Alain Duhamel

CHRU de Strasbourg, Strasburg, Alsace, France

Are you Alain Duhamel?

Claim your profile

Publications (347)1330.51 Total impact

  • Revue de Chirurgie Orthopédique et Traumatologique 06/2015; DOI:10.1016/j.rcot.2015.02.015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Specific immunotherapy is the only curative treatment of hymenoptera venom allergy. Currently, there is no consensus on the maintenance dose to be used. The objective of this study was to evaluate the influence of maintenance dose (100 μg versus 200 μg) on the immunologic response after 5 years of vespula venom immunotherapy.
    Revue Française d'Allergologie 05/2015; DOI:10.1016/j.reval.2015.03.003 · 0.35 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Although constrained condylar knee (CCK) inserts are widely used for total knee arthroplasty (TKA), their long-term outcomes remain unclear. We sought to evaluate patients with at least 10 years' follow-up after CCK TKA to identify potential adverse events (osteolysis, loosening, constraint-mechanism failure), assess functional outcomes with special emphasis on range of motion, and determine prosthesis survival. Increasing constraint by implantation of a CCK insert does not increase the long-term frequencies of osteolysis or mechanical loosening. We studied 43 knees after Legacy(®) CCK TKA. The indication was severe deformity (n=20), pre-operative laxity (n=6), or failure to achieve intra-operative balancing (n=17). There were 41 patients with a mean age of 66 years (21-88). A history of one or more surgical procedures was noted for 27 (63%) knees. Outcome measures were the Hospital for Special Surgery (HSS) knee score, Knee Society Score (KSS), and change in the hip-knee-ankle (HKA) angle. Prosthesis survival was assessed using revision surgery for any reason or for reasons other than infection as the censoring criterion. Complications other than venous thrombosis occurred in 16% of patients, including 3 who required revision surgery (septic loosening, n=2; and major instability in a patient with ipsilateral hip arthrodesis). No cases of osteolysis or aseptic loosening were recorded. Mean follow-up was 12.7 years (range, 10-14). At last follow-up, the HSS score had improved from 53 (26-83) pre-operatively to 80 (55-93), the KSS knee component from 42 (16-77) to 90 (77-99), and the KSS function component from 31 (0-80) to 61 (10-90) (P<0.001). Mean range of flexion increased from 109° (50°-140°) to 112° (90°-130°) (P=0.12). The HKA angle changed from 182°±15.5° (150°-210°) to 179.5°±2.5° (174°-184°) (P=0.5). The 11-year prosthesis survival rate was 88.5% (95% confidence interval, 0.69-0.94) overall and 97.7% (0.76-0.99) after excluding the cases of infection. Long-term functional gains after CCK TKA were similar to those reported after standard posterior-stabilised TKA, with no cases of constraint-mechanism failure or osteolysis. The complication rate was higher, with decreased survival compared to standard TKA, but the knee deformities and/or instability were particularly severe and two-thirds of knees had a history of one or more surgical procedures. Level IV, retrospective case-series study. Copyright © 2015. Published by Elsevier Masson SAS.
