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Quimper, France

Gall E.C.-L.,University Hospital | Gall E.C.-L.,European University of Brittany | Gall E.C.-L.,French Institute of Health and Medical Research | Audrezet M.-P.,University Hospital | And 28 more authors.
Journal of the American Society of Nephrology | Year: 2016

The courseof autosomal dominant polycystic kidney disease (ADPKD)variesamongindividuals,with somereaching ESRD before 40 years of age and others never requiring RRT. In this study, we developed a prognostic model to predict renal outcomes in patients with ADPKD on the basis of genetic and clinical data. We conducted a crosssectional study of 1341 patients from theGenkyst cohort and evaluated the influence of clinical and genetic factors on renal survival. Multivariate survival analysis identified four variables that were significantly associated with age at ESRDonset,andascoringsystemfrom0to9wasdevelopedas follows:beingmale:1 point; hypertensionbefore 35 years of age: 2 points; first urologic event before 35 years of age: 2 points; PKD2 mutation: 0 points; nontruncating PKD1 mutation: 2 points; and truncating PKD1 mutation: 4 points. Three risk categories were subsequently defined as low risk (0-3 points), intermediate risk (4-6 points), and high risk (7-9 points) of progression to ESRD, with correspondingmedian ages for ESRDonset of 70.6, 56.9, and 49 years, respectively. Whereas a score#3 eliminates evolution toESRDbefore60years ofagewith anegative predictive valueof81.4%, a score.6forecastsESRDonset before 60 years of agewith a positive predictive value of 90.9%. This newprognostic score accurately predicts renal outcomes in patients with ADPKD and may enable the personalization of therapeutic management of ADPKD. Source


Guillemin F.,University of Lorraine | Guillemin F.,University of Sfax | Guillemin F.,French Institute of Health and Medical Research | Rat A.C.,University of Lorraine | And 19 more authors.
Osteoarthritis and Cartilage | Year: 2011

Objective: Osteoarthritis (OA) epidemiologic data are scarce in Europe. To estimate the prevalence of symptomatic knee and hip OA in a multiregional sample in France. Design: A two-phase population-based survey was conducted in six regions in 2007-2009. On initial phone contact using random-digit dialing, subjects 40-75 years old were screened with a validated questionnaire. Subjects screened positive were invited for ascertainment: physical examination and hip and/or knee radiography (Kellgren-Lawrence grade ≥ 2). Multiple imputation for data missing not-at-random was used to account for refusals. Results: Of 63,232 homes contacted, 27,632 were eligible, 9621 subjects screened positive, 3707 participated fully in the ascertainment phase, and 1010 had symptomatic OA: 317 hip, 756 knee. Hip OA prevalence according to age class ranged from 0.9% to 3.9% for men and 0.7-5.1% for women. Knee OA ranged from 2.1% to 10.1% for men and 1.6-14.9% for women. Both differed by geographical region. The hip and knee standardized prevalence was 1.9% and 4.7% for men and 2.5% and 6.6% for women, respectively. Conclusions: This confirmed the feasibility of using a screening questionnaire for eliciting population-based estimates of OA. In France, it increases with age and is greater among women above the age of 50. The geographical disparity of hip and knee OA parallels the distribution of obesity. Study registration ID number 906297 at http://www.clinicaltrials.gov/. © 2011 Osteoarthritis Research Society International. Source


Zhang Y.,University of Paris Descartes | Zhang Y.,Shanghai JiaoTong University | Safar M.E.,University of Paris Descartes | Iaria P.,Laennec Hospital | And 3 more authors.
American Heart Journal | Year: 2010

