Alain Duhamel

University of Lille Nord de France, Lille, Nord-Pas-de-Calais, France

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Publications (290)1002.13 Total impact

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    ABSTRACT: Background The aim of the authors was to reassess the impact of a positive surgical margin (R1) after a liver resection for colorectal liver metastases (CLMs) on survival in the era of modern chemotherapy, through their own experience and a literature review.Methods Inclusion criteria were: R1 or R0 resection with no local treatment modalities, extra-hepatic metastases or other cancer.ResultsAmong 337 patients operated between 2000 and 2010, 273 patients were eligible (214 R0/59 R1). The mean follow-up was 43 ± 29 months. Compared with a R0 resection, a R1 resection offered a lower 5-year overall (39.1% versus 54.2%, P = 0.010), disease-free (15.2% versus 31.1%, P = 0.021) and progression-free (i.e. time to the first non-curable recurrence; 33.1% versus 47.3%, P = 0.033) survival rates. Metastases in the R1 group were more numerous, larger and more frequently synchronous. Independent factors of poor survival were: number, size and short-time interval of CLM occurrence, N status, rectal primary, absence of adjuvant chemotherapy, but not a R1 resection. With the more-systematic administration of chemotherapy since 2005, the intergroup difference in progression-free survival disappeared (P = 0.264).ConclusionA R1 resection had no prognostic value per se but reflected a more severe disease. The recent change in the prognostic value of a R1 resection may be linked to the beneficial effect of chemotherapy.
    HPB 08/2014; · 1.94 Impact Factor
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    ABSTRACT: Multiple organ dysfunction, not respiratory failure, is the major cause of death in children with acute lung injury or acute respiratory distress syndrome. This study was undertaken to estimate the predictive value of death of the nonrespiratory Pediatric Logistic Organ Dysfunction-2 in children with acute respiratory failure.
    06/2014;
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    ABSTRACT: Before introducing 70-kVp settings in the low-kilovoltage strategies for pediatric examinations, it was mandatory to demonstrate, at similar dose levels, an equivalence of image quality at 70 kVp and 80 kVp.
    Pediatric Radiology 06/2014; · 1.57 Impact Factor
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    ABSTRACT: Cytoreduction prior-to-allogeneic stem cell transplantation (allo-SCT) for patients with myelodysplastic syndromes remains debated. After excluding patients who had received preconditioning induction chemotherapy, we analyzed 128 consecutive patients with MDS who received reduced intensity or nonmyeloablative conditioning (RIC/NMA) allo-SCT. Among them, 40 had received AZA before transplant (AZA-group) while 88 were transplanted upfront (BSC-group). At diagnosis, 55 patients had intermediate-2 or high-risk IPSS and 33 had high cytogenetic risk-score. Progression to a more advanced disease before allo-SCT was recorded in 22 patients. Source of stem cells were blood (n=112) or marrow (n=16) from sibling (n=78) or HLA-matched unrelated (n=50) donors. With a median follow-up of 60 months, 3-year overall survival, relapse-free survival, cumulative incidence of relapse and non-relapse mortality were 53% versus 53% (p=0.69), 37% versus 42% (p=0.78), 35% versus 36% (p=.99) and 20% versus 23% (p=0.74), for AZA-group and BSC-group, respectively. Multivariate analysis confirmed the absence of statistical differences in outcome between AZA and BSC groups, after adjustment for potential confounders using propensity score approach. The absence of cytoreduction before RIC/NMA allo-SCT did not seem to alter the outcome. However, our results emphasize the need to perform prospective protocols in order to delineate the role of debulking strategy and to identify subsets of patients who may benefit from this approach.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 05/2014; · 3.15 Impact Factor