    Orthopaedics & Traumatology Surgery & Research 05/2015; DOI:10.1016/j.otsr.2015.01.020 · 1.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: & Aims: Several models have been used to determine prognoses of patients with alcoholic hepatitis. These include static systems (the Maddrey discriminant function; the age, bilirubin, international normalized ratio, creatinine [ABIC] score; and model for end-stage liver disease [MELD] score) and dynamic models (the Lille model). We aimed to combine features of all these models to develop a better method to predict outcomes of patients with alcoholic hepatitis. We collected data from several databases of patients with severe alcoholic hepatitis treated with corticosteroids in France and the UK to create a model to predict patient survival (derivation cohort, n=538 patients). We compared the performances of 3 joint-effect models (Maddrey+Lille, MELD+Lille, ABIC+Lille) to determine which combination had the best prognostic value, based on known patient outcomes. The model was validated using data from trials of the effects of corticosteroids in patients in the US, France, Korea, and Belgium (n=604 patients). We created a joint-effect model to predict patient survival after 2 and 6 months; in the derivation and validation cohorts, it predicted outcome significantly better than either static or dynamic models alone (P<.01 for all comparisons). The joint model accurately predicted patient survival regardless of patient risk level. The MELD+Lille combination was better than the Maddrey+Lille or ABIC+Lille in predicting patient survival, with Akaike information criterion values of 1305, 1313, and 1312 respectively. For example, based on the MELD+Lille combination model, predicted 6-month mortality of complete responders with MELD scores of 15-45 (Lille score 0.16) was 8.5% to 49.7%, compared with 16.4%-75.2% for non-responders (Lille score 0.45). According to the joint-effect model, for 2 patients with the same baseline MELD score of 21, the patient with a Lille score of 0.45 had a 1.9-fold higher risk of death than the patient with a Lille score of 0.16 (23.7% vs 12.5%). By combining results from static and dynamic scoring systems for liver disease, we can better predict outcomes of patients with alcoholic hepatitis, compared with either model alone. This may help patient management and design of clinical trials. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
    Gastroenterology 04/2015; DOI:10.1053/j.gastro.2015.04.044 · 13.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The provision of informed consent is a prerequisite for inclusion of a patient in a clinical research project. In some countries, the legislation on clinical research authorizes a third person to provide informed consent if the patient is unable to do so directly (i.e. surrogate consent). This is the case during acute stroke, when the symptoms may prevent the patient from providing informed consent and thus require a third party to be approached. Identification of factors associated with the medical team's decision to resort to surrogate consent may (i) help the care team during the inclusion process and (ii) enable the patient's family circle to be better informed (and thus feel less guilty) about providing surrogate consent. Patients included in the BIOSTROKE cohort (initially dedicated to the analysis of factors influencing stroke severity) were divided into two groups: those having provided informed consent directly and those for whom a third party (such as a family member) had provided surrogate consent. We compared the groups in terms of the initial clinical characteristics (age, gender, type of stroke, severity on the National Institutes of Health Stroke Scale (NIHSS), pre-stroke cognitive status according to the Informant Questionnaire on Cognitive Decline in the Elderly, and the stroke's aetiology) and the functional and cognitive impairments (according to the NIHSS, the modified Rankin score (mRS) and the Mini Mental State Examination) on post-stroke days 8 and 90. Three hundred and ninety five patients were included (mean ± SD age: 67 ± 15 years; 53% males). Surrogate consent had been obtained in 228 cases, and 167 patients had provided consent themselves. The patients included with surrogate consent were likely to be older and more aphasic, with a pre-existing cognitive disorder and more severe stroke (relative to the patients having provided consent). In terms of recovery, the patients included with surrogate consent had a worse functional prognosis (day 90 mRS ≥3: 57.6%, compared with 16.8% in patients having provided consent themselves; p < 0.0001) and a worse cognitive prognosis (day 90 MMS < 24: 15.4% and 4.8%, respectively; p < 0.002). The mortality rate was significantly higher in the surrogate consent group. We found that in addition to age, aphasia and stroke severity, pre-stroke cognitive status is a factor that should prompt the care team to consider requesting surrogate consent for participation in a clinical study. Given that the unfavourable outcome in patients with surrogate consent is often due to their initial clinical state (rather than inclusion in a trial per se), the issue of the family's feelings of guilt (and how to avoid these feelings) should be further addressed.
