for married or living as a couple vs. living alone; p = 0.01). Age, gender, Epworth sleepiness scale, depressive syndrome, associated cardiovascular morbidities, educational attainment and occupation category did not influence CPAP adherence. Conclusions: Marital status and employment status are independent factors of CPAP adherence in addition to BMI and disease severity. Patients living alone and/or working patients are at greater risk of non-adherence, whereas adherence is higher in married and retired patients. These findings suggest that the social context of daily life should be taken into account in risk screening for CPAP non-adherence. Future interventional studies targeting at-risk patients should be designed to address social motivating factors and work-related barriers to CPAP adherence. © 2011 Gagnadoux et al.

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