Paul Calès

University of Angers, Angers, Pays de la Loire, France

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Publications (383)2082.79 Total impact

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    ABSTRACT: Background and study aim: Esophageal video capsule endoscopy (ECE) is a new technique that allows examination of the esophagus using a noninvasive approach. The aim of this study was to compare ECE with esophagogastroduodenoscopy (EGD) for the diagnosis of esophageal varices in patients with cirrhosis. Patients and methods: A total of 330 patients with cirrhosis and with no known esophageal varices were prospectively enrolled. Patients underwent ECE first, followed by EGD (gold standard). The endoscopists who performed EGD were blind to the ECE result. Patient satisfaction was assessed using a visual analog scale (maximum score 100). Results: A total of 30 patients were excluded from the analysis because they did not undergo any endoscopic examinations. Patients (mean age 56 years; 216 male) had mainly alcoholic (45 %) or viral (27 %) cirrhosis. The diagnostic indices of ECE to diagnose and correctly stage esophageal varices were: sensitivity 76 % and 64 %, specificity 91 % and 93 %, positive predictive value 88 % and 88 %, and negative predictive value 81 % and 78 %, respectively. ECE patient satisfaction scored significantly higher than EGD (87 ± 22 vs. 58 ± 35; P < 0.0001). Conclusions: ECE was well tolerated and safe in patients with liver cirrhosis and suspicion of portal hypertension. The sensitivity of ECE is not currently sufficient to replace EGD as a first exploration in these patients. However, due to its excellent specificity and positive predictive value, ECE may have a role in cases of refusal or contraindication to EGD. ECE might also improve compliance to endoscopic follow-up and aid important therapeutic decision making in the prophylaxis of bleeding. Trial registration: EudraCT (ID RCB 2009-A00532-55) and (NCT00941421). © Georg Thieme Verlag KG Stuttgart · New York.
    Endoscopy 03/2015; DOI:10.1055/s-0034-1391393 · 5.20 Impact Factor
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    ABSTRACT: Various critical events, liver-related or not, occur in patients with compensated cirrhosis but their respective burden remain to be prospectively assessed. The aim of this prospective cohort study involving 35 French centres was to capture the whole spectrum of complications occurring in compensated viral cirrhosis using competing risks analyses. Inclusion criteria were: histologically proven cirrhosis due to HCV or HBV; Child-Pugh A; no previous hepatic complications. The cohort was considered as a multi-state disease model, cumulative incidences (CumI) of events were estimated in a competing risks framework. 1,654 patients were enrolled from 2006 to 2012 (HCV 1308, HBV 315, HCV-HBV 31). During a median follow-up of 34 months, at least one liver nodule was detected in 271 patients, confirmed as hepatocellular carcinoma (HCC) in 128 (4-yr cumI: 10.5%) and cholangiocarcinoma in 3. HCC incidence was higher in HCV (4-yr cumI: 11.4% vs. 7.4%, P=0.05). HCC fulfilled Milan criteria in 79.3%, leading to curative treatment in 70.4%. Liver decompensation occurred more frequently in HCV patients (4-yr cumI: 10.8% vs. 3.6%, P=0.0004). Virological eradication/control was achieved in 34.1% HCV and 88.6% HBV patients and was associated to a marked decrease in HCC, decompensation and bacterial infection incidences. Survival was shorter in HCV patients (4-yr cumI 91.6% vs. 97.2%, P=0.0002). Death (n=102, missing data 6) was attributed to liver disease in 48 (47%; liver cancer: n=18, miscellaneous: n=30) and to extra-hepatic causes in 48 (47%; bacterial infection n=13, extra-hepatic cancers n=10, cardiovascular events n=5, miscellaneous: n=20). Conclusion: After 3 years of follow-up, extra-hepatic events still explained half of deaths in patients with compensated viral cirrhosis. A strong decrease in complications was linked to virological eradication/control. This article is protected by copyright. All rights reserved. © 2015 by the American Association for the Study of Liver Diseases.