    BMC Medical Ethics 04/2015; 16(1):26. DOI:10.1186/s12910-015-0018-8 · 1.60 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: & Aims: The effects of bariatric surgery in patients with non-alcoholic fatty liver disease (NASH) are not well established. We performed a prospective study to determine the biologic and clinical effects of bariatric surgery in patients with NASH. From May 1994 through May 2013,109 morbidly obese patients with biopsy-proven NASH underwent bariatric surgery at the University Hospital of Lille, France (the Lille Bariatric Cohort). Clinical, biologic, and histologic data were collected before and 1 year after surgery. One year after surgery, NASH had disappeared from 85% of the patients (95% confidence interval [CI], 75.8%-92.2%). Compared with before surgery, patients had significant reductions in mean body mass index (BMI, from 49.3±8.2 to 37.4±7) and level of alanine aminotransferase (from 52.1±25.7 to 25.1±20); mean levels of glutamyl transferases were reduced from 51 before surgery (interquartile range [IQR], 34-87) to 23 afterward (interquartile range, 14-33) and mean insulin resistance index values were reduced from 3.6±0.5 to 2.9±0.5 (P<.01 for each comparison). NASH disappeared from a higher proportion of patients with mild NASH before surgery (94%) than severe NASH (70%) (P<.05), according to Brunt score. In histologic analysis, steatosis was detected in 60% of the tissue before surgery (IQR, 40%-80%) but only 10% 1 y after surgery (IQR, 2.5%-21.3%); the mean non-alcoholic fatty liver diseases score was reduced from 5 (IQR, 4-5) to 1 (IQR, 1-2) (each P<.001). Hepatocellular ballooning was reduced in 84.2% of samples (n=69; 95% CI, 74.4-91.3) and lobular inflammation in 67.1% (n=55; 95% CI, 55.8-77.1). According to Metavir scores, fibrosis was reduced in 33.8% of patients (95% CI, 23.6%-45.2%). Patients whose NASH persisted 1 y after surgery (n=12) had lost significantly less weight (change in BMI, 9.1±1.5 kg/m(2)) than those without NASH (change in BMI, 12.3±0.6 kg/m(2)) (P=.005). Patients who underwent laparoscopic gastric banding lost less weight (6.4±0.7 kg/m(2)) than those who underwent gastric bypass (14.0±0.5 kg/m(2)) (P<.0001), and a higher proportion had persistent NASH (30.4% vs 7.6% of those with gastric bypass; P=.015). Bariatric surgery induced the disappearance of NASH from nearly 85% of patients and reduced the pathologic features of the disease, after 1 y of follow up. It could be a therapeutic option for appropriate, morbidly obese patients with NASH who do not respond to lifestyle modifications. More studies are needed to determine the long-term effects of bariatric surgery in morbidly obese patients with NASH. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.
    Gastroenterology 04/2015; DOI:10.1053/j.gastro.2015.04.014 · 13.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Due to its high prevalence in dual-task paradigms, freezing of gait in Parkinson's disease is thought to be associated with dysexecutive syndrome and attentional disorders. However, the role of specific attentional disorders in patients with freezing of gait is still unclear. Here, we sought to specifically determine which basic attentional modalities are impaired in patients with freezing of gait. Seventy-eight parkinsonian patients performed a computer-controlled reaction-time paradigm designed to measure the different attentional subcomponents, controlled for visuospatial processing and motor participation. The freezer (n = 42) and non-freezer (n = 36) groups were matched for age, educational level, MMSE and MDRS. There were no intergroup differences in simple reaction times, whereas choice reaction times were higher in the freezer group than in the non-freezer group for divided attention (p = 0.023). At equivalent levels of overall cognitive efficiency, freezer patients showed a greater slowdown than non-freezer patients with a specific impairment in divided attention.
    04/2015; DOI:10.3233/JPD-140498
  • Gastroenterology 04/2015; 148(4):S-39. DOI:10.1016/S0016-5085(15)30135-9 · 13.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Based on theoretical evidence, intensity at the crossover point (COP) of substrate utilization could be considered as potential exercise intensity for metabolic syndrome (MetS). This study aimed to examine the effects of a training program at COP on exercise capacity parameters in women with MetS and to compare two metabolic indices (COP and the maximal fat oxidation rate point LIPOXmax®) with ventilatory threshold (VT). Nineteen women with MetS volunteered to perform a 12-week training program on cycle ergometer, with an intensity corresponding to COP. Pre- and post-training values of anthropometric and exercise capacity parameters were compared in order to determine the effects of exercise training. The pre-post training change of COP, LIPOXmax® and VT were also investigated. After training, anthropometric parameters were significantly modified, with a reduction of body mass (3.0 ± 3.0%, p<0.001), fat mass (3.3 ± 3.4%, p<0.001) and body mass index (3.2 ± 3.4%, p<0.001). Exercise capacity was improved after the training program, with significant increase of maximal power output (25.0 ± 18.4%, p<0.001) and maximal oxygen uptake (VO2max = 9.0 ± 11.2%, p<0.01). Lastly, when expressed in terms of power output, COP, LIPOXmax® and VT occurred at a similar exercise intensity but the occurrence of these three indices is different when expressed in terms of oxygen uptake, heart rate or rating of perceived exertion. This study highlights the effectiveness of 12-week training program at COP to improve physical fitness in women with MetS. The relationships between metabolic indices and VT in terms of power output highlight the determination of VT from a shorter maximal exercise as a useful method for the determination of metabolic indices in MetS.
