Xavier Duval

Paris Diderot University, Lutetia Parisorum, Île-de-France, France

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Publications (179)898.59 Total impact

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    ABSTRACT: This phase I, pilot clinical study was designed to evaluate the safety and the pharmacokinetic (PK) profiles of the CIME (Metabolic Identity Card) combination of ten drugs, with a view to its use as a phenotyping cocktail. Ten healthy Caucasian subjects were orally dosed with the CIME combination (caffeine-CYP1A2, repaglinide-CYP2C8, tolbutamide-CYP2C9, omeprazole-CYP2C19, dextromethorphan-CYP2D6, midazolam-CYP3A, acetaminophen-UGT1A1, 6&9 and 2B15, digoxin-P-gp, rosuvastatin-OATP1B1&3 and memantine-active renal transport). Blood was collected over 3 days and on day 7. CIME probes and relevant metabolites were assayed by LC-MS/MS and PK parameters were calculated. Main results were: (1) good safety with reversible mild or moderate adverse effects, (2) an analytical method able to quantify simultaneously the 10 probes and the major metabolites, (3) calculation of PK parameters for all probes in general agreed with published values, and (4) identification of the low CYP2D6 metabolizer. This pilot study showed that the CIME combination was well tolerated and that its pharmacokinetics could be accurately measured in healthy volunteers. This combination can now confidently be checked for sensitivity and specificity and for lack of interaction to be validated as a phenotyping cocktail.
    European Journal of Drug Metabolism and Pharmacokinetics 12/2014; · 1.31 Impact Factor
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    ABSTRACT: Echocardiography plays a key role in the diagnosis of infective endocarditis (IE) but can be inconclusive in patients in whom prosthetic valve endocarditis (PVE) is suspected. The incremental diagnostic value of (18)F-FDG PET and radiolabeled leukocyte scintigraphy in IE patients has already been reported. The aim of this study was to compare the respective performance of (18)F-FDG PET and leukocyte scintigraphy for the diagnosis of PVE in 39 patients. (18)F-FDG PET and leukocyte scintigraphy were performed on 39 consecutive patients admitted because of clinically suspected PVE and inconclusive echocardiography results. The results of (18)F-FDG PET and leukocyte scintigraphy were analyzed separately and retrospectively by experienced physicians masked to the results of the other imaging technique and to patient outcome. The final Duke-Li IE classification was made after a 3-mo follow-up. Of the 39 patients, 14 were classified as having definite IE, 4 as having possible IE, and 21 as not having IE. The average interval between (18)F-FDG PET and leukocyte scintigraphy was 7 ± 7 d. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 93%, 71%, 68%, 94%, and 80%, respectively, for (18)F-FDG PET and 64%, 100%, 100%, 81%, and 86%, respectively, for leukocyte scintigraphy. Discrepancies between the results of (18)F-FDG PET and leukocyte scintigraphy occurred in 12 patients (31%). In patients with definite IE, 5 had true-positive (18)F-FDG PET results but false-negative leukocyte scintigraphy results. Of these 5 patients, 3 had nonpyogenic microorganism IE (Coxiella or Candida). Of patients for whom endocarditis had been excluded, 6 had true-negative leukocyte scintigraphy results but false-positive (18)F-FDG PET results. These 6 patients had been imaged in the first 2 mo after the last cardiac surgery. The last patient with a discrepancy between (18)F-FDG PET and leukocyte scintigraphy was classified as having possible endocarditis and had positive (18)F-FDG PET results and negative leukocyte scintigraphy results. (18)F-FDG PET offers high sensitivity for the detection of active infection in patients with suspected PVE and inconclusive echocardiography results. Leukocyte scintigraphy offers a higher specificity, however, than (18)F-FDG PET for diagnosis of IE and should be considered in cases of inconclusive (18)F-FDG PET findings or in the first 2 mo after cardiac surgery. © 2014 by the Society of Nuclear Medicine and Molecular Imaging, Inc.
    Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 12/2014; 55(12):1980-5.