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    ABSTRACT: Apathy is characterized by lack of interest, loss of initiative, and flattening of affect. It is a frequent, very disabling nonmotor complication of Parkinson's disease (PD). The condition may notably occur when dopaminergic medications are tapered after the initiation of subthalamic stimulation and thus can be referred to as “dopaminergic apathy.” Even in the absence of tapering, some patients may develop a form of apathy as PD progresses. This form is often related to cognitive decline and does not respond to dopaminergic medications (dopa-resistant apathy). We aimed at determining whether dopa-resistant apathy in PD is related to striatofrontal morphological changes. We compared the shape of the striatum (using spherical harmonic parameterization and sampling in a three-dimensional point distribution model [SPHARM-PDM]), cortical thickness, and fractional anisotropy (using tract-based spatial statistics) in 10 consecutive patients with dopamine-refractory apathy, 10 matched nonapathetic PD patients and 10 healthy controls. Apathy in PD was associated with atrophy of the left nucleus accumbens. The SPHARM-PDM analysis highlighted (1) a positive correlation between the severity of apathy and atrophy of the left nucleus accumbens, (2) greater atrophy of the dorsolateral head of the left caudate in apathetic patients than in nonapathetic patients, and (3) greater atrophy in the bilateral nucleus accumbens in apathetic patients than in controls. There were no significant intergroup differences in cortical thickness or fractional anisotropy. Dopa-resistant apathy in PD was associated with atrophy of the left nucleus accumbens and the dorsolateral head of the left caudate. © 2014 International Parkinson and Movement Disorder Society
    Movement Disorders 05/2014; · 4.56 Impact Factor
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    ABSTRACT: Adult patients with cystic fibrosis (CF) frequently have reduced exercise tolerance, which is multifactorial but mainly due to bronchial obstruction. The aim of this retrospective analysis was to determine the mechanisms responsible for exercise intolerance in patients with mild-to-moderate or severe disease.
    BMC Pulmonary Medicine 04/2014; 14(1):74. · 2.76 Impact Factor
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    ABSTRACT: The objective of the present study was to investigate the time course of long-interval intracortical inhibition (LICI) and late cortical disinhibition (LCD) as a function of the motor task (index abduction, thumb-index precision grip). Motor-evoked potentials were recorded from the first dorsal interosseus (FDI) muscle of the dominant limb in 13 healthy subjects. We used paired-pulse transcranial magnetic stimulation (TMS) paradigms in which a test pulse was preceded by a suprathreshold priming pulse (130% of the resting motor threshold) with varying interstimulus intervals (ISIs). In each task, double pulses were delivered with ISIs ranging from 30% of the corresponding silent period (SP; ~ 45 ms) to 220% of the SP (~ 330 ms). In both tasks, we found that LICI was followed by LCD (namely a period of increased cortical excitability lasting until ~ 200% of the SP). The time-dependent modulation of LICI and LCD differed in the two tasks; LICI was shorter (i.e. disinhibition occurred earlier) and LCD was more intense during precision grip than during index abduction. Long-interval intracortical inhibition disappeared well before the end of the SP in the precision grip task, suggesting that the mechanisms underlying these two inhibitory phenomena are distinct. Our data suggest that disinhibition might reflect adaptation of neural circuit excitability to the functional requirements of the motor task.
    European Journal of Neuroscience 02/2014; · 3.75 Impact Factor
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    ABSTRACT: The aim of the study was to evaluate left atrial (LA) volume in smokers according to the severity of emphysema, with the objective of providing indirect evidence of reduced pulmonary venous return due to capillary destruction. A total of 121 smokers underwent a high-pitch and high-temporal resolution computed tomography (CT) angiographic examination, enabling quantification of emphysema, total lung volume, and LA volume measurements normalized to body surface area. The CT phenotypes were as follows: emphysema predominant (group 1; n=57); airway predominant (group 2; n=30); a mixed pattern of emphysema and airway disease (group 3; n=15); and absence of bronchopulmonary CT abnormalities (group 4; n=19). A negative correlation was found between the indexed LA volume and the percentage of emphysema: (a) in the overall study group (P=0.032; r=-0.19); (b) in group 1 (P=0.0163; r=-0.32); and (c) in groups 1 and 3 when analyzed together (P=0.0492; r=-0.23). A negative correlation was found between the indexed LA volume and the total lung volume in the overall study group (P=0.039; r=-0.19) and in group 1 (P=0.048; r=-0.26), whereas no correlations were found in group 2 (P=0.44; r=-0.15), group 3 (P=0.52; r=-0.17), and groups 1 and 3 analyzed as a whole (P=0.14; r=-0.17). The indexed LA volume, impacting left ventricular preload, is correlated to the severity of emphysema.
