Publications by authors named "Benoit Marin"

101 Publications

Time-trend evolution and determinants of sex ratio in Amyotrophic Lateral Sclerosis: a dose-response meta-analysis.

J Neurol 2021 Feb 25. Epub 2021 Feb 25.

Unit of Biostatistics, Fondazione IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy.

Background: A noticeable change of the male-to-female sex ratio (SR) has been observed in Amyotrophic Lateral Sclerosis (ALS) leading to an apparent regression of SR with time (SR close to 1:1).

Objective: To provide a global SR estimate and investigate its relation with respect to population age.

Methods: A systematic review and meta-analysis was conducted including only population-based studies with a high-quality methodology in European ancestral origin population. Male-to-female SR was estimated by three different measures: SR number, SR crude incidence and SR standardized incidence. Standard and dose-response meta-analyses were performed to assess the pooled SR measures (irrespective of population age) and the evolution of the SR measures with respect to population age, respectively. Potential sources of heterogeneity were investigated via meta-regression.

Results: Overall, 3254 articles were retrieved in the literature search. Thirty-nine studies stratified by time periods were included. The overall pooled male-to-female ratio was 1.28 (95% CI 1.23-1.32) for SR number, 1.33 (95% CI 1.29-1.38) for SR crude incidence and 1.35 (95% CI 1.31-1.40) for SR standardized incidence. The SR number with respect to population age reveals a progressive reduction of SR at increasing age, while the SR crude incidence in relation to age displays a U-shaped curve.

Conclusions: The number and the incidence of ALS cases were consistently higher in males than females. Dose-response meta-analysis showed that SR measures change with respect to population age. Further original research is needed to clarify if our findings are reproducible in other populations.
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http://dx.doi.org/10.1007/s00415-021-10464-2DOI Listing
February 2021

Hypermetabolism is a reality in amyotrophic lateral sclerosis compared to healthy subjects.

J Neurol Sci 2021 01 3;420:117257. Epub 2020 Dec 3.

Nutrition Unit, University Hospital of Limoges, Limoges, France; INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France.

Rationale: Hypermetabolism (HM) in Amyotrophic lateral sclerosis (ALS) is the reflection of a high energy metabolic level, but this alteration seems controversial. The main objective of the study was to confirm the existence of HM during ALS compared to healthy subjects.

Methods: A cohort of ALS patients was compared to a control group without metabolic disorder. The assessment included anthropometric criteria measurements, body composition by bioelectric impedance analysis and resting energy expenditure (REE) by indirect calorimetry. HM was defined as a variation > +10% between measured and calculated REE. Statistical analysis used Mann-Withney and Chi2 tests. Multivariate analysis included logistic regression.

Results: 287 patients and 75 controls were included. The metabolic level was higher in ALS patients (1500 kcal/24 h [1290-1693] vs. 1230 kcal/24 h [1000-1455], p < 0.0001) as well as the REE/fat free mass ratio (33.5 kcal/kg/24 h [30.4-37.8] vs. 28.3 kcal/kg/24 h [26.1-33.6], p < 0.0001). 55.0% of ALS patients had HM vs. 13.3% of controls (p < 0.0001). HM was strongly and positively associated with ALS (OR = 9.50 [4.49-20.10], p < 0.0001).

Conclusions: HM in ALS is a reality, which affects more than half of the patients and is associated with ALS. This work confirms a very frequent metabolic deterioration during ALS. The identification of HM can allow a better adaptation of the patients' nutritional intake.
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http://dx.doi.org/10.1016/j.jns.2020.117257DOI Listing
January 2021

COVID-19 studies registration worldwide for prospective studies with a specific focus on the fast-tracking of French ethic procedures.

Anaesth Crit Care Pain Med 2020 08 30;39(4):481-482. Epub 2020 Jun 30.

Direction générale de la santé, ministère des Solidarités et de la Santé, Paris, France.

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http://dx.doi.org/10.1016/j.accpm.2020.06.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326406PMC
August 2020

Comorbidities of epilepsy in low and middle-income countries: systematic review and meta-analysis.

Sci Rep 2020 06 2;10(1):9015. Epub 2020 Jun 2.

Department of family medicine, Chung-Kang Branch, Cheng Ching hospital, Taiwan No.966.sec. 4, Taiwan Blvd. Xitun Dist., Taichung, Taiwan, ROC.

