Artigues-près-Bordeaux, France
Artigues-près-Bordeaux, France

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Touloumi G.,National and Kapodistrian University of Athens | Pantazis N.,National and Kapodistrian University of Athens | Chaix M.-L.,University of Paris Descartes | Bucher H.C.,Basel Institute for Clinical Epidemiology and Biostatistics | And 8 more authors.
PLoS ONE | Year: 2013

Background:We aimed to compare rates of virologic response and CD4 changes after combination antiretroviral (cART) initiation in individuals infected with B and specific non-B HIV subtypes.Methods:Using CASCADE data we analyzed HIV-RNA and CD4 counts for persons infected ≥1996, ≥15 years of age. We used survival and longitudinal modeling to estimate probabilities of virologic response (confirmed HIV-RNA <500 c/ml), and failure (HIV-RNA>500 c/ml at 6 months or ≥1000 c/ml following response) and CD4 increase after cART initiation.Results:2003 (1706 B, 142 CRF02_AG, 55 A, 53 C, 47 CRF01_AE) seroconverters were included in analysis. There was no evidence of subtype effect overall for response or failure (p = 0.075 and 0.317, respectively) although there was a suggestion that those infected with subtypes CRF01_AE and A responded sooner than those with subtype B infection [HR (95% CI):1.37 (1.01-1.86) and 1.29 (0.96-1.72), respectively]. Rates of CD4 increase were similar in all subtypes except subtype A, which tended to have lower initial, but faster long-term, increases.Conclusions:Virologic and immunologic response to cART was similar across all studied subtypes but statistical power was limited by the rarity of some non-B subtypes. Current antiretroviral agents seem to have similar efficacy in subtype B and most widely encountered non-B infections in high-income countries. © 2013 Touloumi et al.


Goret J.,Hospital Pellegrin | Blanchi J.,Hospital Pellegrin | Eckert C.,National Reference Laboratory for Clostridium difficile | Lacome S.,Hospital Pellegrin | And 4 more authors.
Gut Pathogens | Year: 2015

Background: Rapid commercial assays, including nucleic acid amplification tests and immunoassays for Clostridium. difficile toxins, have replaced the use of older assays. They are included in a two-step algorithm diagnosis, including first the detection of the glutamate dehydrogenase (GDH) as a screening method and second the detection of toxins as a confirmatory method. Although assays that detect the presence of free toxins in feces are known to lack sensitivity, they are preferable to confirm infection. We evaluated the accuracy of the chemiluminescence-based method detecting C. difficile GDH and free toxins A/B (DiaSorin algorithm) to an enzyme-immunoassay (EIA) for GDH with a molecular toxins test (Meridian algorithm), EIA-GDH and an EIA-toxins A/B algorithm (Alere algorithm) with and without toxigenic culture for confirmation. Findings: A total of 468 diarrhoeal and loose stool samples were included in the study. A positive result was defined by a positive GDH and a positive toxin test. Discordant samples were resolved using an enriched toxigenic culture considered as the reference method. After resolution, the DiaSorin algorithm showed a high sensitivity (86.7 %) compared to that of the Alere algorithm with (60.0 %) and without (50.0 %) confirmation by culture and was as sensitive as the Meridian algorithm (90.0 %), while the specificities were similar: 99.1, 99.5, 99.5 and 98.9 %, respectively. Conclusions: The DiaSorin algorithm was as sensitive as an algorithm including nucleic acid amplification test for toxins. Chemiluminescence toxin-enhanced signal assay compensates the lack of sensitivity usually observed for EIA tests for toxins. © 2015 Goret et al.


PubMed | National Reference Laboratory for Clostridium difficile and Hospital Pellegrin
Type: | Journal: Gut pathogens | Year: 2015

Rapid commercial assays, including nucleic acid amplification tests and immunoassays for Clostridium. difficile toxins, have replaced the use of older assays. They are included in a two-step algorithm diagnosis, including first the detection of the glutamate dehydrogenase (GDH) as a screening method and second the detection of toxins as a confirmatory method. Although assays that detect the presence of free toxins in feces are known to lack sensitivity, they are preferable to confirm infection. We evaluated the accuracy of the chemiluminescence-based method detecting C. difficile GDH and free toxins A/B (DiaSorin algorithm) to an enzyme-immunoassay (EIA) for GDH with a molecular toxins test (Meridian algorithm), EIA-GDH and an EIA-toxins A/B algorithm (Alere algorithm) with and without toxigenic culture for confirmation.A total of 468 diarrhoeal and loose stool samples were included in the study. A positive result was defined by a positive GDH and a positive toxin test. Discordant samples were resolved using an enriched toxigenic culture considered as the reference method. After resolution, the DiaSorin algorithm showed a high sensitivity (86.7%) compared to that of the Alere algorithm with (60.0%) and without (50.0%) confirmation by culture and was as sensitive as the Meridian algorithm (90.0%), while the specificities were similar: 99.1, 99.5, 99.5 and 98.9%, respectively.The DiaSorin algorithm was as sensitive as an algorithm including nucleic acid amplification test for toxins. Chemiluminescence toxin-enhanced signal assay compensates the lack of sensitivity usually observed for EIA tests for toxins.