  • Xavier Duval, Bruno Hoen
    Lancet. 11/2014;
  • C Chirouze, B Hoen, X Duval
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    ABSTRACT: Historically, infective endocarditis (IE) affected patients with predisposing cardiac conditions and community-acquired bacteremia. Over the past 30 years, significant changes have occurred, regarding microorganisms, underlying valvular heart diseases, portals of entry, and patients' comorbidities. Given these epidemiological changes and unproven prophylaxis efficacy, experts in most countries currently limit antibiotic indications to patients with high-risk cardiac conditions having oral procedures and, in the UK, recommend discontinuing their use altogether. To date, no epidemiological impact on streptococcal IE incidence has been observed. Policy must now address these epidemiological modifications, focus on community-acquired and health care-associated staphylococcal bacteremia prevention, and prompt the adoption of broader and nonexclusively antibiotic-based strategies.
    Current Infectious Disease Reports 11/2014; 16(11):440.
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    ABSTRACT: A 65 year-old woman was admitted for acute heart failure and severe sepsis revealing definite mitral infective endocarditis with severe regurgitation, complicated by multiple embolisms. Three blood cultures yielded a group G Streptococcus canis strain. Urgent surgery was performed with bioprosthetic valve replacement. Polymerase chain reaction analysis of the valve found S canis DNA. Amoxicillin and gentamicin were given for 2 weeks followed by 4 weeks of amoxicillin alone. She reported contact with a dog without bite. S canis has been reported to cause zoonotic septicemia but to our knowledge, this is the first human case of native valve infective endocarditis. Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
    The Canadian journal of cardiology 11/2014; 30(11):1462.e1-2. · 3.12 Impact Factor
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    ABSTRACT: Preventive services provided opportunistically by GPs are insufficient. Reasons are most often gathered through GPs' self-reports, rather than through independent observation.
    Family practice. 06/2014;
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    ABSTRACT: Whether sex-related differences in the prognosis of infective endocarditis (IE) are due to differences in disease severity or comorbid patterns, physiological specificities or a treatment indication bias is unclear. We conducted an analysis of the pooled database of two population-based cohorts of IE to reassess the relationships between sex, early valve surgery (EVS) and outcome in patients with IE.
    Heart (British Cardiac Society) 06/2014; · 5.01 Impact Factor
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    ABSTRACT: Introduction – objectifs La faible concordance inter-observateurs dans la lecture de la radiographie thoracique (RT) et la meilleure sensibilité du scanner thoracique (ST) soulève la question de l’utilité du ST dans la prise en charge des patients (pts) suspects de PAC. L’objectif était de déterminer l’impact diagnostique et thérapeutique du ST dans les suspicions cliniques de PAC. Matériels et méthodes Cette étude prospective multicentrique incluait des pts suspects de PAC (≥ 1 signe d’infection systémique et ≥ 1 signe respiratoire récent). Un ST avec interprétation standardisée était réalisé dans les 4 heures. La certitude diagnostique (échelle de Likert) de PAC et les projets thérapeutiques étaient établis par l’urgentiste avant puis après le ST. Le diagnostic final de PAC était établi à J 28 par un comité d’adjudication (CA). Résultats Entre novembre 2011 et décembre 2012, 319 pts ont été inclus (âge moyen 64,7 ans). Avant ST, le diagnostic de PAC était certain pour 143 pts (44,8 %), probable pour 118 (37 %), possible pour 54 (17 %) et exclu pour 4 pts (1,2 %). Après ST, le diagnostic était certain pour 162 pts (50,8 %), probable pour 35 (11 %), possible pour 30 (9,4 %), exclu pour 92 pts (28,8 % ; diagnostic alternatif retenu). Le diagnostic était modifié par le ST chez 187 pts (58,6 % IC95 % [53,2 ; 64]), et conforme au diagnostic final du CA dans 73 % des cas. Un traitement antibiotique était initié (51pts) ou interrompu (29 pts) à la suite du ST chez 70 pts (22 %). Conclusion En cas de suspicion clinique de PAC, le ST précoce modifie la probabilité diagnostique dans 60 % des cas, exclut ce diagnostic dans 30 % et modifie le choix thérapeutique chez 20 %. L’impact sur le pronostic devrait être évalué.
