Dewavrin F.,Valenciennes Hospital |
Dewavrin F.,Lille University |
Dewavrin F.,Bordeaux University Hospital Center |
Dewavrin F.,University of Lille Nord de France |
Dewavrin F.,Lille University Hospital Center
PloS one | Year: 2014
OBJECTIVES: Amylase concentration in respiratory secretions was reported to be a potentially useful marker for aspiration and pneumonia. The aim of this study was to determine accuracy of α-amylase in diagnosing microaspiration in critically ill patients.METHODS: Retrospective analysis of prospectively collected data collected in a medical ICU. All patients requiring mechanical ventilation for at least 48 h, and included in a previous randomized controlled trial were eligible for this study, provided that at least one tracheal aspirate was available for α-amylase measurement. As part of the initial trial, pepsin was quantitatively measured in all tracheal aspirates during a 48-h period. All tracheal aspirates were frozen, allowing subsequent measurement of α-amylase for the purpose of the current study. Microaspiration was defined as the presence of at least one positive tracheal aspirate for pepsin (>200 ng.mL-1). Abundant microaspiration was defined as the presence of pepsin at significant level in >74% of tracheal aspirates.RESULTS: Amylase was measured in 1055 tracheal aspirates, collected from 109 patients. Using mean α-amylase level per patient, accuracy of α-amylase in diagnosing microaspiration was moderate (area under the receiver operator curve 0.72±0.05 [95%CI 0.61-0.83], for an α-amylase value of 1685 UI.L-1). However, when α-amylase levels, coming from all samples, were taken into account, area under the receiver operator curve was 0.56±0.05 [0.53-0.60]. Mean α-amylase level, and percentage of tracheal aspirates positive for α-amylase were significantly higher in patients with microaspiration, and in patients with abundant microaspiration compared with those with no microaspiration; and similar in patients with microaspiration compared with those with abundant microaspiration. α-amylase and pepsin were significantly correlated (r2 = 0.305, p = 0.001).CONCLUSION: Accuracy of mean α-amylase in diagnosing microaspiration is moderate. Further, when all α-amylase levels were taken into account, α-amylase was inaccurate in diagnosing microaspiration, compared with pepsin.
Nseir S.,University Hospital of Lille |
Nseir S.,Lille University |
Blazejewski C.,University Hospital of Lille |
Lubret R.,University Hospital of Lille |
And 4 more authors.
Clinical Microbiology and Infection | Year: 2011
The objective of this prospective cohort study was to determine whether admission to an intensive care unit (ICU) room previously occupied by a patient with multidrug-resistant (MDR) Gram-negative bacilli (GNB) increases the risk of acquiring these bacteria by subsequent patients. All patients hospitalized for >48h were eligible. Patients with MDR GNB at ICU admission were excluded. The MDR GNB were defined as MDR Pseudomonas aeruginosa, Acinetobacter baumannii and extended spectrum β-lactamase (ESBL) -producing GNB. All patients were hospitalized in single rooms. Cleaning of ICU rooms between two patients was performed using quaternary ammonium disinfectant. Risk factors for MDR P. aeruginosa, A. baumannii and ESBL-producing GNB were determined using univariate and multivariate analysis. Five hundred and eleven consecutive patients were included; ICU-acquired MDR P. aeruginosa was diagnosed in 82 (16%) patients, A. baumannii in 57 (11%) patients, and ESBL-producing GNB in 50 (9%) patients. Independent risk factors for ICU-acquired MDR P. aeruginosa were prior occupant with MDR P. aeruginosa (OR 2.3, 95% CI 1.2-4.3, p0.012), surgery (OR 1.9, 95% CI 1.1-3.6, p0.024), and prior piperacillin/tazobactam use (OR 1.2, 95% CI 1.1-1.3, p0.040). Independent risk factors for ICU-acquired A. baumannii were prior occupant with A. baumannii (OR 4.2, 95% CI 2-8.8, p<0.001), and mechanical ventilation (OR 9.3, 95% CI 1.1-83, p0.045). Independent risk factors for ICU-acquired ESBL-producing GNB were tracheostomy (OR 2.6, 95% CI 1.1-6.5, p0.049), and sedation (OR 6.6, 95% CI 1.1-40, p0.041). We conclude that admission to an ICU room previously occupied by a patient with MDR P. aeruginosa or A. baumannii is an independent risk factor for acquisition of these bacteria by subsequent room occupants. This relationship was not identified for ESBL-producing GNB. © 2010 The Authors. Clinical Microbiology and Infection © 2010 European Society of Clinical Microbiology and Infectious Diseases.