    Medicine and science in sports and exercise 03/2015; DOI:10.1249/MSS.0000000000000674 · 4.46 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: After more than 50 years of treating Parkinson's disease with l-DOPA, there are still no guidelines on setting the optimal dose for a given patient. The dopamine transporter type 1, now known as solute carrier family 6 (neurotransmitter transporter), member 3 (SLC6A3) is the most powerful determinant of dopamine neurotransmission and might therefore influence the treatment response. We recently demonstrated that methylphenidate (a dopamine transporter inhibitor) is effective in patients with Parkinson's disease with motor and gait disorders. The objective of the present study was to determine whether genetic variants of the dopamine transporter type 1-encoding gene (SLC6A3) are associated with differences in the response to treatment of motor symptoms and gait disorders with l-DOPA and methylphenidate (with respect to the demographic, the disease and the treatment parameters and the other genes involved in the dopaminergic neurotransmission). This analysis was part of a multicentre, parallel-group, double-blind, placebo-controlled, randomized clinical trial of methylphenidate in Parkinson's disease (Protocol ID:2008-005801-20; ClinicalTrials.gov:NCT00914095). We scored the motor Unified Parkinson's Disease Rating Scale and the Stand-Walk-Sit Test before and after a standardized acute l-DOPA challenge before randomization and then after 3 months of methylphenidate treatment. Patients were screened for variants of genes involved in dopamine metabolism: rs28363170 and rs3836790 polymorphisms in the SLC6A3 gene, rs921451 and rs3837091 in the DDC gene (encoding the aromatic L-amino acid decarboxylase involved in the synthesis of dopamine from l-DOPA), rs1799836 in the MAOB gene (coding for monoamine oxidase B) and rs4680 in the COMT gene (coding for catechol-O-methyltransferase). Investigators and patients were blinded to the genotyping data throughout the study. Eighty-one subjects were genotyped and 61 were analysed for their acute motor response to l-DOPA. The SLC6A3 variants were significantly associated with greater efficacy of l-DOPA for motor symptoms. The SLC6A3 variants were also associated with greater efficacy of methylphenidate for motor symptoms and gait disorders in the ON l-DOPA condition. The difference between motor Unified Parkinson's Disease Rating Scale scores for patients with different SLC6A3 genotypes was statistically significant in a multivariate analysis that took account of other disease-related, treatment-related and pharmacogenetic parameters. Our preliminary results suggest that variants of SLC6A3 are genetic modifiers of the treatment response to l-DOPA and methylphenidate in Parkinson's disease. Further studies are required to assess the possible value of these genotypes for (i) guiding l-DOPA dose adaptations over the long term; and (ii) establishing the risk/benefit balance associated with methylphenidate treatment for gait disorders. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Brain 03/2015; DOI:10.1093/brain/awv063 · 10.23 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objectives of the present study were to (i) better characterize visual emotional experience in patients with temporal lobe epilepsy (TLE), (ii) identify clinical risk factors that might be predictive of a change in emotional experience, and (iii) study the relationships between emotional experience and psychobehavioral/quality-of-life factors. Fifty patients with TLE and fifty matched controls evaluated the emotional content of unpleasant, pleasant, and neutral pictures with respect to their valence (unpleasant-to-pleasant) and arousal (low-to-high) levels. Demographic, cognitive, and psychobehavioral data were recorded for all participants, and clinical data and factors related to quality of life were also collected for patients with TLE. There were no significant differences between the group with TLE and the control group in terms of valence evaluations. However, arousal scores for neutral pictures were significantly higher in patients with TLE than in controls. There was also a nonsignificant trend towards lower arousal scores for pleasant pictures in patients with TLE than in controls. Although none of the recorded clinical factors were found to be related to emotional experience, the level of apathy was predictive of greater arousal experience for neutral pictures in patients with TLE. In conclusion, emotional experience appears to be modified in TLE and might be related to apathy. Changes in emotional experience should be taken into account in studies in which neutral stimuli are used to establish a baseline level when assessing emotional and cognitive processing. Copyright © 2015 Elsevier Inc. All rights reserved.