    Médecine et Maladies Infectieuses 06/2014; 44(6):3–4. · 0.75 Impact Factor
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    ABSTRACT: Legionellosis is a life-threatening disease. The clinical superiority of quinolones or macrolides for treating patients with legionellosis has not been established. We performed a systematic review and meta-analysis of studies reporting data that allowed the comparison of quinolones versus macrolides in the treatment of proven legionellosis published from 1 January 1985 to 31 January 2013. We collected baseline aggregate patient characteristics. Studied outcomes included mortality, clinical cure, time to apyrexia, length of hospital stay and occurrence of complications in each treatment group. Treatment effect was assessed using a Mantel-Haenszel random effects model. Among 1005 abstracts reviewed, 12 studies were selected (n = 879 patients). No randomized controlled trial was performed directly comparing quinolone and macrolide efficacy in legionellosis. Mean age was 58.3 years, 27.7% were women and Fine score was ≥4 in 35.8%. Among 253 patients who received quinolone monotherapy, 10 died (4.0%). Among 211 patients who received macrolide monotherapy, 23 died (10.9%). The pooled OR of death for treatment with a quinolone versus a macrolide was 0.5 (95% CI 0.2-1.3, n = 8 studies, 464 patients). Length of stay was significantly shorter in the quinolone monotherapy group. The difference was 3.0 days (95% CI 0.7-5.3, P = 0.001, n = 3 studies, 263 patients). Neither of two tests for heterogeneity was significant (I (2 )= 0% for both, P = 1). Other studied outcomes were not significantly different among treatment groups. Few clinical data on legionellosis treatment are available. This first meta-analysis showed a trend toward a lower mortality rate and a significant decrease in length of hospital stay among patients receiving quinolones. These results must be confirmed by a randomized controlled trial.
    Journal of Antimicrobial Chemotherapy 05/2014; · 5.34 Impact Factor
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    ABSTRACT: Background Patient-reported outcomes (PROs) are particularly relevant in influenza vaccine trials in the elderly where reduction in symptom severity could prevent illness-related functional impairment.Objectives To evaluate PROs in people aged ≥65 years receiving two different vaccines.Methods This was a phase III, randomised, observer-blind study (NCT00753272) of the AS03-adjuvanted inactivated trivalent split-virion influenza vaccine (AS03-TIV) versus non-adjuvanted vaccine (TIV). Using the FluiiQ questionnaire, symptom (systemic, respiratory, total) and life impact (activities, emotions, relationships) scores were computed as exploratory endpoints, with minimal important difference (MID) in influenza severity between vaccines considered post-hoc as >7%. Vaccine efficacy of AS03-TIV relative to TIV in severe influenza (hospitalisation, complication, most severe one-third of episodes based on the area under the curve for systemic symptom score) was calculated post-hoc. The main analyses (descriptive) were conducted in the according-to-protocol cohort (n = 280 AS03-TIV, n = 315 TIV) for influenza confirmed by culture or reverse transcriptase polymerase chain reaction.ResultsMean systemic symptom, total symptom and impact on activities scores were lower with AS03-TIV versus TIV. Mean respiratory symptom, impact on emotions and impact on relationships scores were similar. Influenza tended to be less severe with AS03-TIV, but the MID was reached only for impact on activities (mean 9·0%). Relative vaccine efficacy in severe influenza was 29·38% (95% CI: 7·60–46·02).ConclusionsAS03-TIV had advantages over TIV in impact on systemic symptoms and activities as measured by the FluiiQ in elderly people. Higher efficacy of AS03-TIV relative to TIV was shown for prevention of severe illness.