Epilepsy is a major public health concern in low and middle-income countries (LMICs) and comorbidities aggravate the burden associated with the disease. The epidemiology of these comorbidities has not been well described, although, identifying the main comorbidities of epilepsy, and their relative importance, is crucial for improving the quality of care. Comorbidities were defined as disorders coexisting with or preceding epilepsy, or else compounded or directly attributed to epilepsy or to its treatment. A meta-analysis of the proportion of main comorbidities by subcontinent as well as overall was also conducted. Out of the 2,300 papers identified, 109 from 39 countries were included in this systematic review. Four groups of comorbidities were identified: parasitic and infectious diseases (44% of comorbid conditions), somatic comorbidities (37%), psychosocial (11%), as well as psychiatric comorbidities (8%). Heterogeneity was statistically significant for most variables then random effect models were used. The most frequently studied comorbidities were: neurocysticercosis (comorbid proportion: 23%, 95% CI: 18-29), head trauma (comorbid proportion: 9%, 95% CI: 5-15) malnutrition (comorbid proportion: 16%, 95% CI: 28-40), stroke (comorbid proportion: 1.3%, 95% CI: 0.2-7.0), and discrimination for education (comorbid proportion: 34%, 95% CI: 28-40). Many comorbidities of epilepsy were identified in LMICs, most of them being infectious.
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http://dx.doi.org/10.1038/s41598-020-65768-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265529PMC
June 2020

[Clinical trials during pandemic crisis: How to ensure safety and maintain access to innovation].

Bull Cancer 2020 Jun 7;107(6):617-619. Epub 2020 May 7.

Agence Nationale de Sécurité du Médicament et des Produits de Santé (ANSM), 143-147, boulevard Anatole France, 93285 Saint-Denis cedex, France.

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http://dx.doi.org/10.1016/j.bulcan.2020.04.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203020PMC
June 2020

Increased resting energy expenditure compared with predictive theoretical equations in amyotrophic lateral sclerosis.

Nutrition 2020 09 14;77:110805. Epub 2020 Mar 14.

Nutrition Unit, University Hospital of Limoges, Limoges, France; INSERM (Institut National de la Santé et de la Recherche Médicale), U1094, Tropical Neuroepidemiology, Limoges, France; University of Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, Limoges, France.

Objectives: Approximately 50% to 60% of amyotrophic lateral sclerosis (ALS) is characterized by an increase in metabolic rate. The Harris and Benedict (HB) 1919 formula is the equation mainly used to calculate resting energy expenditure (cREE) compared with measured REE (mREE) by indirect calorimetry (IC), but other formulas are also applied in current practice. The present study aimed to assess mREE in patients with ALS compared with 12 cREE formulas and study the relevant threshold of REE variation to screen patients with a higher evolving risk.

Methods: Nutritional assessments and body composition (by bioimpedance analysis) were performed in patients with ALS. mREE was measured by IC, and cREE was calculated using the HB 1919, HB 1984, World Schofield, De Lorenzo, Johnstone, Mifflin, World Health Organization/Food and Agriculture Organization, Owen, Fleisch, Wang, Rosenbaum, and Nelson formulas. Functional and respiratory evolution and survival by log-rank test according to two thresholds of REE variation (10% and 20%) were studied.

Results: A total of 315 patients with ALS were included in the study. The median mREE was 1503 kcal/24 h (range, 1290-1698 kcal/24 h), which was higher than all predictive equations (P < 0.0001). Depending on the predictive equation, REE variation >10% and 20% was found in 35.2% to 76.3% and 14.6% to 53.3% of patients with ALS, respectively. Patients with an REE variation >20% with HB 1919 and HB 1984 had a lower survival. Moreover, with this same threshold and the Mifflin formula, patients had higher functional and respiratory evolutions and lower survival.

Conclusions: The increase in metabolic rate is present according to the different cREE formulas used compared with IC. In clinical practice, REE formulas (e.g., HB 1919, HB 1984, or Mifflin) can be used as a reference value compared with IC to screen patients with ALS with an REE variation >20% and a higher evolving risk.
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http://dx.doi.org/10.1016/j.nut.2020.110805DOI Listing
September 2020

Validity of death certificates in the identification of cases of amyotrophic lateral sclerosis (ALS) in the Limousin region, France. A population-based study.