    Journal of thoracic imaging 01/2014; · 1.42 Impact Factor
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    ABSTRACT: We investigated the impact of rabbit antithymocyte globulins (ATG) on patient outcome after allogeneic stem cell transplantation (allo-SCT) for progressive myelodysplastic syndrome (MDS). Of the 242 consecutive patients who underwent allo-SCT for progressive MDS between October 1999 and December 2009, 93 received ATG (ATG group) at the median dose of 5 mg/kg while 149 patients did not (no-ATG group). Donors were sibling (n=153) or HLA-matched unrelated (n=89). Patients received blood (n=90) or marrow (n=152) grafts following either myeloablative (n=109) or reduced intensity (n=133) conditioning. Three-year overall and event-free survival, nonrelapse mortality, relapse, and chronic graft-versus-host disease (GVHD) development were not significantly different between the two groups. In contrast, acute grade II-IV GVHD occurred more often in the no-ATG group (55% of the patients) than in the ATG group (27%, p<0.0001). Similar results were observed with acute grade III-IV GVHD (28% and 14% in the no-ATG group and ATG group, respectively; p=0.009). In multivariate analysis, after adjustment with propensity score, the absence of ATG was the strongest parameter associated with an increased risk of acute grade II-IV GVHD [HR=2.13, 95% CI: 1.35-3.37, p=0.001]. ATG had no impact on overall and event free survival or cumulative incidence of the relapse. In conclusion, the addition of ATG to allo-SCT conditioning did not increase the incidence of relapse of patients with progressive MDS. The incidence of acute GVHD was decreased without compromising outcomes.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 01/2014; · 3.15 Impact Factor
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    ABSTRACT: Cytoreduction prior-to-allogeneic stem cell transplantation (allo-SCT) for patients with myelodysplastic syndromes remains debated. After excluding patients who had received preconditioning induction chemotherapy, we analyzed 128 consecutive patients with MDS who received reduced intensity or nonmyeloablative conditioning (RIC/NMA) allo-SCT. Among them, 40 had received AZA before transplant (AZA-group) while 88 were transplanted upfront (BSC-group). At diagnosis, 55 patients had intermediate-2 or high-risk IPSS and 33 had high cytogenetic risk-score. Progression to a more advanced disease before allo-SCT was recorded in 22 patients. Source of stem cells were blood (n=112) or marrow (n=16) from sibling (n=78) or HLA-matched unrelated (n=50) donors. With a median follow-up of 60 months, 3-year overall survival, relapse-free survival, cumulative incidence of relapse and non-relapse mortality were 53% versus 53% (p=0.69), 37% versus 42% (p=0.78), 35% versus 36% (p=.99) and 20% versus 23% (p=0.74), for AZA-group and BSC-group, respectively. Multivariate analysis confirmed the absence of statistical differences in outcome between AZA and BSC groups, after adjustment for potential confounders using propensity score approach. The absence of cytoreduction before RIC/NMA allo-SCT did not seem to alter the outcome. However, our results emphasize the need to perform prospective protocols in order to delineate the role of debulking strategy and to identify subsets of patients who may benefit from this approach.
    01/2014;
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    ABSTRACT: Background Because of growing body of interest on the association between fibrosing idiopathic interstitial pneumonias (f-IIP) and ischemic heart disease, we initiated this prospective study to evaluate the prevalence of asymptomatic coronary artery disease (CAD) in patients with f-IIP. Methods 42 patients with f-IIP underwent noninvasive screening for CAD that included (a) a chest CT examination enabling calculation of the coronary artery calcium (CAC) score, then depiction of coronary artery stenosis; and (b) stress myocardial perfusion scintigraphy (MPS). Patients with significant coronary abnormalities, defined by a CAC score >400 or coronary artery stenosis >50% at CT and/or perfusion defect > 5% at MPS, were referred to the cardiologist. Coronary angiography was indicated in presence of a perfusion defect > 10% at MPS or significant left main or proximal left anterior descending stenosis whatever MPS findings. Results Combining CT and MPS, significant abnormalities were detected in 32/42 patients (76%). The cardiologist: (a) did not consider further investigation in 21 patients (CT abnormalities but no ischemia at MPS: 12/21; false-positive findings at MPS: 3/21; poor respiratory condition: 6/21); (b) proceeded to coronary angiography in 11 patients which confirmed significant stenoses in 5 patients (5/42; 12%). In the worst-case-scenario (i.e., inclusion of 6 patients with significant coronary artery abnormalities who were not investigated due to poor respiratory condition), the prevalence of CAD reached 26% (11/42). Conclusion In the studied population of patients with f-IIP, asymptomatic CAD ranged between 12% and 26%.
