Gisèle Pickering

University of Auvergne, Clermont, Auvergne, France

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Publications (45)104.97 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: The efficiency of inhibitory pain descending pathways (evaluated using conditioned pain modulation [CPM]) has not been studied in postherpetic neuralgia (PHN). To compare CPM in PHN patients with healthy controls. Nine PHN patients and nine control individuals were matched according to age and sex. Amplitudes of cortical thermal-evoked potentials were recorded on the surface of the scalp; clinical pain and thermal pain were evaluated on a 0 to 10 numerical rating scale, at baseline and at intervals during the 6 min after CPM (elicited by a cold pressor test, 8°C). A battery of cognitive tests was performed. Amplitude differences, percentages and related areas under the curve (AUC CPM<⁄span>) were calculated and all data were compared between both groups; P<0.05 was considered to be statistically significant. AUC CPM0-6 min<⁄span> was significantly lower in PHN patients compared with controls (-39±51 µV⁄min versus -144±66 µV⁄min; P=0.0012) and correlated (P=0.04) with clinical pain intensity. Pain ratings before CPM were similar in both groups but were significantly lower in the control group 3 min after the cold pressor test. Cognitive test results were not significantly different. Psychophysical and electrophysiological approaches have shown that patients with PHN exhibit a deficiency of pain inhibition modulation, which could signal a predisposing factor to developing chronic pain. This deficiency was not linked to the cognitive performance but rather to subtle in situ cognitivoemotional adaptations, which remain to be investigated.
    Pain research & management : the journal of the Canadian Pain Society = journal de la societe canadienne pour le traitement de la douleur. 01/2014;
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    ABSTRACT: Pain management in the elderly remains insufficient, be it at home, in nursing homes or hospitals. Inadequate evaluation and/or misinterpretation of the clinical signs present probably explain this poor management and are linked to the particularities of the old patient. Thus, recommendations to improve evaluation of pain in the elderly were formulated. However, these guidelines are rarely implemented in daily practice, most likely because they markedly increase the workload of the geriatric healthcare workers already required to perform multiple evaluations. Unfortunately, the dysfunctions observed are detrimental to the quality of life of these patients, and their morbidity and mortality. To improve pain management in the elderly, it is important to simplify the tasks of the different actors involved by proposing evaluation algorithms taking advantage of the complementarity of self-report and behavioral scales.
    Douleurs Evaluation - Diagnostic - Traitement 01/2014;
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    ABSTRACT: N-methyl-D-aspartate (NMDA) receptor antagonists are used for post-surgery neuropathic pain but severe side-effects limit their clinical use. Memantine, when given after surgery, shows conflicting results as regard neuropathic pain alleviation. Memantine is here administered in animals before or after spinal nerve ligation (SNL) in order to evaluate the induced antinociceptive/cognitive effects and associated molecular events, including the phosphorylation of several tyrosine (pTyr(1336), pTyr(1472)) and serine (pSer(1303)) residues in the NR2B subunit of the NMDA receptor. Spinal nerve ligated and sham animals received memantine (20mg/kg/day) or vehicle (1ml/kg/day) by intraperitoneal route. Pre-emptive protocol started 4 days before surgery and continued for 2 days post-surgery. In the post-operative protocol, the 7 day-treatment began on the day of surgery. Tests were done before and after surgery. Tactile allodynia, mechanical hyperalgesia and spatial memory were respectively evaluated by von Frey, Randall & Selitto and Y-maze-tests, and molecular events by western-blot analysis. Spinal nerve ligated animals displayed nociception, impaired memory and increased expression of the three phosphorylated residues. Post-operative memantine had no beneficial effect. Pre-emptive memantine prevented the development of post-surgical nociception, impairment of spatial memory and did not increase the expression of pTyr(1472)NR2B at spinal, insular and hippocampal levels. Memantine administered a few days before surgery is a promising strategy to alleviate neuropathic pain development and impairment of cognitive function in animals. The pivotal role of pTyr(1472)NR2B must be studied further, and these findings will now be challenged in patients for the prevention of postsurgical neuropathic pain.