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    ABSTRACT: Chronic liver diseases are highly prevalent and require an accurate evaluation of liver fibrosis to determine patient management. Over the last decade, great effort has been made to develop non-invasive liver fibrosis tests. The ensuing increase of literature is however impaired by extensive heterogeneity in the quality of published reports. The Standards for Reporting of Diagnostic Accuracy Studies (STARD), first published in 2003, were developed to improve the quality of research reports on diagnostic studies. We aimed to evaluate STARD statements in the setting of diagnostic studies on non-invasive liver fibrosis tests, and to propose an extended version developed specifically for those studies.
    Journal of Hepatology 11/2014; 62(4). DOI:10.1016/j.jhep.2014.10.042 · 10.40 Impact Factor
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    ABSTRACT: Interleukin-26 (IL-26) is a member of the IL-10 cytokine family, first discovered based on its peculiar expression by virus-transformed T cells. IL-26 is overexpressed in chronic inflammation (rheumatoid arthritis and Crohn's disease) and induces proinflammatory cytokines by myeloid cells and some epithelial cells. We thus investigated the expression and potential role of IL-26 in chronic HCV infection, a pathology associated with chronic inflammation.
    Gut 09/2014; DOI:10.1136/gutjnl-2013-306604 · 13.32 Impact Factor
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    ABSTRACT: Background: The criteria for defining failure to control bleeding in cirrhotic patients were introduced at the Baveno II/III meetings and were widely used as endpoints in clinical trials. Because they lacked specificity, the Baveno IV criteria were proposed in 2005 and slightly modified in 2010 (Baveno V). These criteria included a new index for patients undergoing transfusion, called adjusted-blood-requirement-index (ABRI= number of blood units/(final-initial hematocrit + 0.01)), with a cut-off value of 0.75. In this multicenter prospective study, we sought to (1) validate the Baveno IV/V criteria; (2) compare them to the Baveno II/III criteria; (3) assess ABRI performance using a standardized calculation.Methods: The key inclusion criteria were: (1) variceal bleeding; (2) cirrhosis; (3) no need to modify the transfusion policy. The patients were classified according to the Baveno IV, V, and II/III criteria. The gold standard for failure during a 5-day period was the clinical judgment of 3 independent experts, blinded to the Baveno assessments.Results: A total of 249 patients were included. The experts’ agreement in clinical judgment of the failure was 80%. Failure occurred in 20.5% of patients; the c-statistics were 0.72 vs. 0.64 and 0.65 for Baveno IV vs. Baveno II/III and Baveno V criteria (p=0.001 for both). ABRI did not improve the diagnostic performance of the Baveno IV criteria. The Baveno IV, but not Baveno II/III, criteria independently predicted survival.Conclusion: The Baveno IV criteria demonstrated a higher accuracy than the Baveno II/III and Baveno V criteria for assessing failure to control bleeding and predicted survival independently. Together, our results show that ABRI is not a useful metric, and the Baveno IV criteria should replace the Baveno II/III criteria. (Hepatology 2014;)
    Hepatology 09/2014; 61(3). DOI:10.1002/hep.27407 · 11.19 Impact Factor
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    ABSTRACT: Introduction: No data are available about the prediction of long-term survival using repeated non-invasive tests of liver fibrosis in chronic hepatitis C (CHC). We aimed to assess the prognostic value of 3-year liver stiffness measurement (LSM), APRI, and FIB-4 evolution in CHC. Patients and methods: CHC patients with two LSM (1000-1500 days interval) were prospectively included. Blood fibrosis tests APRI and FIB-4 were calculated the day of baseline (bLSM) and follow-up (fLSM) LSM. Evolution of fibrosis tests was expressed as delta: (follow-up-baseline results)/duration. Date and cause of death were recorded during follow-up that started the day of fLSM. Results: 1025 patients were included. Median follow-up after fLSM was 38.0 months (IQR: 27.7-46.1) during which 35 patients died (14 liver-related death) and 7 had liver transplantation. Prognostic accuracy (Harrell C-index) of multivariate models including baseline and delta results was not significantly different between LSM and FIB-4 (p≥0.24) whereas FIB-4 provided more accurate prognostic models than APRI (p=0.03). By multivariate analysis including LSM variables, overall survival was independently predicted by bLSM, delta (dLSM), and SVR. Prognosis was excellent in patients having bLSM <7 kPa, SVR, or no increase (<1 kPa/year) in 7-14 kPa bLSM. Prognosis was significantly impaired in patients with increase (≥1 kPa/year) in 7-14 kPa bLSM, or decrease (≤0 kPa/year) in ≥14 kPa bLSM (p=0.949 between these two groups). Patients with increase (>0 kPa/year) in ≥14 kPa bLSM had the worst prognosis. Baseline and delta FIB-4 also identified patient subgroups with significant different prognosis. Conclusion: Three-year evolution of non-invasive tests of liver fibrosis has a strong prognostic value in CHC patients. These tests should be repeated to monitor patients and predict their outcome. (Hepatology 2014;).