Girard J.,Lille University |
Girard J.,Lille University Hospital Center |
Roumazeille T.,Lille University Hospital Center |
Sakr M.,Lille University Hospital Center |
Migaud H.,Lille University Hospital Center
HIP International | Year: 2011
Young adults with osteochondral lesions of the femoral head are at risk of rapid progression to symptomatic arthritis of the hip joint. Between January 2008 and July 2009, 10 patients were treated for femoral cartilage damage by a osteochondral mosaicplasty of the femoral head through a trochanteric flap with dislocation of the hip. The consecutive series had the following exclusion criteria: Acetabular chondropathy, age above 25 years, and femoral head osteonecrosis. Patients were followed up after surgery using the Oxford-12 score, Harris hip score and the Merle d'Aubigné score, and activity assessed by the UCLA and Devane scores. Radiological evaluation by computed tomographic (CT) arthrography was undertaken in all patients at 6 months and plain radiographs. Mean follow-up was 29.2 months (20-39 months). The Postel Merle d'Aubigné score improved from the pre-operative period to the latest follow-up, from 10.5 points (8-13) to 15.5 points (12-17). Global range of motion increased from 175.4° (140-215) to 210.7° (175-240). All radiological investigations at latest follow-up showed that the autograft plugs were well-incorporated at the site of osteochondroplasty in the femoral head with intact cartilage over them and smooth interfaces between articulating bony surfaces. Osteochondral autograft transplantation may be a new alternative option for osteochondral lesions of the femoral head, but this has to be confirmed with longer follow-up and in a larger number of patients. The results of similar surgery in the knee have been mixed, and in the hip the technique is demanding, requiring familiarity with surgical hip dislocation. © 2011 Wichtig Editore.
Shore N.D.,Urologic |
Chowdhury S.,King's College London |
Villers A.,Lille University |
Klotz L.,University of Toronto |
And 7 more authors.
The Lancet Oncology | Year: 2016
Background: Enzalutamide is an oral androgen-receptor inhibitor that has been shown to improve survival in two placebo-controlled phase 3 trials, and is approved for patients with metastatic castration-resistant prostate cancer. The objective of the TERRAIN study was to compare the efficacy and safety of enzalutamide with bicalutamide in patients with metastatic castration-resistant prostate cancer. Methods: TERRAIN was a double-blind, randomised phase 2 study, that recruited asymptomatic or minimally symptomatic men with prostate cancer progression on androgen-deprivation therapy (ADT) from academic, community, and private health-care provision sites across North America and Europe. Eligible patients were randomly assigned (1:1) via an interactive voice response system to receive enzalutamide 160 mg/day or bicalutamide 50 mg/day, both taken orally, in addition to ADT, until disease progression. Patients were stratified by a permutated block method (block size of four), by whether bilateral orchiectomy or receipt of luteinising hormone-releasing hormone agonist or antagonist therapy started before or after the diagnosis of metastases, and by study site. Participants, investigators, and those assessing outcomes were masked to group assignment. The primary endpoint was progression-free survival, analysed in all randomised patients. Safety outcomes were analysed in all patients who received at least one dose of study drug. The open-label period of the trial is in progress, wherein patients still on treatment at the end of the double-blind treatment period were offered open-label enzalutamide at the discretion of the patient and study investigator. This trial is registered with ClinicalTrials.gov, number NCT01288911. Findings: Between March 22, 2011, and July 11, 2013, 375 patients were randomly assigned, 184 to enzalutamide and 191 to bicalutamide. 126 (68%) and 168 (88%) patients, respectively, discontinued their assigned treatment before study end, mainly due to progressive disease. Median follow-up time was 20·0 months (IQR 15·0-25·6) in the enzalutamide group and 16·7 months (10·2-21·9) in the bicalutamide group. Patients in the enzalutamide group had significantly improved median progression-free survival (15·7 months [95% CI 11·5-19·4]) compared with patients in the bicalutamide group (5·8 months [4·8-8·1]; hazard ratio 0·44 [95% CI 0·34-0·57]; p<0·0001). Of the most common adverse events, those occurring more frequently with enzalutamide than with bicalutamide were fatigue (51 [28%] of 183 patients in the enzalutamide group vs 38 [20%] of 189 in the bicalutamide group), back pain (35 [19%] vs 34 [18%]), and hot flush (27 [15%] vs 21 [11%]); those occurring more frequently with bicalutamide were nausea (26 [14%] vs 33 [17%]), constipation (23 [13%] vs 25 [13%]), and arthralgia (18 [10%] vs 30 [16%]). The most common grade 3 or worse adverse events in the enzalutamide or bicalutamide treatment groups, respectively, were hypertension (13 [7%] vs eight [4%]), hydronephrosis (three [2%] vs seven [4%]), back pain (five [3%] vs three [2%]), pathological fracture (five [3%] vs two [1%]), dyspnoea (four [2%] vs one [1%]), bone pain (one [1%] vs four [2%]), congestive cardiac failure (four [2%] vs two [1%]), myocardial infarction (five [3%] vs none), and anaemia (four [2%] vs none]). Serious adverse events were reported by 57 (31%) of 183 patients and 44 (23%) of 189 patients in the enzalutamide and bicalutamide groups, respectively. One of the nine deaths in the enzalutamide group was thought to be possibly related to treatment (due to systemic inflammatory response syndrome) compared with none of the three deaths in the bicalutamide group. Interpretation: The data from the TERRAIN trial support the use of enzalutamide rather than bicalutamide in patients with asymptomatic or mildly symptomatic metastatic castration-resistant prostate cancer. Funding: Astellas Pharma, Inc and Medivation, Inc. © 2016 Elsevier Ltd.