    European journal of pharmacology 06/2013; · 2.59 Impact Factor
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    ABSTRACT: BACKGROUND AND AIMS: Neuropathic pain has been shown to be accompanied by cognitive impairment, but the specific impact of postherpetic neuropathic pain on cognitive processes has not been explored. This study aims to evaluate the impact of pain on several domains of cognition in older patients with postherpetic neuralgia (PHN). METHODS: This cross-sectional study ( NCT 00989040) included 84 individuals after signature of informed consent. Participants: 42 patients with PHN and 42 healthy volunteers. Of the 42 PHN patients, 21 received systemic treatment (antidepressants, anticonvulsants, opiates) and 21 had topical treatment with the 5% lidocaine medicated plaster. All participants performed a panel of four cognitive tests: reaction time, semantic memory, decision-making, and visual memory (Cantab(®) , Cambridge). RESULTS: Forty men and 44 women with a mean age of 72 ± 8 years participated. Each PHN patient was matched by age and gender with a healthy volunteer. Vigilance, decision-making, and semantic memory were significantly impaired (P < 0.05) in patients on systemic treatment, especially with antidepressants, while no significant changes were noted between the lidocaine plaster group and their matched controls of healthy volunteers. CONCLUSION: This study shows the deleterious effect of systemic PHN treatment on several domains of cognition. Cognitive impairment associated with pain and antidepressants may be reversed by topical pain management. Topical treatment with 5% lidocaine medicated plaster is a valuable alternative for pain alleviation and maintains cognitive integrity in this vulnerable population.
    Pain Practice 05/2013; · 2.61 Impact Factor
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    ABSTRACT: The role of the gut microbiota in patho-physiology of irritable bowel syndrome (IBS) is suggested by several studies. However, standard cultural and molecular methods used to date have not revealed specific and consistent IBS-related groups of microbes. To explore the constipated-IBS (C-IBS) gut microbiota using a function-based approach. The faecal microbiota from 14 C-IBS women and 12 sex-match healthy subjects were examined through a combined strictly anaerobic cultural evaluation of functional groups of microbes and fluorescent in situ hybridisation (16S rDNA gene targeting probes) to quantify main groups of bacteria. Starch fermentation by C-IBS and healthy faecal samples was evaluated in vitro. In C-IBS, the numbers of lactate-producing and lactate-utilising bacteria and the number of H(2) -consuming populations, methanogens and reductive acetogens, were at least 10-fold lower (P < 0.05) compared with control subjects. Concomitantly, the number of lactate- and H(2) -utilising sulphate-reducing population was 10 to 100 fold increased in C-IBS compared with healthy subjects. The butyrate-producing Roseburia - E. rectale group was in lower number (0.01 < P < 0.05) in C-IBS than in control. C-IBS faecal microbiota produced more sulphides and H(2) and less butyrate from starch fermentation than healthy ones. A major functional dysbiosis was observed in constipated-irritable bowel syndrome gut microbiota, reflecting altered intestinal fermentation. Sulphate-reducing population increased in the gut of C-IBS and were accompanied by alterations in other microbial groups. This could be responsible for changes in the metabolic output and enhancement in toxic sulphide production which could in turn influence gut physiology and contribute to IBS pathogenesis.
    Alimentary Pharmacology & Therapeutics 02/2012; 35(7):828-38. · 4.55 Impact Factor
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    ABSTRACT: Previous studies suggest that the antinociceptive action of paracetamol (acetaminophen, APAP) might involve descending inhibitory pain pathways and the opioidergic system: this study explores this issue in humans with naloxone, the opioid antagonist. After ethical approval, 12 healthy male volunteers were included in this randomized, controlled, double-blind, crossover, four-arm study. They were administered intravenous paracetamol (APAP 1 g) or saline (placebo, pl) followed at 100 min with IV naloxone (Nal 8 mg) or saline, every week for 4 weeks. The amplitude of cerebral potentials evoked by thermal/painful stimuli applied on the arm was recorded nine times over 150 min, witnessing of pain integration at central level. Amplitude changes as well as areas under the curve (AUCs) over 150 min were compared for the four treatments by repeated measures anova (significance 0.05). Amplitude changes were significant for APAP/pl vs. pl/pl at t(150) : -44% (95%CI -58 to -30) vs. -27% (95%CI -37 to -17; P < 0.05) but not vs. APAP/Nal. AUC (0-150) of APAP/pl is significantly different from pl/pl (-3452%.min (95%CI -4705 to -2199) vs. -933% min (95%CI -2273 to 407; P = 0.015) but not from APAP/Nal (-1731% min (95%CI -3676 to 214; P = 0.08) and other treatments. AUC (90-150) is not significantly different. This pilot study shows for the first time in human volunteers that naloxone does not inhibit paracetamol antinociception, suggesting no significant implication of the opioid system in paracetamol mechanism of action: this needs be confirmed on a larger number of subjects.