    Hepatology 07/2014; 60(1). DOI:10.1002/hep.27069 · 11.19 Impact Factor
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    ABSTRACT: Chronic hepatitis C virus (HCV) infection is characterized by progressive hepatic fibrosis, a process dependent on monocyte recruitment and accumulation into the liver. The mediators expressed in chronically injured liver that control the differentiation of human monocytes into pro-fibrotic macrophages (Mφ), remain poorly defined. We report that chronically HCV-infected patients with high fibrosis stages have higher serum levels of M-CSF and IL-34 than HCV-infected patients with lower fibrosis stages and healthy subjects. Immunohistochemistry reveals an intense expression of IL-34 and M-CSF by hepatocytes around liver lesions. In addition, HCV infection and inflammatory cytokines enhance the in vitro production of IL-34 and M-CSF by hepatocytes. We next analyzed the acquisition of pro-fibrotic properties by Mφ generated with M-CSF (M-CSF-Mφ) or IL-34 (IL-34-Mφ). M-CSF and IL-34 upregulate the expression, by differentiating monocytes, of CCL2, CCL4, CCR1 and CCR5 which are involved in monocyte recruitment/Mφ accumulation in liver lesions. M-CSF-Mφ and IL-34-Mφ also express the hepatic stellate cell (HSC) activators, PDGF, TGF-φ and galectin-3. IL-34-Mφ and M-CSF-Mφ induce type I collagen synthesis by HSC, the main collagen-producing cells in liver fibrosis. IL-13, which expression correlates with the fibrosis stage in HCV-infected patients, decreases the expression of the collagenase MMP-1 by IL-34-Mφ and M-CSF-Mφ, thereby enhancing collagen synthesis. By inhibiting the production of IFN-φ by activated NK cells, IL-34-Mφ and M-CSF-Mφ prevent the IFN-φ-induced killing of HSC. Collectively, these results identify M-CSF and IL-34 as potent pro-fibrotic factors in HCV liver fibrosis. (Hepatology 2014;)
    Hepatology 07/2014; 60(6). DOI:10.1002/hep.27328 · 11.19 Impact Factor
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    ABSTRACT: Elastometry is more accurate than blood tests for cirrhosis diagnosis. However, blood tests were developed for significant fibrosis, with the exception of CirrhoMeter developed for cirrhosis. We compared the performance of Fibroscan and CirrhoMeter, and classic binary cirrhosis diagnosis versus new fibrosis staging for cirrhosis diagnosis. The diagnostic population included 679 patients with hepatitis C and liver biopsy (Metavir staging and morphometry), Fibroscan, and CirrhoMeter. The prognostic population included 1110 patients with chronic liver disease and both tests. Binary diagnosis: AUROCs for cirrhosis were: Fibroscan: 0.905; CirrhoMeter: 0.857; and P=0.041. Accuracy (Youden cutoff) was: Fibroscan: 85.4%; CirrhoMeter: 79.2%; and P<0.001. Fibrosis classification provided 6 classes (F0/1, F1/2, F2±1, F3±1, F3/4, and F4). Accuracy was: Fibroscan: 88.2%; CirrhoMeter: 88.8%; and P=0.77. A simplified fibrosis classification comprised 3 categories: discrete (F1±1), moderate (F2±1), and severe (F3/4) fibrosis. Using this simplified classification, CirrhoMeter predicted survival better than Fibroscan (respectively, χ=37.9 and 19.7 by log-rank test), but both predicted it well (P<0.001 by log-rank test). Comparison: binary diagnosis versus fibrosis classification, respectively, overall accuracy: CirrhoMeter: 79.2% versus 88.8% (P<0.001); Fibroscan: 85.4% versus 88.2% (P=0.127); positive predictive value for cirrhosis by Fibroscan: Youden cutoff (11.1 kPa): 49.1% versus cutoffs of F3/4 (17.6 kPa): 67.6% and F4 classes (25.7 kPa): 82.4%. Fibroscan's usual binary cutoffs for cirrhosis diagnosis are not sufficiently accurate. Fibrosis classification should be preferred over binary diagnosis. A cirrhosis-specific blood test markedly attenuates the accuracy deficit for cirrhosis diagnosis of usual blood tests versus transient elastometry, and may offer better prognostication.