Pinaquy J.-B.,Hospital Pellegrin | De Clermont-Galleran H.,Hospital Pellegrin | De Clermont-Galleran H.,Universitie Bordeaux | Pasticier G.,Hospital Pellegrin | And 7 more authors.
Prostate | Year: 2015

Background. Accurate staging is important before surgical decision in patients with high-risk prostate cancer (PCa). The purpose of this study was to prospectively compare the diagnostic performance of 18F-FCholine and MRI with diffusion weighted imaging (DWIMRI) for local and regional lymph node (LN) staging before radical prostatectomy (RP) with extended pelvic lymphadenectomy (PLND). Methods. We identified 47 patients who underwent 18F-FCholine and DWIMRI followed by surgical treatment (either prostatectomy or LN dissection or an association of prostatectomy and LN dissection) between May 2010 and December 2012 at Bordeaux University Hospital. These patients were part of a prospective study (EudraCT number 2009-014839-21) evaluating the interest of 18F-FCholine in staging of high-risk PCa. Diagnostic performances were retrospectively determined for each of 18F-FCholine and DWIMRI considering LN invasion, each of prostate sextants, capsular invasion and extension to seminal vesicles. 18F-FCholine and MR findings were correlated with histological findings. Results. In a region-based LN analysis, the sensitivity and positive predictive value specificity were respectively, 56% and 98% for 18F-Choline, and 17% and 97% for DWIMRI. In a patient-based analysis the sensitivity and positive predictive value were respectively 78% and 94% for 18F-Choline and 33% and 84% for DWIMRI (P=0.015). For tumor staging, DWIMRI showed better performances with a better specificity (69%) for sextants analysis and sensitivity to detect seminal vesicle invasion (73% vs. 36%). Conclusions. 18F-FCholine imaging appears to provide helpful additional information in the staging of high-risk PCa. It appears essential for predicting LN status due to its higher sensitivity and specificity for LN involvement. However, despite excellent performance, it cannot replace MRI that remains better for tumoral localization and local evaluation, especially for seminal vesicle invasion. PATIENT SUMMARY. This study highlights the interest of 18F-Choline in the staging of high risk prostate cancer in addition with DWI MRI, especially so in the evaluation of lymph node involvement due to its high sensitivity and excellent specificity. © 2014 Wiley Periodicals, Inc.


Henriques de Figueiredo B.,Institute Bergonie | Henriques de Figueiredo B.,French National Center for Scientific Research | Zacharatou C.,Institute Bergonie | Galland-Girodet S.,Hospital Haut Leveque | And 10 more authors.
Strahlentherapie und Onkologie | Year: 2015

Background and purpose: Positron emission tomography (PET) with [18F]-fluoromisonidazole ([18F]-FMISO) provides a non-invasive assessment of hypoxia. The aim of this study is to assess the feasibility of a dose escalation with volumetric modulated arc therapy (VMAT) guided by [18F]-FMISO-PET for head-and-neck cancers (HNC). Patients and methods: Ten patients with inoperable stages III–IV HNC underwent [18F]-FMISO-PET before radiotherapy. Hypoxic target volumes (HTV) were segmented automatically by using the fuzzy locally adaptive Bayesian method. Retrospectively, two VMAT plans were generated delivering 70 Gy to the gross tumour volume (GTV) defined on computed tomography simulation or 79.8 Gy to the HTV. A dosimetric comparison was performed, based on calculations of tumour control probability (TCP), normal tissue complication probability (NTCP) for the parotid glands and uncomplicated tumour control probability (UTCP). Results: The mean hypoxic fraction, defined as the ratio between the HTV and the GTV, was 0.18. The mean average dose for both parotids was 22.7 Gy and 25.5 Gy without and with dose escalation respectively. FMISO-guided dose escalation led to a mean increase of TCP, NTCP for both parotids and UTCP by 18.1, 4.6 and 8 % respectively. Conclusion: A dose escalation up to 79.8 Gy guided by [18F]-FMISO-PET with VMAT seems feasible with improvement of TCP and without excessive increase of NTCP for parotids. © 2014, Springer-Verlag Berlin Heidelberg.