    Epilepsy & Behavior 03/2015; 45:15-20. DOI:10.1016/j.yebeh.2015.02.005 · 2.06 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The prognosis of myelodysplastic syndromes (MDS) after allogeneic stem cell transplantation is critically determined by cytogenetic abnormalities, as previously defined by International Prognostic Scoring System (IPSS) cytogenetics. It has been shown that a new cytogenetic classification, included in the IPSS-R (cytogenetic-IPSS-R [C-IPSS-R]), can better predict the outcome of untreated MDS patients. In this study, we assessed the impact of the IPSS-R cytogenetic score (C-IPSS-R) on the outcome of 367 MDS patients transplanted from HLA-identical siblings or HLA allele-matched unrelated donors. According to the C-IPSS-R, 178 patients (48%) fell in the good risk, 102 (28%) in the intermediate risk, 77 (21%) in the poor risk, and 10 (3%) in the very poor risk group. In multivariate analysis, after a median follow-up of 4 years, the poor and very poor-risk categories correlated with shorter overall survival (OS) (4-year OS, 32%; hazard ratio [HR], 1.59; P = 0.009 and OS, 10%; HR, 3.18; P = 0.002, respectively) and higher cumulative incidence of relapse (CIR) (CIR, 52%; HR, 1.82; P = 0.004 and CIR, 60%; HR, 2.44; P = 0.060, respectively). Overall, the C-IPSS-R changed the IPSS cytogenetic risk only in 8% of cases but identified a new risk group, the very poor C-IPSS-R category, with dismal outcome after allogeneic stem cell transplantation (10% 4-year OS, 60% 4-year CIR). Posttransplantation maintenance therapy should be investigated in prospective trials for patients with high-risk C-IPSS-R karyotypes.
    Transplantation 03/2015; DOI:10.1097/TP.0000000000000649 · 3.78 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Performances of 99mTc-mebrofenin hepatobiliary scintigraphy (HBS) are currently evaluated before major hepatic resection for early detection of liver failure in high risk patients. Published studies included small numbers of patients with planar scintigraphy, and more recently SPECT data. Our aim was to evaluate intra- and interobserver reproducibility of HBS in planar and SPECT modalities for functional assessment of the future remnant liver (FRL) before major hepatic resection. We also evaluated the impact of potential variability factors such as biliary excretion and isocontour threshold choice.