    Journal of clinical gastroenterology 05/2014; DOI:10.1097/MCG.0000000000000138 · 3.19 Impact Factor
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    ABSTRACT: Background Recent longitudinal studies have emphasised the prognostic value of noninvasive tests of liver fibrosis and cross-sectional studies have shown their combination significantly improves diagnostic accuracy.AimTo compare the prognostic accuracy of six blood fibrosis tests and liver biopsy, and evaluate if test combination improves the liver-prognosis assessment in chronic hepatitis C (CHC).MethodsA total of 373 patients with compensated CHC, liver biopsy (Metavir F) and blood tests targeting fibrosis (APRI, FIB4, Fibrotest, Hepascore, FibroMeter) or cirrhosis (CirrhoMeter) were included. Significant liver-related events (SLRE) and liver-related deaths were recorded during follow-up (started the day of biopsy).ResultsDuring the median follow-up of 9.5 years (3508 person-years), 47 patients had a SLRE and 23 patients died from liver-related causes. For the prediction of first SLRE, most blood tests allowed higher prognostication than Metavir F [Harrell C-index: 0.811 (95% CI: 0.751–0.868)] with a significant increase for FIB4: 0.879 [0.832–0.919] (P = 0.002), FibroMeter: 0.870 [0.812–0.922] (P = 0.005) and APRI: 0.861 [0.813–0.902] (P = 0.039). Multivariate analysis identified FibroMeter, CirrhoMeter and sustained viral response as independent predictors of first SLRE. CirrhoMeter was the only independent predictor of liver-related death. The combination of FibroMeter and CirrhoMeter classifications into a new FM/CM classification improved the liver-prognosis assessment compared to Metavir F staging or single tests by identifying five subgroups of patients with significantly different prognoses.Conclusions Some blood fibrosis tests are more accurate than liver biopsy for determining liver prognosis in CHC. A new combination of two complementary blood tests, one targeted for fibrosis and the other for cirrhosis, optimises assessment of liver-prognosis.
