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Gourraud P.-A.,University of California at San Francisco | Le Gall C.,Institut Universitaire de France | Puzenat E.,University of Franche Comte | Aubin F.,University of Franche Comte | And 2 more authors.
Journal of Investigative Dermatology | Year: 2012

Although the demand for evidence-based decisions is increasing in clinical practice, recent systematic reviews on the accuracy of existing psoriasis severity scales, including the Psoriasis Area and Severity Index (PASI), suggest that their validity is not fully characterized. We simulated the evaluation of PASI by two practitioners in 1,000 sets of 100 patients. PASI data from several practitioners who examined the same patients were used to generate PASI scores by two practitioners, in order to compare how well commonly used statistics assess the inter-rater agreement for the PASI. Because the PASI score has an asymmetric distribution, statistics such as Pearson's linear correlation coefficient "r" and Spearman's rank correlation coefficient overestimated the inter-rater agreement of PASI as compared with the intra-class correlation coefficient (ICC; r=0.8, ρ=0.7, ICC=0.5). When restricting the analysis to patients with a PASI <20, inter-rater agreement severely decreased (r=0.38, ρ=0.41, ICC=0.17), resulting in unacceptable therapeutic decision agreement (κ=0.38). Our study indicates that owing to the skewed distribution of the PASI its validity to influence therapeutic decisions is questionable. The ICC is preferable to the commonly used statistics (r and ρ) for assessing the inter-rater agreement reliability of asymmetrically distributed scores such as the PASI. © 2012 The Society for Investigative Dermatology.


Meignan M.,University Paris Est Creteil | Itti E.,University Paris Est Creteil | Gallamini A.,Nice University | Gallamini A.,S Croce Hospital | Younes A.,Sloan Kettering Cancer Center
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2015

FDG PET/CT has changed the management of FDG-avid lymphoma and is now recommended as the imaging technique of choice for staging and restaging. The need for tailoring therapy to reduce toxicity in patients with a favourable outcome and for improving treatment in those with high-risk factors requires accurate diagnostic methods and a new prognostic algorithm to identify different risk categories. New drugs are used in relapsed/refractory patients. The role of FDG PET/CT as a biomarker in this context is summarized in this review. New trends in FDG metabolic imaging in lymphoma are addressed including metabolic tumour volume measurement at staging and integrative PET which combines PET data with clinical and molecular markers or other imaging techniques. The quantitative approach for response assessment which is under investigation and is used in large ongoing trials is compared with visual criteria. The place of FDG in the era of targeted therapy is discussed. © 2014, Springer-Verlag Berlin Heidelberg.


Gallamini A.,Nice University | Zwarthoed C.,Nice University | Borra A.,S Croce Hospital
Cancers | Year: 2014

Since its introduction in the early nineties as a promising functional imaging technique in the management of neoplastic disorders, FDG-PET, and subsequently FDG-PET/CT, has become a cornerstone in several oncologic procedures such as tumor staging and restaging, treatment efficacy assessment during or after treatment end and radiotherapy planning. Moreover, the continuous technological progress of image generation and the introduction of sophisticated software to use PET scan as a biomarker paved the way to calculate new prognostic markers such as the metabolic tumor volume (MTV) and the total amount of tumor glycolysis (TLG). FDG-PET/CT proved more sensitive than contrast-enhanced CT scan in staging of several type of lymphoma or in detecting widespread tumor dissemination in several solid cancers, such as breast, lung, colon, ovary and head and neck carcinoma. As a consequence the stage of patients was upgraded, with a change of treatment in 10%–15% of them. One of the most evident advantages of FDG-PET was its ability to detect, very early during treatment, significant changes in glucose metabolism or even complete shutoff of the neoplastic cell metabolism as a surrogate of tumor chemosensitivity assessment. This could enable clinicians to detect much earlier the effectiveness of a given antineoplastic treatment, as compared to the traditional radiological detection of tumor shrinkage, which usually takes time and occurs much later. © 2014 by the authors; licensee MDPI, Basel, Switzerland.