    Medecine Nucleaire 03/2015; 39(3). DOI:10.1016/j.mednuc.2015.01.005 · 0.16 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Although an inhibin B assay may be useful in the assessment of testicular function in a number of genital conditions, reliable reference ranges are still lacking. This study sought to establish the reference range for serum inhibin B by applying the updated Gen II assay. Design: This prospective study included 818 men referred for semen analysis: 377 were normozoospermic (reference group) and 441 presented at least one abnormal semen parameter (case group). Methods: Semen parameters were interpreted according to the 2010 WHO manual and David's modified classification for normal morphology. The inhibin B concentration was determined with the currently enzyme-linked immunosorbent assay. Results: In the reference group, the 2.5th percentile for inhibin B was 92 pg/mL and the 97.5th percentile for FSH was 7.8 IU/L. In the overall population, an inhibin B level <92 pg/ml was associated with increased odds ratio [95% Confidence Interval] for oligozoospermia (16.93 [9.82-29.18], p<0.0001), asthenozoospermia (4.87 [2.88-8.10], p<0.0001) and teratozoospermia (2.20 [1.31-3.68]. The combination of a FSH >7.8 IU/L and an inhibin B <92 pg/ml was associated with greater odds ratio for oligozoospermia (98.74 [23.99-406.35], p<0.0001) than for each hormone considered separately. Conclusion(s): A new reference range for serum inhibin B was established by the use of updated immunoassay. The correlations between hormone levels and semen parameters highlighted the importance of establishing these values with respect to the spermogram. When combined with FSH assay, the inhibin B range may be of value in the evaluation of spermatogenesis in a number of male genital conditions.
    European Journal of Endocrinology 03/2015; 172(6). DOI:10.1530/EJE-14-0932 · 3.69 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of the study was to evaluate the prevalence of compressive lymphadenopathy on pulmonary veins (PV) and left atrium (LA) in patients with sarcoidosis. A total of 101 consecutive patients underwent a chest computed tomography angiographic examination with specific analysis of: (a) 3 nodal stations (ie, 7, 8, and 9 stations) for detection of LA compression; (b) 2 nodal stations (ie, 10 and 11 right and left stations) for detection of PV compression. Lymphadenopathy was present in 64 patients (64/101; 63.4%) with computed tomography features of venoatrial compression in 17 patients (17/101; 16.8%). This subgroup included 10 patients with LA compression alone (10/64; 15.6%), 6 patients with PV compression alone (6/64; 9.4%), and 1 patient with both (1/64; 1.5%). The mean diameter of enlarged lymph nodes compressing the LA and PVs was 3.18±0.73 cm (range: 2.1 to 4.4 cm) and 1.9±0.45 cm (range: 1 to 2.9 cm), respectively. PV compression was depicted in a total of 7 patients (7/101; 6.9%), observed as a unilateral (n=5) or bilateral (n=2) finding, with a mean number of 3.0 PVs compressed per patient (range: 1 to 7). A total of 10 venous sections showed features of compression, at the level of a lobar confluence (n=6) or individual segmental veins (V6; n=4), with a mean reduction in the venous cross-sectional area of 51.09%±12.85% (median: 50.06%). Nonfibrotic lung infiltration associated with sarcoidosis was observed in 88.2% of patients with compressive lymphadenopathy (15/17). The prevalence of venoatrial compression in sarcoidosis is 16.8% in the studied population.
    Journal of Thoracic Imaging 02/2015; DOI:10.1097/RTI.0000000000000134 · 1.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare the quality of low-dose CT images with sinogram affirmed iterative reconstruction (SAFIRE), and full-dose CT with filtered back projection reconstructions (FBP). Fifty pulmonary CT performed by a dual-source technique (120kVp; 110mAs) with (a) the same energy in both tubes, and (b) the distribution of reference mAs with 40% in tube A (44mAs) and 60% in tube B (66mAs). Each acquisition allowed reconstruction of: (a) full-dose images (with both tubes) with FBP reconstructions (group 1); and (b) low-dose images (from tube A) reconstructed with SAFIRE (group 2). Group 2 images presented: (a) a significant objective reduction in noise measured in the trachea on mediastinal (16.04±5.66 vs 17.66±5.84) (P=0.0284) and pulmonary (29.77±6.79 vs 37.96±9.03) (P<0.0001) images; (b) a similar subjective perception of noise and overall image quality (P=1), which was considered to be excellent in 66% (33/50) of the cases, with no influence on the detection of elementary pulmonary lesions of infiltration (98.4%; 95% CI=[96.9%-99.9%]). Despite a 60% reduction in radiation dose, the image quality with iterative reconstruction is objectively better and subjectively similar to full-dose FBP images. Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.