    European Journal of Radiology. 01/2014;
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    ABSTRACT: The aim of this study was to determine the type and the number of accelerometer monitoring days needed to predict weekly sedentary behaviour and physical activity in obese youth. Fifty-three obese youth wore a triaxial accelerometer for 7 days to measure physical activity in free-living conditions. Analyses of variance for repeated measures, Intraclass coefficient (ICC) and regression linear analyses were used. Obese youth spent significantly less time in physical activity on weekends or free days compared with school days. ICC analyses indicated a minimum of 2 days is needed to estimate physical activity behaviour. ICC were 0·80 between weekly physical activity and weekdays and 0·92 between physical activity and weekend days. The model has to include a weekday and a weekend day. Using any combination of one weekday and one weekend day, the percentage of variance explained is >90%. Results indicate that 2 days of monitoring are needed to estimate the weekly physical activity behaviour in obese youth with an accelerometer. Our results also showed the importance of taking into consideration school day versus free day and weekday versus weekend day in assessing physical activity in obese youth.
    Clinical Physiology and Functional Imaging 12/2013; · 1.33 Impact Factor
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    ABSTRACT: Aims. The pathophysiological role of iron in Parkinson's disease (PD) was assessed by a chelation strategy aimed at reducing oxidative damage associated with regional iron deposition without affecting circulating metals. Translational cell and animal models provided concept proofs and a delayed-start treatment paradigm the basis for preliminary clinical assessments. Results. For translational studies we assessed the effect of oxidative insults in mice systemically pre-chelated with deferiprone (DFP) by following motor functions, striatal dopamine (HPLC and MRI-PET) and brain iron deposition (relaxation-R2*-MRI) aided by spectroscopic measurements of neuronal labile iron (with fluorescence-sensitive iron sensors) and oxidative damage by markers of protein, lipid and DNA modification. DFP significantly reduced labile iron and biological damage in oxidation-stressed cells and animals, improving motor functions while raising striatal-dopamine. For a pilot double-blind, placebo-controlled-randomized clinical trial, early-stage Parkinson's patients on stabilized dopamine regimens enrolled in a 12-months single-center study with DFP (30 mg/kg/day). Based on a 6-month delayed-start paradigm, early-start (n=19) compared to (n=18) delayed-start patients (37/40 completed) responded significantly earlier and sustainably to treatment in both substantia-nigra iron deposits (R2* MRI) and UPDRS motor indicators of disease progression (p<.03 and p<.04, respectively). Apart from three rapidly resolved neutropenia cases, safety was maintained throughout the trial. Novelty. A moderate iron chelation regimen that avoids changes in systemic iron levels may constitute a novel therapeutic modality for PD. Conclusions. The therapeutic features of a chelation modality established in translational models and in pilot clinical trials, warrant comprehensive evaluation of symptomatic and/or disease-modifying potential of chelation in PD.