    Influenza and Other Respiratory Viruses 04/2014; · 1.47 Impact Factor
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    ABSTRACT: Background: Linezolid is an antimicrobial agent for the treatment of multiresistant gram-positive infections. We assessed the impact of linezolid on microbiota and the emergence of resistance and investigated its relationship with plasma pharmacokinetics of the antibiotic.Methods: Twenty-eight patients were treated for the first time with linezolid administered orally (n=17) or parenterally (n=11) at 600 mg twice a day. Linezolid plasma pharmacokinetic analysis was performed on day 7. Colonization by fecal enterococci, pharyngeal streptococci and nasal staphylococci were assessed using selective media with or without supplemented linezolid. The resistance to linezolid was characterized.Results: The treatment led to a decrease of enterococci, staphylococci and streptococci in the fecal (p=0.03), nasal and pharyngeal (p<0.01) microbiota. The appearance of resistant strains was observed only in enterococci from the fecal microbiota between the 7(th) and 21(st) days of treatment in four patients (14.3%). The resistance was mainly due for the first time to the mutation G2447T in the 23S rDNA. No pharmacokinetic parameters were significantly different between the patients, regardless of the appearance of resistance.Conclusion: The emergence of linezolid resistance during treatment was observed only in intestinal microbiota and unrelated to pharmacokinetic parameters. However, colonization by gram-positive bacteria was reduced under treatment in all microbiota.
    Antimicrobial Agents and Chemotherapy 02/2014; · 4.57 Impact Factor
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    ABSTRACT: The French Hospital Database on HIV (FHDH) is a hospital-based multicentre open cohort with inclusions ongoing since 1989. The research objectives focus mainly on mid- and long-term clinical outcomes and therapeutic strategies, as well as severe AIDS and non-AIDS morbidities, and public health issues relative to HIV infection. FHDH also serves to describe HIV-infected patients receiving hospital care in France. FHDH includes data on more than 120 000 HIV-infected patients from 70 French general or university hospitals distributed throughout France. Patients are eligible for inclusion if they are infected by HIV-1 or HIV-2 and give their written informed consent. Standardized variables are collected at each outpatient visit or hospital admission during which a new clinical manifestation is diagnosed, a new treatment is prescribed or a change in biological markers is noted, and/or at least every 6 months. Since its inception, variables collected in FHDH include demographic characteristics, HIV-related biological markers, the date and type of AIDS and non AIDS-defining events, antiretroviral treatments and the date and causes of death, as reported in the medical records. Since 2005, data have also been collected on: co-infection with hepatitis B or C virus; alcohol and tobacco use; and non HIV-related biomarkers. Anyone can submit a research project by completing a standardized form available on the FHDH website (http://www.ccde.fr/_fold/fl-1385734776-429.pdf) or from the corresponding author, describing the context and objectives of the study. All projects are reviewed by the scientific committee.
    International Journal of Epidemiology 02/2014; · 6.98 Impact Factor
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    ABSTRACT: IMPORTANCE Infective endocarditis (IE) is a rare disease with poor prognosis. When IE is suspected, skin examination is mandatory to look for a portal of entry and classic skin lesions to help diagnose and manage the condition. OBJECTIVES To describe the prevalence of and factors associated with dermatological manifestations in patients with definite IE. DESIGN Observational, prospective, population-based epidemiological study between January 1 and December 31, 2008. Subsequently, collected dermatological data were subjected to post hoc analysis. SETTING AND PARTICIPANTS Patients (n = 497) diagnosed in 7 French regions and hospitalized in France for definite IE satisfying modified Duke criteria. MAIN OUTCOMES AND MEASURES Patient and disease epidemiological information was collected, focusing on the most classic dermatological manifestations of IE (Osler nodes, Janeway lesions, purpura, and conjunctival hemorrhages). Disease outcome was also recorded. RESULTS Among 497 definite IE cases, 487 had known dermatological status. Of 487 cases, 58 (11.9%) had skin manifestations, including 39 (8.0%) with purpura, 13 (2.7%) with Osler nodes, 8 (1.6%) with Janeway lesions, and 3 (0.6%) with conjunctival hemorrhages (5 patients had 2 skin manifestations). Patients with skin manifestations had a higher rate of IE-related extracardiac complications than patients without skin manifestations, particularly cerebral emboli (32.8% vs 18.4%, P = .01), without increased mortality. Patients with purpura had larger cardiac vegetations (18.1 vs 13.7 mm, P = .01), and Janeway lesions were associated with more extracerebral emboli (75.0% vs 31.8%, P = .02). CONCLUSIONS AND RELEVANCE Specific skin manifestations of IE are associated with a higher risk of complications and should alert physicians to examine for extracardiac complications, notably with cerebral imaging.