Lebrun C.,Nice University |
Blanc F.,University of Strasbourg |
Brassat D.,Toulouse 1 University Capitole |
Zephir H.,Lille University |
De Seze J.,University of Strasbourg
Multiple Sclerosis | Year: 2010
Background: Radiologically isolated syndrome (RIS) is characterized by patients with asymptomatic T2 hypersignals detected by brain MRI fulfilling dissemination in space criteria and is suggestive of subclinical multiple sclerosis (MS). In previous studies, it was demonstrated that visual evoked potential and cerebrospinal fluid help to identify pejorative markers in converting to MS. Objective: To date the cognitive function has never been investigated in a cohort of RIS. The objective of this study was to investigate cognitive function in a cohort of 26 RIS patients. Methods: We prospectively assessed the BCcogSEP (a French adaptation of the Brief Repeatable Battery (BRB) including eight cognitive tests) of 26 patients with RIS, compared with 26 MS patients and 26 healthy subjects matched for age, sex and level of education. Results: When comparing the three groups, the cognitive performance was significantly lower in the RIS and MS groups compared with healthy subjects for the Paced Auditory Serial Addition Test (PASAT) 3 seconds (p = 0.002), phonemic fluencies (p = 0.02), the code of the WAIS (p = 0.05), the direct (p = 0.002) or indirect (p = 0.007) digit span test, the cross-taping test (p = 0.019) and Go-No-Go (p = 0.001). When we compared RIS and MS, the cognitive performance was significantly lower in MS patients for the direct span number (p = 0.003) and cross-tapping test (p = 0.05). We did not find significant differences between the three groups for the other tests. We did not find a correlation between clinical, biological and MRI results and cognitive dysfunctions. Conclusions: This study confirms the recently developed concept of RIS patients who present similar features to MS patients. Further studies are necessary to confirm these initial results and to correlate cognitive disorders with MRI surrogate markers. © 2010 The Author(s).
Nseir S.,Intensive Care Unit |
Nseir S.,Lille University |
Zerimech F.,University Hospital of Lille |
Fournier C.,Calmette Hospital |
And 6 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2011
Rationale: Underinflation of the tracheal cuff frequently occurs in critically ill patients and represents a risk factor for microaspiration of contaminated oropharyngeal secretions and gastric contents that plays a major role in the pathogenesis of ventilator-associated pneumonia (VAP). Objectives: To determine the impact of continuous control of tracheal cuff pressure (P cuff) on microaspiration of gastric contents. Methods: Prospective randomized controlled trial performed in a single medical intensive care unit. A total of 122 patients expected to receive mechanical ventilation for at least 48 hours through a tracheal tube were randomized to receive continuous control of P cuffusing a pneumatic device (intervention group, n = 61) or routine care of P cuff (control group, n = 61). Measurements and Main Results: The primary outcome was microaspiration of gastric contents as defined by the presence of pepsin at a significant level in tracheal secretions collected during the 48 hours after randomization. Secondary outcomes included incidence of VAP, tracheobronchial bacterial concentration, and tracheal ischemic lesions. The pneumatic device was efficient in controlling P cuff. Pepsin was measured in 1,205 tracheal aspirates. Percentage of patients with abundant microaspiration (18 vs. 46%; P = 0.002; OR [95% confidence interval], 0.25 [0.11-0.59]), bacterial concentration in tracheal aspirates (mean ± SD 1.6 ± 2.4 vs. 3.1 ± 3.7 log 10 cfu/ml, P = 0.014), and VAP rate (9.8 vs. 26.2%; P = 0.032; 0.30 [0.11-0.84]) were significantly lower in the intervention group compared with the control group. However, no significant difference was found in tracheal ischemia score between the two groups. Conclusions: Continuous control of P cuff is associated with significantly decreased microaspiration of gastric contents in critically ill patients.
