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Pierot L.,Reims University Hospital Center | Cognard C.,Toulouse University Hospital Center | Spelle L.,CHU Beaujon | Moret J.,CHU Beaujon
American Journal of Neuroradiology | Year: 2012

The balloon remodeling technique was initially designed for the endovascular treatment of anatomically complex aneurysms, specifically wide-neck aneurysms. A nondetachable balloon is inflated in front of the aneurysm neck during coil deposition and removed at the end of the procedure. Some controversies regarding the safety of the technique were introduced by the recent publication of a series showing a much higher rate of complications with the remodeling technique compared with the standard coiling technique. However, recent data from the literature review and from the large ATENA and CLARITY series show that the safety of standard coiling and remodeling is quite similar. Anatomic results are also probably better after remodeling. Finally, due to equivalent safety and better anatomic results, the remodeling technique can be widely used in the management of both ruptured and unruptured aneurysms.


Pierot L.,Service de Radiologie | Barbe C.,Reims University Hospital Center | Spelle L.,Service de Neuroradiologie
Stroke | Year: 2010

Background and Purpose- The strategy of treatment of small unruptured intracranial aneurysms is complex because of their presumably low risk of rupture. A precise knowledge of the perioperative complications in this specific subgroup is mandatory. The purpose of this study was to compare the results of the endovascular treatment of aneurysms ≤3 mm and aneurysms >3 mm included in the Analysis of Treatment by Endovascular Approach of Nonruptured Aneurysms study. Methods- The study included 626 patients harboring 682 unruptured aneurysms. Perioperative adverse events and clinical outcome were analyzed in patients treated for aneurysms ≤3 mm (51 patients, 51 aneurysms) and in patients treated for aneurysms >3 mm (575 patients, 631 aneurysms). Results- Endovascular treatment failed more often in aneurysms ≤3 mm (13.7%) compared to aneurysms >3 mm (3.3%; P=0.003). The rate of intraoperative rupture for aneurysms ≤3 mm (3.9%; 95% CI, 0.5-13.5) did not significantly differ compared to aneurysms >3 mm (2.4%; 95% CI, 1.2-3.6; P=0.37). Thromboembolic events were not significantly different in both groups (3.9%; 95% CI, 0.5-13.5 in very small aneurysms and 7.1%; 95% CI, 5.1-9.1 in larger aneurysms; P=0.57). One month morbidity/mortality was not significantly different for patients with very small aneurysms (2.0%; 95% CI, 0.05-10.45) and for patients with larger aneurysms (3.3%; 95% CI, 1.8-4.8; P=0.60). Conclusions- The risks of endovascular treatment are similar in patients with very small or with larger aneurysms. Because the risk of spontaneous rupture is lower in very small aneurysms, their management will include follow-up MRI and active treatment in case of morphological modification. © 2010 American Heart Association, Inc.


Tournier J.-M.,University of Reims Champagne Ardenne | Birembaut P.,University of Reims Champagne Ardenne | Birembaut P.,Reims University Hospital Center
Current Opinion in Oncology | Year: 2011

Purpose of review: To highlight the current body of knowledge regarding the role of nicotinic acetylcholine receptors (nAChRs) in lung cancer predisposition. Recent findings: Smoking is a documented risk factor for cancer, especially for lung carcinomas. Nicotine and its derived carcinogenic nitrosamines contribute to lung cancer development and progression through the binding to nAChRs, which then activate proliferation, apoptosis, angiogenesis and tumour invasion. Recent genome-wide association studies have associated single nucleotide polymorphisms spanning the nAChR encoding genes cluster CHRNA3/A5/B4 with both nicotine dependence and lung cancer incidence and susceptibility. The α7 nAChR has also been implicated in the regulation of inflammation and immunity and, as a repressor of airway basal cell proliferation, α7 nAChR plays a role in the remodelling of the airway epithelium. Its decreased function may lead to squamous metaplasia and possibly the emergence of preneoplastic lesions. Summary: nAChRs participate in the predisposition for preneoplastic lesions and the further emergence of lung carcinomas. More studies are needed to determine the influence of gene polymorphisms on nAChRs function and of nAChRs activation/desensitization on lung diseases, which represents a new stimulating approach in the understanding of lung tumorigenesis with potential clinical applications. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Renois F.,Reims University Hospital Center | Bouin A.,Reims University Hospital Center | Andreoletti L.,Reims University Hospital Center
Journal of Clinical Microbiology | Year: 2013

Enterovirus 68 was detected in 10 respiratory specimens from pediatric patients hospitalized for acute wheezing or bronchitis during 2009 in the northeast of France. Viral loads ranged from 2×105 to 7.2×107 copies/ml. Alignment of 5' nontranslated regions and phylogenetic analysis of partial VP1 gene sequences show that these viruses clustered and belonged to clade C. Copyright © 2013, American Society for Microbiology.


Kabore R.,Reims University Hospital Center
Transplantation | Year: 2016

BACKGROUND: The risk of graft failure in young kidney transplant recipients has been found to increase during adolescence and early adulthood. However, this question has not been addressed outside the USA so far. Our objective was to investigate whether the hazard of graft failure also increases during this age period in France irrespective of age at transplantation. METHODS: Data of all first kidney transplantation performed before 30 years of age between 1993 and 2012 were extracted from the French kidney transplant database. The hazard of graft failure was estimated at each current age using a 2-stage modelling approach that accounted for both age at transplantation and time since transplantation. Hazard ratios comparing the risk of graft failure during adolescence or early adulthood to other periods were estimated from time-dependent Cox models. RESULTS: A total of 5,983 renal transplant recipients were included. The risk of graft failure was found to increase around the age of 13 years until the age of 21 years, and decrease thereafter. Results from the Cox model indicated that the hazard of graft failure during the age period 13-23 years was almost twice as high as than during the age period 0-12 years, and 25% higher than after 23 years. CONCLUSION: Among first kidney transplant recipients younger than 30 years in France, those currently in adolescence or early adulthood have the highest risk of graft failure. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.