    JAMA dermatology. 02/2014;
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    ABSTRACT: Objectives: Infective endocarditis (IE) is a primary systemic vasculitis mimic and was sporadically reported to produce anti-neutrophil cytoplasmic antibodies (ANCA). Because the frequency of ANCAs in IE is unknown, we assessed the seroprevalence of ANCAs in a large number of cases with IE. Methods: The study was conducted in the framework of a single-center prospective cohort study of incident IE cases. Demographic, clinical, laboratory and microbiological data were collected and MRI of the brain was performed at diagnosis. Among the patients for whom sera had been stored at diagnosis, ANCA were searched by indirect immunofluorescence assay using ethanol-, formalin- and methanol-fixed neutrophils, and anti-proteinase 3 (PR3) and anti-myeloperoxidase (MPO) ELISA. Rheumatoid factor (RF), antinuclear antibodies (ANA), anticardiolipin antibodies (aCL) and serum immunoglobulin (Ig) levels were also measured. Comparisons used Wilcoxon rank-sum and chi-square or Fisher's exact tests. Results: Among 109 IE cases, 18% had cytoplasmic and/or perinuclear ANCA (C-/P-ANCA) and 8% had PR3-ANCA or MPO-ANCA, some with very high titers. Positivity for both C-/P-ANCA and PR3-ANCA or MPO-ANCA were found in 6% and RF, ANA and aCL were detected in 35%, 16% and 23% of samples. No consistent clinical IE pattern was observed for the anti-PR3/anti-MPO-positive IE cases whereas C-/P-ANCA were associated with younger age (P = 0.022), more common vegetations (P = 0.043) and above-normal serum IgG levels (P = 0.017). Conclusions: ANCA, including PR3- and MPO-ANCA, occur in a substantial proportion of IE cases. The link between C-/P-ANCA and IE features requires further study. © 2014 American College of Rheumatology.
    Arthritis & rheumatology (Hoboken, N.J.). 02/2014;
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    ABSTRACT: Background. Few studies have prospectively assessed viral etiologies of acute respiratory infections in community-based elderly individuals. We assessed viral respiratory pathogens in individuals ≥65 years with influenza-like illness (ILI).Methods. Multiplex reverse-transcriptase polymerase chain reaction identified viral pathogens in nasal/throat swabs from 556 episodes of moderate-to-severe ILI, defined as ILI with pneumonia, hospitalization, or maximum daily influenza symptom severity score (ISS) >2. Cases were selected from a randomized trial of an adjuvanted vs nonadjuvanted influenza vaccine conducted in elderly adults from 15 countries.Results. Respiratory syncytial virus (RSV) was detected in 7.4% (41/556) moderate-to-severe ILI episodes in elderly adults. Most (39/41) were single infections. There was a significant association between country and RSV detection (P = .004). RSV prevalence was 7.1% (2/28) in ILI with pneumonia, 12.5% (8/64) in ILI with hospitalization, and 6.7% (32/480) in ILI with maximum ISS > 2. Any virus was detected in 320/556 (57.6%) ILI episodes: influenza A (104/556, 18.7%), rhinovirus/enterovirus (82/556, 14.7%), coronavirus and human metapneumovirus (each 32/556, 5.6%).Conclusions. This first global study providing data on RSV disease in ≥65 year-olds confirms that RSV is an important respiratory pathogen in the elderly. Preventative measures such as vaccination could decrease severe respiratory illnesses and complications in the elderly.