Henriques De Figueiredo B.,Institute Bergonie | Henriques De Figueiredo B.,French National Center for Scientific Research | Merlin T.,French National Center for Scientific Research | De Clermont-Gallerande H.,Hospital Pellegrin | And 7 more authors.
Strahlentherapie und Onkologie | Year: 2013

Background and purpose: Positron-emission tomography (PET) with [ 18F]-fluoromisonidazole (FMISO) permits consideration of radiotherapy dose escalation to hypoxic volumes in head and neck cancers (HNC). However, the definition of FMISO volumes remains problematic. The aims of this study are to confirm that delayed acquisition at 4 h is most appropriate for FMISO-PET imaging and to assess different methods of volume segmentation. Patients and methods: A total of 15 HNC patients underwent several FMISO-PET/computed tomography (CT) acquisitions 2, 3 and 4 h after FMISO injection. Three automatic methods of PET image segmentation were tested: fixed threshold, adaptive threshold based on the ratio between tumour-derived and background activities (RT/B) and the fuzzy locally adaptive Bayesian (FLAB) method. The hypoxic fraction (HF), which is defined as the ratio between the FMISO and CT volumes, was also calculated. Results: The RT/B for images acquired at 2, 3 and 4 h differed significantly, with mean values of 2.5 (1.7-2.9), 3 (2-4.5) and 3.4 (2.3-6.1), respectively. The mean tumour volume, as defined manually using CT images, was 39.1 ml (1.2-116 ml). After 4 h, the mean FMISO volumes were 18.9 (0.1-81), 9.5 (0.9-33.1) and 12.5 ml (0.9-38.4 ml) with fixed threshold, adaptive threshold and the FLAB method, respectively; median HF values were 0.47 (0.1-1.93), 0.25 (0.11-0.75) and 0.35 (0.14-1.05), respectively. FMISO volumes were significantly different. Conclusion: The best contrast is obtained at the 4-hour acquisition time. Large discrepancies were found between the three tested methods of volume segmentation. © 2013 Springer Heidelberg Berlin.


Henriques de Figueiredo B.,Institute Bergonie | Antoine M.,Institute Bergonie | Trouette R.,Hospital Haut Leveque | Lagarde P.,Institute Bergonie | And 4 more authors.
Radiation Oncology | Year: 2014

Background: The aim of this study was to assess if FDG-PET could guide dose prescription heterogeneity and decrease arbitrary location of hotspots in SBRT. Methods: For three patients with stage I lung cancer, a CT-simulation and a FDG-PET were registered to define respectively the PTVCT and the biological target volume (BTV). Two plans involving volumetric modulated arc therapy (VMAT) and simultaneous integrated boost (SIB) were calculated. The first plan delivered 4 × 12 Gy within the PTVCT and the second plan, with SIB, 4 × 12 Gy and 13.8 Gy (115% of the prescribed dose) within the PTVCT and the BTV respectively. The Dmax-PTVCT had to be inferior to 60 Gy (125% of the prescribed dose). Plans were evaluated through the D95%, D99% and Dmax-PTVCT, the D2 cm, the R50% and R100% and the dice similarity coefficient (DSC) between the isodose 115% and BTV. DSC allows verifying the location of the 115% isodose (ideal value = 1). Results: The mean PTVCT and BTV were 36.7 (±12.5) and 6.5 (±2.2) cm3 respectively. Both plans led to similar target coverage, same doses to the OARs and equivalent fall-off of the dose outside the PTVCT. On the other hand, the location of hotspots, evaluated through the DSC, was improved for the SIB plans with a mean DSC of 0.31 and 0.45 for the first and the second plans respectively. Conclusions: Use of PET to decrease arbitrary location of hotspots is feasible with VMAT and SIB for lung cancer. © Henriques de Figueiredo et al.; licensee BioMed Central.


Martin G.,Hospital Pellegrin | Martin G.,Hospital Padilla | Gille O.,Bordeaux University Hospital Center | Vital J.M.,Bordeaux University Hospital Center
Coluna/ Columna | Year: 2012

Objective: We studied the incidence of lombar AS surgically treated and the factors associated with it. Method: Retrospective cross sectional study. Results: We found 50 surgeries for AS performed in 1662 cases, 530 in the lumbar spine, incidence: 9.4%. Average age: 62 years. Main symptoms: radicular claudication (80%). Radiographs prior to the first surgery level that will suffer AS: UCLA 1 (45%) and 2 (27%), lordosis pre-revision: 36° average and 44° post-revision. Pre-revision: IP 55°, VP 26° and PS 29° and postoperative IP 56°, VP 22° and PS 34°. Sagittal imbalance pre-revision 60% and postoperative 27%, coronal balance recovered in both cases. MRI before the first intervention was 83% with Pfirmann IV. AS level: 38% L3-L4, L5-S1: 26%. AS types: lumbar stenosis worsened by monosegmental antero-listhesis in 20 and retro-listhesis in 14; multisegmental stenosis 4, disc herniation 4, crush fracture 4, stenosis without listhesis 4. Period between the 2 surgeries: on average 6 years. Conclusion: An incidence of 9.4% of reoperation due to adjacent syndrome makes this disease an important long-term problem, forcing the surgeon to take all the possible steps to avoid this. With the results of this retrospective study we could only say that the segments more likely to develop AS are those with Pfirmann IV on MRI and that the relation VP (20%) and PS (80%) pre and post-operative should be taken into account to return to the spinal column perfect mechanical condition. Prospective clinical studies are needed for more conclusive results.

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