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University of Technology of Compiègne, France

Ulla M.,CHU Clermont Ferrand | Ulla M.,University Clermont 1 | Bonny J.M.,French National Institute for Agricultural Research | Ouchchane L.,Unite Technologies | And 6 more authors.
PLoS ONE | Year: 2013

Purpose: To study changes of iron content in basal ganglia in Parkinson's disease (PD) through a three-year longitudinal follow-up of the effective transverse relaxation rate R2*, a validated MRI marker of brain iron content which can be rapidly measured under clinical conditions. Methods: Twenty-seven PD patients and 26 controls were investigated by a first MRI (t0). Longitudinal analysis was conducted among the 18 controls and 14 PD patients who underwent a second MRI (t1) 3 years after. The imaging protocol consisted in 6 gradient echo images obtained at different echo-times for mapping R2*. Quantitative exploration of basal ganglia was performed by measuring the variation of R2* [R2*(t1) - R2*(t0)] in several regions of interest. Results: During the three-year evolution of PD, R2* increased in Substantia nigra (SN) (by 10.2% in pars compacta, p = 0.001, and 8.1% in pars reticulata, p = 0.013) and in the caudal putamen (11.4%, p = 0.011), without significant change in controls. Furthermore, we showed a positive correlation between the variation of R2* and the worsening of motor symptoms of PD (p = 0.028). Conclusion: Significant variation of R2* was longitudinally observed in the SN and caudal putamen of patients with PD evolving over a three-year period, emphasizing its interest as a biomarker of disease progression. Our results suggest that R2* MRI follow-up could be an interesting tool for individual assessment of neurodegeneration due to PD, and also be useful for testing the efficiency of disease-modifying treatments. © 2013 Ulla et al.

Duale C.,French Institute of Health and Medical Research | Gayraud G.,French Institute of Health and Medical Research | Taheri H.,French Institute of Health and Medical Research | Taheri H.,Center Jean Perrin | And 4 more authors.
Journal of Cardiothoracic and Vascular Anesthesia | Year: 2015

Objectives To explore the barriers to the use of epidural block (EDB) or paravertebral block (PVB) for thoracotomy or thoracoscopy. Design Cross-sectional ancillary study. Setting French nationwide practice survey. Participants Lead anesthesiologists at centers practicing thoracic surgery completed an online questionnaire. Interventions A 9-item electronic questionnaire regarding perceived barriers to the use of EDB and PVB was developed, including technical factors, nursing factors (training and supervision), and reluctance of non-anesthesiologist colleagues (eg, surgeons, nurses and hospital managers). Descriptive and factorial analyses were conducted, including the current use of the techniques in the model. Measurements and Main Results The questionnaire was answered by 84 of 103 (82%) centers. For both techniques, the most frequently cited barriers were the 4 technical ones and lack of nursing supervision. There was a high rate of do not know/no opinion responses regarding barriers to paravertebral block. The type of center did not influence the responses, but paravertebral block was used more often in university hospitals. Colleague reluctance and time consumption (for both techniques), nursing barriers (for epidural block), and perception of risk and complexity (for paravertebral block), were correlated inversely with actual use. Perception of cost had no influence on practice. Conclusions This survey suggested that the use of epidural or paravertebral block to provide analgesia for thoracic surgery might be increased by multimodal actions focused on improved communication with surgical and managerial teams. Paravertebral block, as an emerging technique, still is insufficiently recognized in France. © 2015 Elsevier Inc.