    The Journal of Infectious Diseases 01/2014; · 5.85 Impact Factor
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    ABSTRACT: The estimation of the effectiveness of vaccination against seasonal influenza is guided by the comparison of antigenicities between influenza virus isolates from clinical breakthrough cases with strains included in the vaccine. This study examined whether the prediction of antigenicity using sequence analysis of the hemagglutinin (HA) gene-encoded HA1-domain could be a simpler alternative to using the conventional hemagglutination inhibition (HI) assay, which requires influenza virus culturing. Specimens were taken from breakthrough cases that occurred in a trivalent influenza vaccine efficacy trial involving over 43000 participants during the 2008-2009 season. A total of 498 influenza viruses were successfully subtyped as A(H3N2) (380), A(H1N1) (29), B(Yamagata) (23) and B(Victoria) (66), from 603 PCR- or culture-confirmed specimens. Unlike the B-strain, most A(H3N2) (377) and all A(H1N1) viruses were designated as homologous to the respective vaccine strains based on the HA1-domain nucleic acid sequence. HI titers relative to the respective vaccine strains and PCR subtyping were determined for 48% (182/380) of A(H3N2) and 86% (25/29) of A(H1N1) viruses. Eighty-four percent of the A(H3N2) and A(H1N1) viruses designated as homologous by sequence were matched to the respective vaccine strains by HI testing. However, these homologous A(H3N2) and A(H1N1) viruses displayed a wide range of relative HI titers. Therefore, although PCR was a sensitive diagnostic method to confirm influenza cases, HA1 sequence analysis appeared to be of limited value in accurately predicting antigenicity and hence may be inappropriate to classify clinical specimens as homologous or heterologous to the vaccine-strain for estimating vaccine efficacy in a prospective clinical trial.
    Clinical and vaccine Immunology: CVI 12/2013; · 2.60 Impact Factor
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    ABSTRACT: Quinolone-resistant Escherichia coli (QREC) primarily emerge in commensal bacteria under selective pressure. The aim of this work was to investigate the characteristics of QREC from the faecal microbiota after quinolone exposure, as they remain largely unknown. Forty-eight healthy volunteers received ciprofloxacin from day 1 to day 14. QREC were detected in stools from 14 subjects at day 42. QREC were compared in terms of genetic background, metabolic properties, stress resistance and intestinal colonization abilities with quinolone-susceptible E. coli (QSEC) from the same 14 individuals and from 29 volunteers who remained QREC-free. QREC always belonged to a single clone for a given volunteer and to restricted phylogenetic groups. QREC carried significantly more iron capture systems than QSEC. Maximum growth rates in minimal medium with gluconate, general stress regulator RpoS activity assessed by iodine staining and resistance to oxidative and acid stresses were significantly higher for QREC than for QSEC. In a mouse colonization model, QREC efficiently colonized the intestine microbiota despite the presence of QSEC competitors. At day 42, QREC and QSEC faecal counts from the 14 volunteers were comparable except in three subjects where only QREC could be detected. These results suggest that QREC do not have a fitness cost, probably as a result of genetic co-selection, but are highly adapted to a commensal lifestyle. They may not be eliminated easily from the faecal microbiota from healthy subjects once selected.
    Journal of Antimicrobial Chemotherapy 10/2013; · 5.34 Impact Factor
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    ABSTRACT: Pandemicinfluenza vaccinemanufacturing capacity and distribution agility is enhanced through the availabilityof equivalent antigen-sparing vaccines. We evaluated equivalence in terms of immunogenicity between GlaxoSmithKline Vaccines' A/California/7/2009(H1N1)v-like-AS03 vaccines manufactured in Dresden (D-Pan), and Quebec (Q-Pan). In two studies,334 adults 18-60 years of age received 2 doses of D-Pan or Q-Pan containing 3.75 mug haemagglutinin antigen (HA) adjuvanted with AS03Aadministered21 days apart, and 209 children 3-9 years of age received 1reduced dose of D-Panor Q-Pan (0.9 mug HA) or Q-Pan (1.9 mug HA) with AS03B. Haemagglutination inhibition (HI)titres were assessed before and 21 days post-vaccination. HI persistence was assessed after 12 months in adults and 6 months in children. Pre-defined criteria for immunological equivalence of Q-Pan versus D-Pan were achieved in both populations. After one vaccine dose, >=97.6% of adults and children had HI titres >=1:40, with increases in titre>=25.7-fold. CHMP and CBER regulatory acceptance criteria for influenza vaccines were exceeded by all groups in both studies at Day 21. In adults,the percentage with HI titres >=1:40 at Month 12 was 82.9% (Q-Pan) and 84.0% (D-Pan). In children, the percentages at Month 6 were 75.3.3% (Q-Pan0.9), 85.1% (D-Pan0.9) and 79.3% (Q-Pan1.9). Safety profile of the study vaccines was consistent with previously published data. Two studies indicate that A/California/7/2009 (H1N1)v-like HA manufactured at two sitesand combined with AS03 are equivalent in terms of immunogenicity in adults and children and highly immunogenic. Different HA doses elicited an adequate immune response through 180 days post-vaccination in children 3-9 years of age.Trial registrationClinicalTrials.gov: NCT00979407 and NCT01161160.