    Alimentary Pharmacology & Therapeutics 05/2014; 40(2). DOI:10.1111/apt.12813 · 4.55 Impact Factor
  • Journal of Hepatology 04/2014; 60(1):S448-S449. DOI:10.1016/S0168-8278(14)61271-X · 10.40 Impact Factor
  • Journal of Hepatology 04/2014; 60(1):S414. DOI:10.1016/S0168-8278(14)61177-6 · 10.40 Impact Factor
  • Journal of Hepatology 04/2014; 60(1):S32. DOI:10.1016/S0168-8278(14)60079-9 · 10.40 Impact Factor
  • Journal of Hepatology 04/2014; 60(1):S232. DOI:10.1016/S0168-8278(14)60651-6 · 10.40 Impact Factor
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    ABSTRACT: Morphometry provides an objective evaluation of fibrosis in liver diseases. We developed an image analysis algorithm using automated thresholding and segmentation to separately quantify the areas and the fractal dimensions of portal-bridging fibrosis and perisinusoidal fibrosis in chronic hepatitis C liver biopsies. We studied 427 digitized liver biopsies and compared the automated measures of the different fibrosis compartments with (1) the Metavir F (fibrosis) and A (activity) histological scores, (2) the digitally assessed area of steatosis, and (3) the liver stiffness measured by elastography (Fibroscan). The perisinusoidal fibrosis area was higher than that of portal fibrosis in stages ≤F2; it reached its highest value in F2 stage and stabilized thereafter. The F3 stage was characterized by equal proportions of portal-bridging and perisinusoidal fibrosis, whereas portal-bridging area was predominant in cirrhosis. Measurement of portal-bridging fibrosis showed highly significantly different values between contiguous F stages; the ratio of portal-bridging fibrosis/perisinusoidal fibrosis displayed less overlap between Metavir stages than did the whole fibrosis area values. Fractal dimension showed that portal-bridging fibrosis tended to display a homogeneous surface-like spatial organization, whereas perisinusoidal fibrosis appeared more heterogeneous according to stage and curvilinear. The portal-bridging fibrosis area was low in cases with low Metavir activity and little steatosis, and became predominant with increasing activity and steatosis. Using stepwise multiple linear regression analysis, the liver stiffness was independently correlated to the portal-bridging fibrosis area (first step, P<0.001), the steatosis area (second step, P<0.001), and the Metavir A grade (third step, P=0.001), but not to the perisinusoidal fibrosis area. Automated quantification in a large cohort of chronic hepatitis C showed that perisinusoidal fibrosis progressively grew in early fibrosis stages but did not increase in septal or cirrhotic stages and that the portal-bridging fibrosis area appeared as a more accurate tool to assess fibrosis progression than the whole fibrosis area.Modern Pathology advance online publication, 3 January 2014; doi:10.1038/modpathol.2013.225.
    Modern Pathology 01/2014; DOI:10.1038/modpathol.2013.225 · 6.36 Impact Factor
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    ABSTRACT: Background Liver stiffness evaluation (LSE) by Fibroscan is now widely used to assess liver fibrosis in chronic hepatitis C. Liver steatosis is a common lesion in chronic hepatitis C as in other chronic liver diseases, but its influence on LSE remains unclear. We aimed to precisely determine the influence of steatosis on LSE by using quantitative and precise morphometric measurements of liver histology. Methods 650 patients with chronic hepatitis C, liver biopsy, and LSE were included. Liver specimens were evaluated by optical analysis (Metavir F and A, steatosis grading) and by computerized morphometry to determine the area (%, reflecting quantity) and fractal dimension (FD, reflecting architecture) of liver fibrosis and steatosis. Results The relationships between LSE and liver histology were better described using morphometry. LSE median was independently linked to fibrosis (area or FD), steatosis (area or FD), activity (serum AST), and IQR/LSE median. Steatosis area ≥4.0 % induced a 50 % increase in LSE result in patients with fibrosis area <9 %. In patients with IQR/LSE median ≤0.30, the rate of F0/1 patients misclassified as F ≥ 2 by Fibroscan was, respectively for steatosis area <4.0 and ≥4.0 %: 12.6 vs 32.4 % (p = 0.003). Steatosis level did not influence LSE median when fibrosis area was ≥9 %, and consequently did not increase the rate of F ≤ 3 patients misclassified as cirrhotic. Conclusion A precise evaluation of liver histology by computerized morphometry shows that liver stiffness measured by Fibroscan is linked to liver fibrosis, activity, and also steatosis. High level of steatosis induces misevaluation of liver fibrosis by Fibroscan.