Lukacs B.,University Paris - Sud | Loeffler J.,Nice University | Bruyre F.,University of Tours | Blanchet P.,Pointe a Pitre University Hospital | And 9 more authors.
European Urology | Year: 2012

Background: Evidence supporting the widespread use of GreenLight High Performance System (HPS) 120-W photoselective vaporization of the prostate (PVP) is lacking. Objective: To assess the noninferiority of PVP compared with transurethral resection of the prostate (TURP) on urinary symptoms and the superiority of PVP over TURP on length of hospital stay. Design, setting, and participants: A multicenter randomized controlled trial was conducted. Intervention: Patients underwent monopolar TURP or PVP with the GreenLight HPS 120-W laser. Measurements: International Prostate Symptom Score (IPSS), Euro-QOL questionnaire, uroflowmetry, Danish Prostate Symptom Score Sexual Function Questionnaire, sexual satisfaction, and adverse events were collected at 1, 3, 6, and 12 mo. The two groups were compared using the 95% confidence interval (CI) of median difference for testing noninferiority of the IPSS at 12 mo and the student t test for testing the difference in length of hospital stay. Results and limitations: A total of 139 patients (70 vs 69 men in each group) were randomized. Median IPSS scores at 12-mo follow-up were 5 (interquartile range [IQR]: 3-8) for TURP versus 6 (IQR: 3-9) for PVP, and the 95% CI of the difference of the median was equal to -2 to 3. Because the upper limit of the 95% CI was >2 (the noninferiority margin), the hypothesis of noninferiority could not be considered demonstrated. Median length of stay was significantly shorter in the PVP group than in the TURP group, with a median of 1 (IQR: 1-2) versus 2.5 (IQR: 2-3.5), respectively (p < 0.0001). Uroflowmetry parameters and complications were comparable in both groups. Sexual outcomes were slightly better in the PVP group without reaching statistical significance. Conclusions: The present study failed to demonstrate the noninferiority of 120-W GreenLight PVP versus TURP on prostate symptoms at 1 yr but showed that PVP was associated with a shorter length of stay in the hospital. © 2012 European Association of Urology.


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).


Kilcik A.,Akdeniz University | Ozguc A.,Bogazici University | Yurchyshyn V.,Big Bear Solar Observatory | Rozelot J.P.,Nice University
Solar Physics | Year: 2014

We used two methods to investigate the periodic behavior of sunspot counts in four categories for the time period January 1986 - October 2013. These categories include the counts from simple (A and B), medium (C), large (D, E, and F), and final (final-stage; H) sunspot groups. We used i) the multitaper method with red noise approximation, and ii) the Morlet wavelet transform for periodicity analysis. Our main findings are that 1) the solar rotation periodicity of about 25 to 37 days, which is of obvious significance, is found in all groups with at least a 95 % significance level; 2) the periodic behavior of a cycle is strongly related to its amplitude and group distribution during the cycle; 3) the appearance of periods follows the amplitude of the investigated solar cycles; and that 4) meaningful periods do not appear during the minimum phases of the investigated cycles. We would like to underline that the cyclic behavior of all categories is not exactly the same; there are some differences between these groups. This result can provide a clue for the better understanding of solar cycles. © 2014 Springer Science+Business Media Dordrecht.


Kilcik A.,Big Bear Solar Observatory | Yurchyshyn V.B.,Big Bear Solar Observatory | Abramenko V.,Big Bear Solar Observatory | Goode P.R.,Big Bear Solar Observatory | And 3 more authors.
Astrophysical Journal | Year: 2011