    Fundamental and Clinical Pharmacology 11/2011; · 1.99 Impact Factor
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    ABSTRACT: Patients undergoing major surgery represent a good model for the study of the hepatic metabolism of acetaminophen (APAP) after surgery and for the evaluation of how the detoxification process is influenced by aging. Thirty patients received intravenous APAP (1 g/6 h) for 4 days (D1-D4). Daily 24-h urinary metabolites-cysteine-APAP, mercapturate-APAP, APAP, and glucuronide and sulfate conjugates-as well as blood glutathione levels were compared with repeated-measures analysis of variance (significance, P<0.05). Between D1 and D4, cysteine-APAP increased (308±308 mg vs. 570±512 mg, P=0.005), and sulfate and glucuronide conjugates decreased (1,365±1,084 mg vs. 694±600 mg, P<0.0001 and 2,418±817 mg vs. 1,513±1,076 mg, P=0.011, respectively). Blood glutathione decreased (790±125 vs. 623±132 µmol/l, P<0.0001. These changes increased with aging. APAP disposition after major surgery shifts toward the oxidative pathways of metabolism, and this is enhanced with aging. Supplementation with sulfur-containing amino acids should be investigated further as it might minimize the effect on antioxidant defenses, especially in older persons undergoing more extensive surgical procedures.
    Clinical Pharmacology &#38 Therapeutics 11/2011; 90(5):707-11. · 6.85 Impact Factor
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    ABSTRACT: Studies in animals and in patients have suggested that magnesium (Mg), a physiological blocker of N-methyl-D-aspartate receptor, could have an antinociceptive effect in painful situations. This randomised, double-blind, controlled trial in two parallel groups aims at studying oral Mg effects in patients with neuropathic pain. It explores the impact of Mg (6x419 mg Mg chloride/capsule per day for a month), versus placebo (lactose) on pain [Neuropathic Pain Symptom Inventory (NPSI) and numerical scale (NS)], and on quality of life indicators after 4 weeks treatment, in 45 patients suffering from neuropathic pain. After 4 weeks, NPSI, NS and quality of life are not different in the Mg and placebo groups, while the frequency of pain paroxysms diminishes and the emotional component improves in the Mg group compared to baseline. This clinical trial displays a large placebo response and could not demonstrate any significant difference in pain alleviation after a month of oral treatment between Mg and placebo in patients suffering from neuropathic pain. Frequency of pain paroxysms and emotional impact will be explored in future studies as they constitute major aspects of pain alleviation in chronic pain conditions.
    Magnesium research: official organ of the International Society for the Development of Research on Magnesium 06/2011; 24(2):28-35. · 1.38 Impact Factor
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    ABSTRACT: Studies in animals and in healthy volunteers have demonstrated the central serotonergic analgesic mechanism of action of paracetamol involving the inhibition of this analgesia by tropisetron, a 5-HT3 antagonist. This randomized, double-blind, controlled study aims at studying this interaction in post-operative patients after ear surgery. Thirty-six patients are included in two parallel groups with intravenous paracetamol (1 g) and either tropisetron (T, 5 mg/mL) or placebo (c, NaCl 0.9%) administered at the end of surgery. Numerical pain evaluations are performed every 30 min, six times after awakening. The difference between the sums of numerical scales of both groups [9 ± 10 (T) vs. 6 ± 7 (c)] is not significant, but the tropisetron group displays higher pain scores despite additional rescue analgesia. The limits of this trial call for a much larger study to investigate further this pharmacodynamic interaction.