Bonnefond A.,French National Center for Scientific Research |
Bonnefond A.,Lille University |
Bonnefond A.,European Genomic Institute for Diabetes EGID |
Froguel P.,French National Center for Scientific Research |
And 3 more authors.
Cell Metabolism | Year: 2015
Type 2 diabetes (T2D) had long been referred to as the "geneticist's nightmare." Genome-wide association studies have fully confirmed the polygenic nature of T2D, demonstrating the role of many genes in T2D risk. The increasingly busier picture of T2D genetics is quite difficult to understand for the diabetes research community, which can create misunderstandings with geneticists, and can eventually limit both basic research and translational outcomes of these genetic discoveries. The present review wishes to lift the fog around genetics of T2D with the hope that it will foster integrated diabetes modeling approaches from genetic defects to personalized medicine. © 2015 Elsevier Inc.
Chevalier D.,Lille University |
Gregoire V.,Catholic University of Louvain |
Myers E.,University of Pittsburgh |
Rogers S.,University of Liverpool
European Archives of Oto-Rhino-Laryngology | Year: 2010
The population in developed countries is growing older, with the number of people over 85 years of age increasing especially rapidly. The incidence of a head and neck cancer increases with age, only a few patients are under 40 years of age and the highest incidence in many sites occurs in patients over 70 years of age. The aging population has increasing amounts of comorbidities. The treatment protocols for head and neck cancer have over the last two decades become intensified as a consequence of larger surgical resections with reconstruction, high dose radiotherapy often in combination with chemotherapy or targeted therapeutic drugs. Should the elderly and old patients be treated similarly to the younger counterparts or should the treatment be altered based on chronologic age? During the EUFOS Congress in Oto-Rhino-Laryngology Head and Neck Surgery in Vienna, Austria 2007, a panel addressed this issue and this is a summary of the conclusions. © 2010 Springer-Verlag.
Tassin M.,University of Paris Descartes |
Descriaud C.,University of Tours |
Elie C.,University of Paris Descartes |
Houfflin Debarge V.,Lille University |
And 3 more authors.
Prenatal Diagnosis | Year: 2013
Objective: This study aims to evaluate the perinatal outcomes of fetuses with isolated omphalocele diagnosed before 14weeks of gestation (WG) and determine whether visceral-abdominal disproportion (ratio between mean omphalocele diameter and transverse abdominal diameter) and omphalocele contents can predict neonatal morbidity. Methods: This is a retrospective cohort study of omphaloceles diagnosed before 14 WG at three tertiary centers between January 1998 and January 2010. In the group of isolated omphaloceles (i.e., euploid and no other malformation), ratio of visceral-abdominal disproportion and omphalocele contents were evaluated as predictors of perinatal morbidity. Results: Among 153 fetal omphaloceles diagnosed before 14WG, 74 were excluded because of abnormal karyotype or other malformations. Among the 79 isolated fetal omphaloceles, the survival rate at birth was 68% (54/79), with a global morbidity rate of 33% (18/54). Of the live born fetuses, 92.6% (50/54) survived the neonatal period, and 96% (48/50) without long-term sequelae. There was a significant increase in neonatal morbidity when the ratio of disproportion was greater than 0.8 or when the liver was contained in the omphalocele in the first trimester. Conclusion: In cases of isolated omphalocele in the first trimester, visceral-abdominal disproportion and omphalocele contents predict perinatal morbidity. © 2013 John Wiley & Sons, Ltd.
Becquemont D.,Lille University
Studies in History and Philosophy of Science Part C :Studies in History and Philosophy of Biological and Biomedical Sciences | Year: 2011
Considering the variety of contradictory definitions which have been attributed to the term in the course of more than a century, one may be tempted to admit that 'Social Darwinism' can be reduced to a social myth. But it seems nevertheless necessary to answer the question: what has been called 'Social Darwinism' for more than one century and why was the expression used in a negative way to express contradictory opinions which sometimes have nothing to do with Darwin's theory.What we still call 'Social Darwinism' is the result of a misunderstanding: the theories expressed under that phrase have little to do with the Darwinian concepts of natural selection or descent with modification. They have their origin in a pre-darwinian conception of the struggle for existence, which Darwin used in a metaphorical sense.This confusion will then appear to refer clearly to the relationship we establish between biology and society, whether biological laws are directly prolonged in society, or more or less intermingle in a close network. The issue of the definition of Social Darwinism depends obviously on the possible answers to this question, and so does the issue of redefining Darwinism at large. © 2010 Elsevier Ltd.