    Journal of Gastroenterology 01/2014; 49(3). DOI:10.1007/s00535-013-0819-9 · 4.02 Impact Factor
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    ABSTRACT: Objective The aspartate aminotransferase activity (AST)/alanine aminotransferase activity (ALT) ratio is used as liver fibrosis index whereas the reported data are conflicting. In chronic hepatitis C (CHC), reported diagnostic accuracies range from none to good for significant fibrosis and to excellent for cirrhosis. Assuming that AST/ALT increases are mainly due to vitamin B6 defects since pyridoxal phosphate (PLP), active form of B6, acts as coenzyme in transamination reactions, we evaluated the diagnostic accuracy of the AST/ALT ratio using standardized methods for AST and ALT activities, with PLP addition as recommended, in a prospective multicenter cohort of CHC patients. Methods ALT and AST activities were measured using the recommended IFCC methods with addition of pyridoxal 5’-phosphate. We evaluated the AST/ALT ratio for the diagnosis of liver fibrosis or cirrhosis in a cohort of CHC patients included in a multicenter prospective study. A liver biopsy was performed in each patient and reviewed by two independent pathologists in order to determine the fibrosis stage according to Metavir classification which was the reference standard. Results AST/ALT ratio significantly increased with histological stage of liver fibrosis and there was a significant correlation between Metavir fibrosis stage and AST/ALT ratio (r = 0.129, P < 0.0035). The ROC curve analyses showed that the AST/ALT ratio does not discriminate significant fibrosis (F ≥ 2) (AUROC = 0.531) and had only very poor diagnostic accuracies for severe fibrosis (F ≥ 3) (AUROC = 0.584) or cirrhosis (F4) (AUROC = 0.626). Conclusion AST/ALT ratio is not a good and discriminative index of liver fibrosis in CHC when aminotransferase activities are determinate according to the international recommendations.
    Gastroentérologie Clinique et Biologique 11/2013; 37(5):467–472. DOI:10.1016/j.clinre.2013.07.003 · 1.98 Impact Factor
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    ABSTRACT: Our main objective was to improve non-invasive fibrosis staging accuracy by resolving the limits of previous methods via new test combinations. Our secondary objectives were to improve staging precision, by developing a detailed fibrosis classification, and reliability (personalized accuracy) determination. All patients (729) included in the derivation population had chronic hepatitis C, liver biopsy, 6 blood tests and Fibroscan. Validation populations included 1584 patients. The most accurate combination was provided by using most markers of FibroMeter and Fibroscan result targeted for significant fibrosis, i.e., "E-FibroMeter". Its classification accuracy (91.7%) and precision (assessed by F difference with Metavir: 0.62±0.57) were better than those of FibroMeter (84.1%, p<0.001; 0.72±0.57, p<0.001), Fibroscan (88.2%, p=0.011; 0.68±0.57, p=0.020), and a previous CSF-SF classification of FibroMeter + Fibroscan (86.7%, p<0.001; 0.65±0.57, p=0.044). The accuracy for fibrosis absence (F0) was increased, e.g., from 16.0% with Fibroscan to 75.0% with E-FibroMeter (p<0.001). Cirrhosis sensitivity was improved, e.g., E-FibroMeter: 92.7% vs. Fibroscan: 83.3%, p=0.004. The combination improved reliability by deleting unreliable results (accuracy <50%) observed with a single test (1.2% of patients) and increasing optimal reliability (accuracy ≥85%) from 80.4% of patients with Fibroscan (accuracy: 90.9%) to 94.2% of patients with E-FibroMeter (accuracy: 92.9%), p<0.001. The patient rate with 100% predictive values for cirrhosis by the best combination was twice (36.2%) that of the best single test (FibroMeter: 16.2%, p<0.001). the new test combination increased: accuracy, globally and especially in patients without fibrosis, staging precision, cirrhosis prediction, and even reliability, thus offering improved fibrosis staging. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 09/2013; 34(6). DOI:10.1111/liv.12327 · 4.41 Impact Factor
  • Annals of internal medicine 09/2013; 159(5):371. DOI:10.7326/0003-4819-159-5-201309030-00020 · 16.10 Impact Factor
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    ABSTRACT: The relationships between systemic hemodynamics and renal blood flow and renal microcirculation are poorly known in sepsis. Norepinephrine (NE) infusion may add another level of complexity. Ventilated and anesthetized rats were submitted to various mean arterial pressure (MAP) steps by blood removal, in presence and absence of sepsis and/or NE. Renal blood flow (RBF) and blood velocity (Vm) in renal cortical capillaries (using Sidestream Dark Field Imaging) were measured. Data were analyzed using linear mixed models enabling us to display the effects of both the considered explanatory variables and their interactions. Positive correlations were found between MAP and RBF. Sepsis had no independent impact on RBF whereas norepinephrine decreased RBF, regardless of the presence of sepsis. The relationship between MAP and RBF was weaker above a MAP of 100 mmHg as opposed to below 100 mmHg, with RBF displaying a relative "plateau" above this threshold. Sepsis and NE impacted carotid blood flow (CBF) differently compared to RBF, demonstrating organ specificity. A positive relationship was observed between MAP and Vm. Sepsis increased Vm while nNE decreased Vm irrespective of MAP. Sepsis was associated with an increase in serum creatinine determined at the end of the experiments, which was prevented by NE infusion. In our model, sepsis at an early phase did not impact RBF over a large range of MAP. NE elicited a renal vasoconstrictive effect. Autoregulation of RBF appeared conserved in sepsis. Conversely, sepsis was associated with "hypervelocity" of blood flow in cortical peritubular capillaries reversed by NE infusion.