    Fundamental and Clinical Pharmacology 03/2011; 26(3):432 - 437. · 1.99 Impact Factor
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    ABSTRACT: Sulfur amino acids are determinant for the detoxification of paracetamol (N-acetyl-p-aminophenol) through sulfate and glutathione conjugations. Long-term paracetamol treatment is common in the elderly, despite a potential cysteine/glutathione deficiency. Detoxification could occur at the expense of anti-oxidative defenses and whole body protein stores in elderly. We tested how older persons satisfy the extra demand in sulfur amino acids induced by long-term paracetamol treatment, focusing on metabolic and nutritional aspects. Effects of 3 g/day paracetamol for 14 days on fasting blood glutathione, plasma amino acids and sulfate, urinary paracetamol metabolites, and urinary metabolomic were studied in independently living older persons (five women, five men, mean (±SEM) age 74 ± 1 years). Dietary intakes were recorded before and at the end of the treatment and ingested sulfur amino acids were evaluated. Fasting blood glutathione, plasma amino acids, and sulfate were unchanged. Urinary nitrogen excretion supported a preservation of whole body proteins, but large-scale urinary metabolomic analysis revealed an oxidation of some sulfur-containing compounds. Dietary protein intake was 13% higher at the end than before paracetamol treatment. Final sulfur amino acid intake reached 37 mg/kg/day. The increase in sulfur amino acid intake corresponded to half of the sulfur excreted in urinary paracetamol conjugates. In conclusion, older persons accommodated to long-term paracetamol treatment by increasing dietary protein intake without any mobilization of body proteins, but with decreased anti-oxidative defenses. The extra demand in sulfur amino acids led to a consumption far above the corresponding population-safe recommendation.
    Age 02/2011; 34(1):181-93. · 6.28 Impact Factor
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    ABSTRACT: To compensate for poor acute pain detection in elderly inpatients with inability to communicate verbally (ICV), the Doloplus Collective team devised the 5-item Algoplus behavior-assessment scale specifically aimed at quickly detecting acute pain in these individuals. Algoplus was developed in three successive phases, including expert opinions, caregivers interviews, patient video recordings and statistical procedures. Among the 1500 recorded primary pain behaviors, 48 were selected and clustered into a 5-item scale. This version was validated based on 349 old inpatients (204 with acute pain and 145 without) from different care settings and hospitals. Comparators were objective acute pain clinical situations, experts' clinical judgment on acute pain presence, and self-rating scales (Visual Analog Scale, Numeric Rating Scale and Verbal Descriptor Scale) for a communicative subsample (n=134). Algoplus showed good discriminant validity with adequate internal consistency (Kuder-Richardson-20, 0.712), excellent interrater reliability (intraclass coefficient, 0.812) and high sensitivity to change during specific pain situations and after starting pain management. Excellent correlations were observed between Algoplus and experts' clinical judgment, acute pain clinical situations or each comparator self-rating-pain score. For patients with acute pain conditions, a score ⩾2 out of 5 on the Algoplus scale was retained as the threshold for the presence of acute pain in elderly ICV inpatients, with 87% sensitivity and 80% specificity. In addition, the very brief rating time of ∼1min is particularly relevant in acute-care settings, where repetitive pain-monitoring is required.
    European journal of pain (London, England) 02/2011; 15(2):198.e1-198.e10. · 3.37 Impact Factor
  • G. Pickering, R. Salimani, C. Dubray
    European Journal of Pain Supplements 01/2010; 4(1):86-87.
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    ABSTRACT: Non-verbal pain assessment scales are useful tools for pain evaluation in persons with communication disorders and moderate-severe dementia. The Doloplus was one of the first scales to be developed and validated as a pain assessment tool in older adults with dementia. This study aims at evaluating the translation of the Doloplus scale in five languages, as regards test-retest and inter-rater reliability. Results show that both tests are good or excellent for the English, Italian, Portuguese and Spanish versions and moderate for the Dutch version. These results bring a unique opportunity to include the translated Doloplus scale in daily assessment of elderly persons with communication disorders, and future studies should focus on enriching the validation of the scale in each language.