    Antioxidants & Redox Signaling 11/2013; · 8.20 Impact Factor
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    ABSTRACT: Even with optimal dopaminergic treatments, many patients with Parkinson's disease (PD) are frequently incapacitated by apathy prior to the development of dementia. We sought to establish whether rivastigmine's ability to inhibit acetyl- and butyrylcholinesterases could relieve the symptoms of apathy in dementia-free, non-depressed patients with advanced PD. We performed a multicentre, parallel, double-blind, placebo-controlled, randomised clinical trial (Protocol ID: 2008-002578-36; clinicaltrials.gov reference: NCT00767091) in patients with PD with moderate to severe apathy (despite optimised dopaminergic treatment) and without dementia. Patients from five French university hospitals were randomly assigned 1:1 to rivastigmine (transdermal patch of 9.5 mg/day) or placebo for 6 months. The primary efficacy criterion was the change over time in the Lille Apathy Rating Scale (LARS) score. 101 consecutive patients were screened, 31 were eligible and 16 and 14 participants were randomised into the rivastigmine and placebo groups, respectively. Compared with placebo, rivastigmine improved the LARS score (from -11.5 (-15/-7) at baseline to -20 (-25/-12) after treatment; F(1, 25)=5.2; p=0.031; adjusted size effect: -0.9). Rivastigmine also improved the caregiver burden and instrumental activities of daily living but failed to improve quality of life. No severe adverse events occurred in the rivastigmine group. Rivastigmine may represent a new therapeutic option for moderate to severe apathy in advanced PD patients with optimised dopaminergic treatment and without depression dementia. These findings require confirmation in a larger clinical trial. Our results also confirmed that the presence of apathy can herald a pre-dementia state in PD. Clinicaltrials.gov reference: NCT00767091.
    Journal of neurology, neurosurgery, and psychiatry 11/2013; · 4.87 Impact Factor
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    ABSTRACT: In Parkinson's disease (PD), the response to l-dopa is highly variable and unpredictable. The major pathway for dopamine synthesis from l-dopa is decarboxylation by aromatic l-amino acid decarboxylase (AAAD, encoded by the DDC gene). To determine the motor response to l-dopa in PD patients as a function of the DDC gene promoter polymorphisms (rs921451 T > C polymorphism (DDC(T/C)) and rs3837091 AGAG del (DDC(AGAG/-))). Thirty-three Caucasian PD patients underwent an acute l-dopa challenge together with the peripheral AAAD inhibitor benserazide and were genotyped for rs921451 and rs3837091. The primary efficacy criterion was the motor response to l-dopa, as estimated by the area under the curve for the change in the Unified Parkinson's Disease Rating Scale part III (UPDRS) score relative to baseline (AUCΔUPDRS) in the 4 h following l-dopa administration. Secondary endpoints were pharmacokinetic parameters for plasma levels of l-dopa and dopamine. Investigators and patients were blinded to genotypes data throughout the study. When adjusted for the l-dopa dose, the AUCΔUPDRS was significantly lower in DDC(CC/CT) patients (n = 14) than in DDC(TT) patients (n = 19) and significantly lower in DDC(-/- or AGAG/-) patients (n = 8) than in DDC(AGAG/AGAG) patients (n = 25). There were no significant intergroup differences in plasma pharmacokinetic parameters for l-dopa and dopamine. The rs921451 and rs3837091 polymorphisms of the DDC gene promoter influence the motor response to l-dopa but do not significantly change peripheral pharmacokinetic parameters for l-dopa and dopamine. Our results suggest that DDC may be a genetic modifier of the l-dopa response in Parkinson's disease.
    Parkinsonism & Related Disorders 10/2013; · 3.27 Impact Factor
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    ABSTRACT: Prednisolone or pentoxifylline is recommended for severe alcoholic hepatitis, a life-threatening disease. The benefit of their combination is unknown. To determine whether the addition of pentoxifylline to prednisolone is more effective than prednisolone alone. Multicenter, randomized, double-blind clinical trial conducted between December 2007 and March 2010 in 1 Belgian and 23 French hospitals of 270 patients aged 18 to 70 years who were heavy drinkers with severe biopsy-proven alcoholic hepatitis, as indicated by recent onset of jaundice in the prior 3 months and a Maddrey score of at least 32. Duration of follow-up was 6 months. The last included patient completed the study in October 2010. None of the patients were lost to follow-up for the main outcome. Patients were randomly assigned to receive either a combination of 40 mg of prednisolone once a day and 400 mg of pentoxifylline 3 times a day (n=133) for 28 days, or 40 mg of prednisolone and matching placebo (n=137) for 28 days. Six-month survival, with secondary end points of development of hepatorenal syndrome and response to therapy based on the Lille model, which defines treatment nonresponders after 7 days of initiation of treatment. In intention-to-treat analysis, 6-month survival was not different in the pentoxifylline-prednisolone and placebo-prednisolone groups (69.9% [95% CI, 62.1%-77.7%] vs 69.2% [95% CI; 61.4%-76.9%], P = .91), corresponding to 40 vs 42 deaths, respectively. In multivariable analysis, only the Lille model and the Model for End-Stage Liver Disease score were independently associated with 6-month survival. At 7 days, response to therapy assessed by the Lille model was not significantly different between the 2 groups (Lille model score, 0.41 [95% CI, 0.36-0.46] vs 0.40 [95% CI, 0.35-0.45], P = .80). The probability of being a responder was not different in both groups (62.6% [95% CI, 53.9%-71.3%] vs 61.9% [95% CI, 53.7%-70.3%], P = .91). The cumulative incidence of hepatorenal syndrome at 6 months was not significantly different in the pentoxifylline-prednisolone and the placebo-prednisolone groups (8.4% [95% CI, 4.8%-14.8%] vs 15.3% [95% CI, 10.3%-22.7%], P = .07). In patients with alcoholic hepatitis, 4-week treatment with pentoxifylline and prednisolone, compared with prednisolone alone, did not result in improved 6-month survival. The study may have been underpowered to detect a significant difference in incidence of hepatorenal syndrome, which was less frequent in the group receiving pentoxifylline. clinicaltrials.gov Identifier: NCT01214226.