Bazin M.,Estaing University Hospital Center | Bonnin M.,Estaing University Hospital Center | Storme B.,Estaing University Hospital Center | Bolandard F.,Estaing University Hospital Center | And 5 more authors.
Anaesthesia | Year: 2011

We studied the potentiation of analgesia for labour by the addition of clonidine to epidural low-concentration levobupivacaine with sufentanil in a randomised, double-blinded study. We enrolled primiparous women who were in spontaneous labour. The study solutions, made of 100 ml levobupivacaine 0.0625% plus sufentanil 0.45 μg.ml-1 and either 150 μg clonidine or no clonidine, were used for induction of analgesia, and for its maintenance with self-administered boluses and a continuous background infusion. The need for additional epidural boluses during labour was lower and analgesia and maternal satisfaction were better in the clonidine (n = 57) than in the control group (n = 58). Blood pressure was lower and the rate of instrumental delivery higher in the clonidine group. Clonidine (1.36 μg.ml-1) added to the epidural solution of low-concentration levobupivacaine improves the quality of analgesia. The relevance of the haemodynamic effects should be explored in larger validation studies. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

Eljezi V.,University Clermont1 | Duale C.,French Institute of Health and Medical Research | Azarnoush K.,University Clermont1 | Skrzypczak Y.,University Clermont1 | And 4 more authors.
Regional Anesthesia and Pain Medicine | Year: 2012

Background and Objectives: The aim of this study was to assess the effects of a continuous postoperative administration of local anesthetic through 2 catheters placed deeply under fascia at the lateral edges of the sternum, close to the emergence of the intercostal nerves.We focused on pain during mobilization, as this aspect is likely to interact with postoperative morbidity. Methods: Forty adult patients scheduled for open heart surgery with sternotomy were included in this randomized, placebo-controlled, double-blind study. A continuous fixed-rate infusion of 4 mL/hr of 0.2% ropivacaine or normal saline was administered during the first 48 postoperative hrs. All patients received acetaminophen and self-administered morphine. The efficacy outcomes were as follows: pain score during standardized mobilization and at rest; morphine consumption; spirometry and arterial blood gases; postoperative rehabilitation criteria, and patient satisfaction. Total ropivacaine plasma level was monitored throughout the study. Results: Pain scores were lower in the ropivacaine group during mobilization (P = 0.0004) and at rest (P = 0.0006), but the analgesic effects were mostly apparent during the second day after surgery, with a 41% overall reduction in movement-evoked pain levels. The bilateral sternal block also reduced morphine consumption. It improved the patients' satisfaction and rehabilitation, but no effects were noted on respiratory outcomes. No major adverse effect due to the treatment occurred, but the ropivacaine plasma level was greater than 4 mg/L in 1 patient. Conclusions: This technique may find a role within the framework of multimodal analgesia after sternotomy, although further confirmatory studies are needed. Copyright © 2012 by American Society of Regional Anesthesia and Pain Medicine.

Cormerais L.,Service des Maladies Infectieuses et Tropicales | Robin F.,University Clermont1 | Robin F.,French National Institute for Agricultural Research | Lesens O.,Service des Maladies Infectieuses et Tropicales | Lesens O.,University Clermont1
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2011

Water access and sanitation has worsened in Gaza strip since the conflict between Israel and Palestine in January 2009. This study aimed to investigate the relationship between attendance for diarrhea to a Primary Health Care Center (PHCC) in Gaza strip and several potential risk factors including water access. A matched case control study with prospective data record was performed. Cases were patients attending a PHCC for diarrhea, and controls were patients attending for any other cause with no diarrhea within the previous three months or since birth. We matched 133 cases and 133 controls, for date of inclusion, age, gender. All patients attended PHCC and were included in January/February 2010. A stool analysis for bacteria and parasites was performed for cases. Of the 266 patients, 62% (166) have to buy water from a private provider. In multivariate analysis, four variables were independently predictive of diarrhea: public water access (OR: 0.046; 95% CI: 0.005-0.454; P= 0.0083), poultry or rabbits at home, and presence of cooker at home. A bacterial cause was found in 5.5% (7) and Giardia duodenalis in 20% (26). Treatments did not comply with WHO recommendations. Efforts should be made to improve water access and to implement guidelines for a better management of diarrhea in Gaza strip. © 2011 Royal Society of Tropical Medicine and Hygiene.

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