Poirsier C.,Reims University Hospital Center
European Journal of Human Genetics | Year: 2015

Although 22q11.2 deletion syndrome (22q11.2DS) is the most recurrent human microdeletion syndrome associated with a highly variable phenotype, little is known about the condition’s true incidence and the phenotype at diagnosis. We performed a multicenter, retrospective analysis of postnatally diagnosed patients recruited by members of the Association des Cytogénéticiens de Langue Française (the French-Speaking Cytogeneticists Association). Clinical and cytogenetic data on 749 cases diagnosed between 1995 and 2013 were collected by 31 French cytogenetics laboratories. The most frequent reasons for referral of postnatally diagnosed cases were a congenital heart defect (CHD, 48.6%), facial dysmorphism (49.7%) and developmental delay (40.7%). Since 2007 (the year in which array comparative genomic hybridization (aCGH) was introduced for the routine screening of patients with intellectual disability), almost all cases have been diagnosed using FISH (96.1%). Only 15 cases (all with an atypical phenotype) were diagnosed with aCGH; the deletion size ranged from 745 to 2904 kb. The deletion was inherited in 15.0% of cases and was of maternal origin in 85.5% of the latter. This is the largest yet documented cohort of patients with 22q11.2DS (the most commonly diagnosed microdeletion) from the same population. French cytogenetics laboratories diagnosed at least 108 affected patients (including fetuses) per year from among a national population of ∼66 million. As observed for prenatal diagnoses, CHDs were the most frequently detected malformation in postnatal diagnoses. The most common CHD in postnatal diagnoses was an isolated septal defect.European Journal of Human Genetics advance online publication, 28 October 2015; doi:10.1038/ejhg.2015.219. © 2015 Macmillan Publishers Limited


Gillery P.,Reims University Hospital Center | Gillery P.,University of Reims Champagne Ardenne
Clinical Chemistry and Laboratory Medicine | Year: 2013

HbA1c was discovered in the late 1960s and its use as marker of glycemic control has gradually increased over the course of the last four decades. Recognized as the gold standard of diabetic survey, this parameter was successfully implemented in clinical practice in the 1970s and 1980s and internationally standardized in the 1990s and 2000s. The use of standardized and well-controlled methods, with well-defined performance criteria, has recently opened new directions for HbA1c use in patient care, e.g., for diabetes diagnosis. Many reports devoted to HbA1c have been published in Clinical Chemistry and Laboratory Medicine (CCLM) journal. This review reminds the major steps of HbA1c history, with a special emphasis on the contribution of CCLM in this field.


Rieu P.,Reims University Hospital Center
Revue du Praticien | Year: 2012

Chronic kidney disease (CKD) is a major public health problem. It is therefore important to slow its progression and to treat its complications. Regardless of the causal nephropathy, arterial hypertension and proteinuria are the major progression factors of CKD. Thus, optimal control of blood pressure, reduction of proteinuria by using rennin angiotension system inhibitors can slow the progression of CKD. This effect can be enhanced by reducing sodium intake. The recent recommendations suggest that blood pressure should not be higher than 130/80mmHg and proteinuria should not exceed 0,5g/day. The consequences of advanced stages of the CKD have to be diagnosed and treated early: anemia, abnormal bone metabolism, hyperkalemia, fluid overload, metabolic acidosis... A particular emphasis has to be given to cardiovascular complications and risk factors. Monitoring data are well defined by the actual recommandations. Nephrologist can provide a set of recommended intervention to the primary care physician. The most accepted criterion of initiation of dialysis, in absence of clinic uremic manifestation is a glomerular filtration rate lower than 7 ml/min/1,73m2. Psychological and medical preparation of the patient to dialysis is essential. The possibility of renal transplantation should be evaluated during the following of patient with CKD.


Delemer B.,Reims University Hospital Center
Annales d'Endocrinologie | Year: 2012

MEN1 gene mutations predispose carriers to pituitary tumors. Molecular pathways involved in the development of these tumors seem different to what is known in sporadic tumors. Clinical studies showed that all types of adenomas can be found with a predominance of prolactinoma and macroadenoma compared to a control population. These MEN1 tumors seem more aggressive, invasive and resistant to treatment requiring a very careful long-life follow-up. Occurrence of these tumors can be described in the pediatric population and it can be the first and only manifestation of MEN1 for some years asking the question of the systematic screening for . MEN1 gene mutation in pediatric population with pituitary adenoma. © 2012.


We report the history of an infant with difficult-to-control eczema who was put on a diet without cow's milk and then became strongly sensitized and allergic to cow's milk, eggs, wheat and peanuts. In the light of the work of Gideon Lack's group, we review the mechanisms of food allergy (sensitization through the skin and tolerance by the oral route) and insist on the importance of diversification of foods in the diet of infants between four and six months, a window of opportunity for the induction of tolerance. © 2014 Elsevier Masson SAS.

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