    02/2015; 96(5). DOI:10.1016/j.diii.2014.08.006
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Access to the renal transplantation (RT) waiting list depends on factors related to lower mortality rates and often occurs after dialysis initiation. The aim of the study was to use a flexible regression model to determine if registration on the RT waiting list is associated with mortality on dialysis, independent of the comorbidities associated with such registration. Data from the French REIN registry on 7138 incident hemodialysis (HD) patients were analyzed. A multi-state model including four states ('HD, not wait-listed', 'HD, wait-listed', 'death', and 'RT') was used to estimate the effect of being wait-listed on the probability of death. During the study, 1392 (19.5%) patients were wait-listed. Of the 2954 deaths observed in the entire cohort during follow-up, 2921 (98.9%) were observed in the not wait-listed group compared with only 33 (1.1%) in the wait-listed group. In the multivariable analysis, the adjusted hazard ratio for death associated with non-registration on the waiting list was 3.52 (95% CI, 1.70-7.30). The risk factors for death identified for not wait-listed patients were not found to be significant risk factors for wait-listed patients, with the exception of age. The use of a multi-state model allowed a flexible analysis of mortality on dialysis. Patients who were not wait-listed had a much higher risk of death, regardless of co-morbidities associated with being wait-listed, and did not share the same risk factors of death as wait-listed patients. Registration on the waiting list should therefore be taken into account in survival analysis of patients on dialysis.
    Journal of Epidemiology 02/2015; 25(2):133-141. DOI:10.2188/jea.JE20130193 · 2.86 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the impact of iterative reconstruction on the detectability of clots. Fifty-three patients were enrolled in a study comparing reduced-dose and full-dose images, available from the same dual-source data set. From each acquisition, three series of images were generated: (1) full-dose images (from both tubes), reconstructed with filtered back projection (FBP) (group 1; standard of reference), (2) reduced-dose images (from tube A only; 60 % dose reduction) reconstructed with FBP (group 2) and iterative reconstruction (SAFIRE) (group 3). In group 1 (mean DLP: 264.6 mGy.cm), (1) PE was diagnosed in 8 patients (15 %) with 82 clots in the central (n = 5), segmental (n = 39) and subsegmental (n = 38) arteries and (2) mean level of noise was 30.56 ± 5.07. In group 2 (mean DLP: 105.8 mGy.cm), a significant increase in noise (44.56 ± 6.24; p < 0.0001) (1) hampered detection of PE in one patient and (2) altered detection of peripheral clots (12 false-negative and 2 false-positive results). In group 3, image noise was not significantly different from that in group 1 (p = 0.1525; effect size: 0.2683), with a similar detection of PE compared to group 1 (p = 1). Reconstruction of reduced-dose images (60 % dose reduction) with SAFIRE provided image quality and diagnostic value comparable to those of full-dose FBP images. • Iterative reconstruction does not alter the detection of endoluminal clots. • Iterative reconstruction allows dose reduction in the context of acute PE. • Iterative reconstruction allows radiologists to approach the prospects of submilliSievert CT.
    European Radiology 01/2015; 25(4). DOI:10.1007/s00330-014-3393-5 · 4.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: There is little information about the impact of hyperglycaemia in twin pregnancies. The objective of our study was to evaluate the maternal, foetal and neonatal complications in patients with twin pregnancy and glucose intolerance defined by gestational diabetes mellitus and gestational mild hyperglycaemia.
    Diabetes & Metabolism 01/2015; DOI:10.1016/j.diabet.2014.12.005 · 2.85 Impact Factor

Publication Stats

5k Citations
1,330.51 Total Impact Points

Institutions

  • 2001–2015
    • CHRU de Strasbourg
      Strasburg, Alsace, France
    • Université du Droit et de la Santé Lille 2
      • Faculty of Medicine
      Lille, Nord-Pas-de-Calais, France
  • 2000–2015
    • Lille Catholic University
      Lille, Nord-Pas-de-Calais, France
  • 1999–2015
    • Centre Hospitalier Régional Universitaire de Lille
      • Division of Neurology
      Lille, Nord-Pas-de-Calais, France
  • 1997–2015
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France