    JAMA The Journal of the American Medical Association 09/2013; 310(10):1033-41. · 29.98 Impact Factor
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    ABSTRACT: A prospective national register was established in 2008 to record all new cases of live-birth newborns with esophageal atresia (EA). This epidemiological survey was recommended as part of a national rare diseases plan. All 38 national centers treating EA participated by completing for each patient at first discharge a questionnaire validated by a national committee of experts. Data were centralized by the national reference center for esophageal anomalies. Quantitative and qualitative analyses were performed, with P-values of less than 0.05 considered statistically significant. Results of the 2008-2009 data collection are presented in this report. Three hundred seven new living cases of EA were recorded between January 1, 2008, and December 31, 2009. The male/female sex ratio was 1.3, and the live-birth prevalence of EA was 1.8 per 10,000 births. Major characteristics were comparable to those reported in the literature. Survival was 95%, and no correlation with caseload was noted. Epidemiologic surveys of congenital anomalies such as EA, which is a rare disease, provide valuable data for public health authorities and fulfill one important mission of reference centers. When compared with previous epidemiological data, this national population-based registry suggests that the incidence of EA remains stable.
    Journal of Pediatric Surgery 08/2013; 48(8):1664-9. · 1.38 Impact Factor
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    ABSTRACT: Rapid eye movement (REM) sleep behavior disorder (RBD) is a risk factor for dementia in Parkinson disease (PD) patients. The objectives of our study were to prospectively evaluate the frequency of RBD in a sample of treatment-naïve, newly diagnosed PD patients and compare sleep characteristics and cognition in RBD and non-RBD groups. Fifty-seven newly diagnosed PD patients were consecutively recruited in a university medical center. All patients underwent two overnight polysomnography (PSG) sessions and were diagnosed with RBD according to the International Classification of Sleep Disorders, Second Revision criteria. Daytime sleepiness was measured in a multiple sleep latency test (MSLT). Cognition was assessed in a standard neuropsychologic examination. Seventeen PD patients (30%) met the criteria for RBD. The RBD patients and non-RBD patients did not significantly differ in mean age, gender ratio, disease duration, motor symptom subtype and severity, total sleep time, percentage of REM sleep, apnea-hypopnea index, mean oxygen saturation, and importantly cognitive performance. However, non-RBD patients had a significantly shorter mean daytime sleep latency than RBD patients (15 vs 18min, respectively; P=.014). A high frequency of RBD was found in our sample of 57 newly diagnosed PD patients. At this stage in the disease, RBD was not found to be associated with other sleep disorders or cognitive decline. Follow-up is needed to assess the risk for developing dementia in early-stage PD patients with RBD.