    Critical care (London, England) 07/2013; 17(4):R139. DOI:10.1186/cc12818
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    ABSTRACT: Hepatocellular carcinoma (HCC) is the third leading cause of death by cancer worldwide. The prognosis of patients with metastatic HCC remains limited, with an expected median survival lower than 50% at 1year. Here, we report the case of a 63-year-old man who suffered from a small HCC in the liver and a large unique metastasis in the right adrenal gland. A surgical resection of both lesions was performed. Seven months later, HCC recurred with an isolated right renal metastatic lymphadenopathy and a high alpha-fetoprotein level. HCC was brought under control by sorafenib; the alpha-fetoprotein level was greatly reduced but remained moderately elevated and stable over 2years after the onset of chemotherapy. Additional external radiotherapy on the metastatic lymphadenopathy led to a normalization of the alpha-fetoprotein level and discontinuation of sorafenib treatment. One year after the end of radiotherapy, a second isolated metastasis occurred in the right lung. This tumor was surgically removed. Twenty-one months after this second surgical procedure, i.e., more than 5.5years after the initial diagnosis of metastatic HCC, the patient was asymptomatic and tumor free.
    Gastroentérologie Clinique et Biologique 04/2013; 38(1). DOI:10.1016/j.clinre.2013.02.006 · 1.98 Impact Factor

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5k Citations
2,082.79 Total Impact Points


  • 1992–2014
    • University of Angers
      • Laboratoire d'Ingénierie des Systèmes Automatisés (LISA)
      Angers, Pays de la Loire, France
    • Centre Hospitalier Régional Universitaire de Lille
      Lille, Nord-Pas-de-Calais, France
  • 1990–2012
    • Centre Hospitalier Universitaire d'Angers
      • • Service d'hépatologie gastro-entérologie
      • • Service de cardiologie
      Angers, Pays de la Loire, France
  • 2009
    • L'Université Nantes Angers Le Mans
      Naoned, Pays de la Loire, France
  • 2008
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2007
    • Centre Hospitalier Universitaire de Nancy
      Nancy, Lorraine, France
  • 2006
    • Centre hospitalier Laennec de Creil
      Creil, Picardie, France
    • Centre Hospitalier Universitaire de Dijon
      Dijon, Bourgogne, France
  • 2004
    • Centre Hospitalier Universitaire de Limoges
      Limages, Limousin, France
  • 2002
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      Lutetia Parisorum, Île-de-France, France
  • 1999
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 1991–1995
    • CHRU de Strasbourg
      Strasburg, Alsace, France
    • Hôpital Antoine-Béclère – Hôpitaux universitaires Paris-Sud
      Clamart, Île-de-France, France
  • 1988–1991
    • Centre Hospitalier Universitaire de Toulouse
      • Service deGastro-Entérologie et Hépatologie
      Toulouse, Midi-Pyrenees, France