    European journal of pain (London, England) 09/2009; 14(5):545.e1-10. · 3.37 Impact Factor
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    Pain 05/2009; 145(3):276-8. · 5.64 Impact Factor
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    ABSTRACT: The mechanism of the analgesic action of acetaminophen involves the serotonergic system. This study explores how acetaminophen interferes with serotonergic descending pain pathways. Eighteen rapid metabolizers of tropisetron were included in this double-blind cross-over study. After ethical approval, the healthy volunteers took 1 g oral acetaminophen (A) or placebo (p) combined with either the 5-HT3 antagonist tropisetron (T) (5 mg) or saline, intravenously, at weekly intervals. Mechanical pain thresholds, determined before and after a cold pressor test (CPT), were repeated seven times during the three post-dosing hours, and area under the concentration-time curves (AUCs) of the three treatments were compared. After CPT, AUC (%*min) of Ap (1,561+/-429) was larger than before CPT (393+/-382, P<0.05); these effects were totally inhibited by tropisetron. Acetaminophen reinforces descending inhibitory pain pathways; it suggests a supraspinal target for acetaminophen's antinociceptive action. This study also confirmed that there is a central serotonergic mechanism of action for acetaminophen that is not stimulus-dependent.
    Clinical Pharmacology &#38 Therapeutics 07/2008; 84(1):47-51. · 6.85 Impact Factor
  • Gisèle Pickering, Françoise Capriz-Ribière
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    ABSTRACT: Neuropathic pain is characterized by a heavier intensity and a longer duration than in non-neuropathic chronic pain. Its frequency is estimated around 9% of the population aged 65 years and over. Diabetes, shingles, cancer, surgery, radiculopathies or stroke are frequent in elderly and may lead to neuropathic pain. It's treatment is a real challenge in elderly. Beside the difficulties of pain evaluation and choice of a therapeutic strategy, intercurrent diseases associated with aging and polymedication require a complex drug treatment. The leading role of cognition, emotion, physical activity for autonomy preservation, and the dynamic interaction between these domains in the old, oldest old and most fragile persons, imply that any pharmacological treatment must be integrated into a non-pharmacological approach. However, very few studies has been specifically devoted to neuropathic pain in elderly. Epidemiological studies and controlled clinical trials are necessary to optimize pain treatment and could result in polymodal therapeutic strategies, which until now only are evidence-based or intuitively developed.
    Psychologie & neuropsychiatrie du vieillissement 07/2008; 6(2):107-14. · 0.89 Impact Factor
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    ABSTRACT: Brain areas that are involved in cognition and mood also play a role in pain processing. The goal of the present study was to examine the relationship between chronic pain and cognition [executive functions (EF) and memory], while controlling for mood, in cognitively intact older persons and in patients with Alzheimer's disease (AD). Two groups of subjects participated: 20 older persons without dementia and 19 patients in an early stage of probable AD who suffered from arthrosis/arthritis. Pain intensity and pain affect were assessed by the Colored Analogue Scale for Pain Intensity and for Pain Affect, the Faces Pain Scale (FPS) and the Number of Words Chosen-Affective (NWC-A). Level of depression and anxiety were evaluated by questionnaires. EF and memory were assessed by neuropsychological tests. The results show that significant correlations between specific cognitive functions, pain intensity and pain affect were lacking in the cognitively intact older persons. Cognition, in particular memory, appeared to be related to depressive symptoms. In contrast, a significant positive correlation was observed between EF, pain intensity and pain affect measured by the FPS in the AD group. Although older persons with depression were excluded, in studies on pain and cognition one should control for the presence of depressive symptoms in older persons with and without dementia.