    Sleep Medicine 07/2013; · 3.49 Impact Factor
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    ABSTRACT: To evaluate the clinical impact of automatic tube voltage selection on chest CT angiography (CTA). Ninety-three patients were prospectively evaluated with a CT protocol aimed at comparing two successive CTAs acquired under similar technical conditions except for the kV selection: (1) the initial CTA was systematically obtained at 120 kVp and 90 ref mAs; (2) the follow-up CTA was obtained with an automatic selection of the kilovoltage (Care KV; Siemens Healthcare) for optimised CTA. At follow-up, 90 patients (97 %) underwent CTA with reduced tube voltage, 100 kV (n = 26; 28 %) and 80 kV (n = 64; 69 %), resulting in a significant dose-length-product reduction (follow-up: 87.27; initial: 141.88 mGy.cm; P < 0.0001; mean dose reduction: 38.5 %) and a significant increase in the CNR at follow-up (follow-up: 11.5 ± 3.5 HU; initial: 10.9 ± 3.7 HU; P = 0.03). The increase in objective image noise at follow-up (follow-up: 23.2 ± 6.7 HU vs. 17.8 ± 5.1 HU; P < 0.0001) did not alter the diagnostic value of images. Automatic tube voltage selection reduced the radiation dose delivered during chest CT angiograms by 38.5 % while improving the contrast-to-noise ratio of the examinations. • As low a dose as possible must be used for CT angiography. • Automatic tube voltage selection permits reduced patient exposure. • Lowering the kVp enables increased intravascular attenuation. • Automatic tube voltage selection does not compromise the overall image quality.
    European Radiology 07/2013; · 3.55 Impact Factor
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    ABSTRACT: Objectif Fournir des informations quantitatives sur l’emphysème chez les fumeurs asymptomatiques, corrélées aux épreuves fonctionnelles respiratoires (EFR). Patients et méthodes La population de l’étude se composait de 75 fumeurs (fumeurs actifs : n = 39 ; ex-fumeurs : n = 36) et 25 non-fumeurs, qui ont bénéficié d’une tomodensitométrie (TDM) thoracique en rendu volumique-haute-résolution avec quantification automatique de l’emphysème et d’EFR. Résultats Chez les fumeurs actifs, le pourcentage d’emphysème était plus élevé dans le poumon droit (p = 0,041) et dans le lobe supérieur droit (p = 0,037). Nous n’avons pas observé de variation du pourcentage global d’emphysème en fonction du stade GOLD (p = 0,77). Les fumeurs atteints d’emphysème avaient des valeurs moyennes significativement plus élevées de CRF (p = 0,0012), de VR (< 0,0001) et de CPT (p = 0,0157) que les fumeurs sans emphysème, mais il n’y avait pas de différence significative concernant les valeurs moyennes de TLCO ou de débits expiratoires (p > 0,05). Nous avons trouvé des corrélations entre le pourcentage d’emphysème et : (a) la consommation de cigarettes des fumeurs actifs (r = 0,34215 ; p = 0,0330) et des ex-fumeurs (r = 0,44104 ; p = 0,0071) ; et (b) des altérations de CPT, CRF, VR et DLCO chez les fumeurs. Conclusion La TDM quantitative permet de mettre en évidence des spécificités de distribution régionale et des altérations fonctionnelles précliniques chez les fumeurs emphysèmateux.
    Journal de Radiologie Diagnostique et Interventionnelle. 06/2013; 94(6):626–635.

Publication Stats

4k Citations
1,002.13 Total Impact Points

Institutions

  • 2000–2014
    • University of Lille Nord de France
      Lille, Nord-Pas-de-Calais, France
  • 1999–2014
    • Centre Hospitalier Régional Universitaire de Lille
      • Division of Neurology
      Lille, Nord-Pas-de-Calais, France
  • 2013
    • Clinique de l'Yvette
      Longjumeau, Île-de-France, France
  • 2001–2013
    • Université du Droit et de la Santé Lille 2
      • Faculty of Medicine
      Lille, Nord-Pas-de-Calais, France
    • CHRU de Strasbourg
      Strasburg, Alsace, France
  • 2002–2011
    • Lille Catholic University
      Lille, Nord-Pas-de-Calais, France
  • 2010
    • Université du Littoral Côte d'Opale (ULCO)
      Dunkirk, Nord-Pas-de-Calais, France
  • 2009
    • Centre Hospitalier Universitaire de Dijon
      Dijon, Bourgogne, France
  • 2004
    • Université Charles-de-Gaulle Lille 3
      Lille, Nord-Pas-de-Calais, France
    • University of Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France