Background: Left ventricular diastolic dysfunction (LVDD) was reported as a significant predictor of mortality, mainly in patients with heart failure. However, prospective data are scarce in the hospitalized elderly population. Methods: We studied the association of severe LVDD, defined by conventional echocardiographic parameters, with cardiovascular and all-cause mortality in a population of 331 hospitalized elderly patients with a history of cardiovascular disease (mean age ± SD, 87 ± 7 years). After a mean follow-up of 378 days, 110 deaths occurred. Results: Compared with left ventricular systolic dysfunction (LVSD), subjects with severe diastolic dysfunction had a similar prevalence (12% vs 10%) and similar cardiovascular and all-cause mortality (18% vs 19%, 49% vs 50%). Both cardiovascular and all-cause mortality increased progressively and significantly with increasing number of diagnostic criteria of LVDD (P = .035, P = .013) and reached 48.7% for all-cause mortality when at least 2 criteria were met. In addition to cardiovascular risk factors and LVSD, severe LVDD provided incremental and independent prognostic information of all-cause mortality with increased χ2 value of Cox regression model (48.1 vs 43.5, P = .022). Conclusions: Severe LVDD, diagnosed by conventional echocardiography, has similar prevalence and prognosis as LVSD and provides incremental prognostic value, which highlights the clinical significance of routine evaluation of LVDD in risk assessment strategies of the hospitalized elderly. © 2010 Mosby, Inc. All rights reserved. Source


Bouyer B.,University of Paris Descartes | Bouyer B.,Biostatistics and Epidemiology Unit | Mazieres B.,Toulouse University Hospital Center | Guillemin F.,Nancy University Hospital Center | And 15 more authors.
Joint Bone Spine | Year: 2016

Objective: To assess the effects of variations in hip morphology on prevalence, clinical severity and progression of hip osteoarthritis. Methods: From 2007 to 2009, we conducted a study of 242 patients aged between 40 and 75 years with symptomatic lower limb osteoarthritis, as part of a population-based osteoarthritis cohort study in France. Standard radiographs of both hips were obtained at baseline and at three years. The progression of hip osteoarthritis was evaluated according to the radiological Kellgren-Lawrence score (KL) and clinical severity from the scores on a Visual Analogic Scale (VAS) for pain recorded yearly. Five measures were used to describe hip morphology: centre edge angle, acetabular index (AI), vertical centre anterior angle, acetabular depth and neck-shaft angle. Results: Of the 484 hips studied, 205 (42%) showed osteoarthritis at baseline and 16 (11 right and 5 left) underwent joint replacement during the follow-up. AI was the morphological measure most consistently and strongly associated with radiographic osteoarthritis at baseline (odds-ratio = 1.05, 95% CI: 1.01-1.08 per degree of angle change), clinical severity (correlation coefficient with VAS during 3 years = 0.15, P = 0.004), radiological progression (odds-ratio = 1.05, 95% CI: 1.00-1.10 per degree) and joint replacement (hazard ratio = 1.18, 95% CI: 1.07-1.29 per degree). Conclusions: Acetabular obliquity and especially AI is strongly, and likely causally, associated with the existence, severity and progression of hip osteoarthritis. © 2015 Société française de rhumatologie. Source


Morvan J.,Laennec Hospital | Bouttier R.,Brest University Hospital Center | Mazieres B.,Toulouse University Hospital Center | Mazieres B.,University Paul Sabatier | And 15 more authors.
Journal of Rheumatology | Year: 2013

Objective. The relationship between acetabular dysplasia (HD) and hip osteoarthritis (OA) remains unclear, especially for mild forms of dysplasia. Our objectives were to estimate the prevalence of HD in a population-based sample with symptoms and to evaluate potential associations linking HD, hip OA, and hip pain. Methods. Individuals 40 to 75 years of age with symptoms in 1 or both hips were recruited during a multiregional prevalence survey. All study participants underwent examination and radiographs. Radiographs were evaluated using Kellgren-Lawrence staging (with stages ≥ 2 indicating hip OA) and HD measures [center-edge (CE) angle, acetabular inclination angle (HTE), acetabular depth (AD), and vertical center-anterior margin angle]. Results. We studied both hips of 842 individuals (1684 hips), among whom 203 had hip OA. Compared to left hips, right hips had significantly smaller CE angles and significantly greater AD and HTE values (p ≤ 0.001). Overall, the prevalence of HD ranged from 7.6% to 22.2% of the hips depending on the measure used. The prevalence of HD was higher in individuals with hip OA, with significant differences for abnormal HTE (19.1% vs 11.4%; p < 0.0001) and abnormal CE (11.3% vs 7.5%; p = 0.04). By logistic regression, only abnormal HTE remained associated with OA. Same-side hip pain was not statistically more common in individuals with HD after stratification on OA status (p = 0.12). Conclusion. Our study confirms the relationship between OA and HD, particularly as defined based on the HTE angle. The Journal of Rheumatology Copyright © 2013. All rights reserved. Source

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