    Gerontology 02/2008; 54(1):50-8. · 2.68 Impact Factor
  • G. Pickering
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    ABSTRACT: Les patients fibromyalgiques souffrent souvent, en plus de la fatigue et de la douleur chronique, de troubles de la cognition, de la mémoire et d’une altération de leur affect. Les études psychophysiques et objectives, dont de neuro-imagerie, confirment ces observations tant dans le domaine de la cognition que de l’émotion, et décrivent chez les patients fibromyalgiques des anomalies de la fonction cérébrale lors de stimuli cognitifs, douloureux et émotionnels, avec une augmentation d’activation au cours de tâches cognitives ou de stimuli douloureux, sur un fond émotionnel perturbé et globalement négatif. Le développement d’études pluridisciplinaires peut aider à mieux comprendre ce dysfonctionnement cognitivo-émotionnel dans le contexte si particulier de la douleur chronique du patient fibromyalgique. Patients suffering from fibromyalgia syndrome frequently report not only fatigue and chronic pain, but also cognitive and memory impairments, as well as affective changes. Psychophysical and objective studies, some employing neuroimaging, confirm these observations and show changes in cerebral activation in response to cognitive, pain and emotional stimuli in patients with fibromyalgia. Future multidisciplinary studies may help to better understand this cognitive-affective dysfunction in the specific context of chronic pain in these patients.
    La Lettre de médecine physique et de réadaptation 01/2007; 23(2):93-96.
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    ABSTRACT: The number of old and very old persons is increasing and there is evidence that aging coincides with chronic painful conditions. Pain induces behavioural disorders that have been so far poorly identified in old and even less in very old animals. The aim of this study was to: (1) compare the evolution of pain in senescent animals (37-39 months) to old (20-22 months) and young (4-6 months) Lou/cjall rats after a chronic constriction of the sciatic nerve; (2) evaluate pain during four weeks after surgery with an experimental and an observational approach to determine how the response to noxious stimuli correlates with recorded spontaneous behaviour. Results showed that senescent animals are less sensitive to neuropathic pain than old or young rats while senescent/old rats are more sensitive to acute pain. The correlation between observational and experimental pain scores stresses the reliability of non-invasive measures for pain evaluation in senescent populations. The dichotomy between neuropathic and acute pain perceptions with age needs to be further investigated and would help to better understand the reasons of this uneven pain perception and expression with age.
    European Journal of Pain 12/2006; 10(8):749-55. · 3.07 Impact Factor
  • G. Pickering, A. Margot-Duclot
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    ABSTRACT: La douleur, la cognition et l'émotion représentent trois domaines complexes qui se modulent et interagissent. De nombreuses études axées sur la psychologie, la physiologie puis sur la neuro-imagerie ont permis de mieux appréhender les interactions entre sensation cognition et émotion. Au coeur de ce triptyque sensoridiscriminatif-affectif-cognitif, le patient douloureux chronique construit et interagit avec ses cognitions et ses émotions. La prise en compte de ce dynamisme mental plastique est nécessaire pour l'optimisation de la prise en charge du patient douloureux. Pain, cognition and emotion are three complex domains that modulate each other and interact. Numerous studies centred on psychology, physiology and neuroimaging have allowed great progress in our understanding of the influences of cognition and emotion in pain. At the heart of this sensory-discriminative/affective/cognitive triptych, the chronic pain patient constructs and interacts with emotions and cognitions. Taking account of this vivid, dynamic plasticity is a necessary step in optimizing chronic pain treatment.
    Douleur et Analgésie 11/2006; 19(4):81-86. · 0.09 Impact Factor

Publication Stats

498 Citations
104.97 Total Impact Points


  • 2000–2012
    • University of Auvergne
      • • Faculty of medicine
      • • Faculty of Pharmaceutical Sciences
      Clermont, Auvergne, France
  • 2011
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2002–2011
    • Université Blaise Pascal - Clermont-Ferrand II
      Clermont, Auvergne, France
  • 2004–2009
    • University Hospital Estaing of Clermont-Ferrand
      Clermont, Auvergne, France
  • 2001–2006
    • Centre Hospitalier Universitaire de Clermont-Ferrand
      Clermont, Auvergne, France
    • Centre Hospitalier Universitaire Rouen
      Rouen, Upper Normandy, France