    BMC Infectious Diseases 09/2013; 13(1):435. · 3.03 Impact Factor
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    ABSTRACT: Cerebral lesions are frequent complications of infective endocarditis (IE) and have a prognostic impact. Cerebral MRI identifies lesions in a high number of patients. However, their determinants have not been identified. The aim of the study was to define the determinants of cerebral lesions in patients with IE undergoing systematic cerebral MRI. Determinants of ischemic lesions and of microbleeds were prospectively analyzed in 120 patients with left-sided IE, using systematic cerebral MRI. Median age was 60 years (interquartile range 51-72); IE occurred on a prosthetic valve in 37 patients (30.8%) and was due to Streptococci in 47 patients and Staphylococci in 36; 15 (12.5%) had neurological symptoms. MRI detected ischemic lesions in 64 patients (53.3%; territorial lesions in 32 and small lesions in 57) and microbleeds in 72 (60.0%). In multivariate analysis, ischemic lesions were associated with vegetation length (odds ratio 1.10/mm; 95% confidence interval 1.03-1.16; P=0.003) and Staphylococcus aureus IE (odds ratio 2.65; 95% confidence interval 1.01-6.96; P=0.05). A vegetation length >4 mm identified ischemic lesions with a sensitivity of 74.6% and a specificity of 51.5%. Microbleeds were associated with prosthetic IE (odds ratio 8.01; 95% confidence interval 2.58-24.90; P=0.0003) and not with prior anticoagulant therapy (P=0.67). Systematic cerebral MRI frequently detects ischemic lesions and microbleeds during acute IE. The high sensitivity of MRI shows that each millimeter increase in vegetation length is associated with a 10% increase in the rate of ischemic lesions. Conversely, microbleeds are associated only with prosthetic IE in this study. http://www.clinicaltrials.gov. Unique identifier: NCT00144885.
    Stroke 09/2013; · 6.16 Impact Factor
  • Bruno Hoen, Xavier Duval
    New England Journal of Medicine 08/2013; 369(8):785. · 54.42 Impact Factor

Publication Stats

2k Citations
898.59 Total Impact Points


  • 2007–2014
    • Paris Diderot University
      Lutetia Parisorum, Île-de-France, France
  • 1999–2014
    • Hôpital Bichat - Claude-Bernard (Hôpitaux Universitaires Paris Nord Val de Seine)
      • • Service de Pneumologie A
      • • Service des Maladies Infectieuses et Tropicales
      Lutetia Parisorum, Île-de-France, France
  • 2012–2013
    • University of Franche-Comté
      Becoinson, Franche-Comté, France
    • Hôpital Universitaire Necker
      Lutetia Parisorum, Île-de-France, France
    • University of Zurich
      Zürich, Zurich, Switzerland
    • Centre Hospitalier Régional et Universitaire de Besançon
      Becoinson, Franche-Comté, France
    • Centre Hospitalier Universitaire de Nancy
      Nancy, Lorraine, France
  • 2009–2013
    • Assistance Publique – Hôpitaux de Paris
      • Department of Cardiology
      Lutetia Parisorum, Île-de-France, France
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2005–2013
    • Hôpitaux Universitaires La Pitié salpêtrière - Charles Foix
      Lutetia Parisorum, Île-de-France, France
    • Hôpital Européen Georges-Pompidou (Hôpitaux Universitaires Paris-Ouest)
      Lutetia Parisorum, Île-de-France, France
    • Pierre and Marie Curie University - Paris 6
      Lutetia Parisorum, Île-de-France, France
  • 2010
    • Université René Descartes - Paris 5
      Lutetia Parisorum, Île-de-France, France
  • 2007–2009
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
  • 1995
    • Hôpital La Pitié Salpêtrière (Groupe Hospitalier "La Pitié Salpêtrière - Charles Foix")
      Lutetia Parisorum, Île-de-France, France