Here we analyze solar activity by focusing on time variations of the number of sunspot groups (SGs) as a function of their modified Zurich class. We analyzed data for solar cycles 20-23 by using Rome (cycles 20 and 21) and Learmonth Solar Observatory (cycles 22 and 23) SG numbers. All SGs recorded during these time intervals were separated into two groups. The first group includes small SGs (A, B, C, H, and J classes by Zurich classification), and the second group consists of large SGs (D, E, F, and G classes). We then calculated small and large SG numbers from their daily mean numbers as observed on the solar disk during a given month. We report that the time variations of small and large SG numbers are asymmetric except for solar cycle 22. In general, large SG numbers appear to reach their maximum in the middle of the solar cycle (phases 0.45-0.5), while the international sunspot numbers and the small SG numbers generally peak much earlier (solar cycle phases 0.29-0.35). Moreover, the 10.7cm solar radio flux, the facular area, and the maximum coronal mass ejection speed show better agreement with the large SG numbers than they do with the small SG numbers. Our results suggest that the large SG numbers are more likely to shed light on solar activity and its geophysical implications. Our findings may also influence our understanding of long-term variations of the total solar irradiance, which is thought to be an important factor in the Sun-Earth climate relationship. © 2011. The American Astronomical Society. All rights reserved.


Kostakoglu L.,Mount Sinai Medical Center | Gallamini A.,Nice University
Journal of Nuclear Medicine | Year: 2013

Hodgkin lymphoma (HL) is a curable disease with currently available chemotherapy regimens. Major late morbidities can potentially be avoided in most limited-stage HL patients if the treatment can be adapted to the patient's early response profile. The therapy efficacy can also be increased early during therapy in nonresponding HL patients with the addition of involved-field radiation therapy or a switch to an escalated therapy protocol, particularly in advancedstage or unfavorable-risk patients. 18F-FDG PET is a well-established surrogate for tumor chemosensitivity early during therapy. The ongoing PET-adaptive clinical trials are testing the hypothesis that a decision can reliably be made on escalating or deescalating therapy based on interim PET results. Discussed in this review is the integral role of interim 18F-FDG PET in HL, challenges, critical issues to improve its accuracy, and the observations from completed interim PET studies and ongoing PET-adaptive clinical trials. © 2013 by the Society of Nuclear Medicine.


Rozelot J.P.,Nice University | Kosovichev A.,New Jersey Institute of Technology | Kilcik A.,Akdeniz University
Astrophysical Journal | Year: 2015

Recent solar radius determinations from space observations of Mercury and Venus transits have been made by different teams in 2003, 2006, 2012, and 2014. Seemingly the results are not consistent: the authors interpreted the discrepancies as caused by the different methods of analysis. However, looking at the wavelength dependence and adding other available observations from X-EUV up to radio, a typical wavelength dependence can be found, reflecting the different heights at which the lines are formed. Measurements obtained during different periods of time would, in principle, allow us to detect a signature of radius temporal dependence. However, the available data are not sufficiently numerous to detect a significant dependence, at least at the level of the uncertainty at which the observations were made. Lastly, no unique theoretical model is available today to reproduce the strong wavelength dependence of the solar radius, which shows an unexpected minimum at around (6.6 ±1.9) μm, after a parabolic fit. © 2015. The American Astronomical Society. All rights reserved..


Kilcik A.,Bogazici University | Ozguc A.,Bogazici University | Rozelot J.P.,Nice University | Atac T.,Bogazici University
Solar Physics | Year: 2010

The periodic analyses of solar flare data have been carried out by different authors for about three decades. Controversial results appear as depending on the analysis techniques and investigated time periods. Considering that different authors applied different methods to different data sets, it seems necessary to reanalyze the periodicity of solar flare index with a unified method. In this study we used two new methods to investigate the periodic behavior of solar flare index data, first for individual cycles 21, 22 and 23, and then for all of them. We used i) the multi taper method with red- and white-noise approximations, and ii) the Morlet wavelet transform for periodicity analysis. Apart from the solar rotation periodicity of about 27 days which is of obvious significance and is found in all examined cycles with at least a 90% significance level, we obtained the following prominent periods: 152 days for cycle 21, 73 days for cycle 22, and 62 days for cycle 23. Finally, we compare our results with the ones previously found. We emphasize the fact that a lesser number of periodicities is found in the range of low frequencies (long periods) while the higher frequencies show a greater number of periodicities. This result might be useful for better predictions of the solar cycles. © 2010 Springer Science+Business Media B.V.

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