Amyotroph Lateral Scler Frontotemporal Degener 2020 05 10;21(3-4):228-234. Epub 2020 Apr 10.

INSERM, University of Limoges, CHU Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France, and.

Mortality data have been used as a proxy for amyotrophic lateral sclerosis (ALS) incidence. However, the accuracy of death certificates (DCs) needs to be validated. This study aims to assess the accuracy of DCs in the identification of ALS cases. This is a retrospective population-based validation study. DC information, provided by the "Centre d'épidémiologie sur les causes médicales de décès", including ICD10 codes for specific cause of death for patients recorded in the French register of ALS cases in the Limousin region (FRALim) and deceased between 2000 and 2011, was assessed. The was used as gold standard. In the study period, DCs were available for 197 patients diagnosed with ALS, of whom 185 (93.9%) were correctly identified with an ICD10 code (G12.2) corresponding to ALS. The overall sensitivity was 93.9% (95% CI 89.6-96.8) and the positive predictive value (PPV) was 64.9 (59.1-70.4), with higher values in the period 2004-2011 (75.0-78.9). Stratification for sex, age, and year at death did not show difference in accuracy, except a lower PPV during the first years of observation. DCs identifying subjects with a diagnosis of ALS in the Limousin region, France showed an overall good sensitivity and moderate PPV. The absence of ALS diagnosis as the main and underlying cause of death on DCs highlights the need to use DC in combination with other administrative data to create algorithms with higher accuracy performances.
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http://dx.doi.org/10.1080/21678421.2020.1746811DOI Listing
May 2020

Predictive formulas for estimation of height in sub-Saharan African older people: A new formula (EPIDEMCA study).

Nutrition 2020 05 17;73:110725. Epub 2020 Jan 17.

Nutrition Unit, University Hospital of Limoges, Limoges, France; INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France; IRD, Associated Unit, Tropical Neuroepidemiology, Limoges, France.

Objectives: Chumlea's formulas are a way of predicting height from knee height (KHt), including among individuals >60 y of age who cannot stand upright. However, the formulas were developed with white and African American people and have not yet been validated in native Africans >60 y of age. The aims of the study were to assess Chumlea's formulas in older people in central Africa and to propose a new validated formula for the same population.

Methods: Height (MHt) and KHt were measured in a population of individuals >65 y of age from the Republic of Congo and the central African Republic. Predicted height (PHt) was calculated using Chumlea's formulas for the American black population (CBP) and for whites (CC). The percentages of accurate predictions (±5 cm) were compared between MHt and PHt. A new formula was estimated after randomization in a derivation sample (n = 877) and assessed for accuracy in a validation sample (n = 877).

Results: The study included 1754 individuals. Prediction was accurate (±5 cm) in 66.8% and 63.2% of CBP and CC, respectively. Overestimation was as high as 24.1% and 29%, respectively. Because an overestimation is unacceptable in clinical practice and population surveys, a new formula was proposed: height (cm) = 72.75 + (1.86 × KHt [cm]) - (0.13 × age [y]) + 3.41 × sex (0: women; 1: men). This new formula significantly increases accuracy (71.3%) and decreases overestimation (14.7%). The nutritional status based on body mass index did not differ with the MHt and the PHt by the new formula.

Conclusion: Chumlea's formulas provided a poor estimate of height in this population sample. The proposed formula more accurately estimates height in older native Africans. This formula should be tested in other sub-Saharan African countries to extend its use in clinical practice and in future studies.
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http://dx.doi.org/10.1016/j.nut.2020.110725DOI Listing
May 2020

Cytomegalovirus (CMV) Shedding in French Day-Care Centers: A Nationwide Study of Epidemiology, Risk Factors, Centers' Practices, and Parents' Awareness of CMV.

J Pediatric Infect Dis Soc 2020 Dec;9(6):686-694

National Reference Center for Herpesviruses, Limoges, France.

Background: Congenital cytomegalovirus (CMV) remains an important healthcare burden, resulting from primary or secondary infection in pregnant women. Exposure to young children's saliva is a major risk factor, as prevalence of CMV shedding can reach 34%.

Methods: This cross-sectional, multicenter, nationwide study was conducted in randomly selected day care centers (DCCs), and complemented with a survey among parents and DCCs. All children aged >3 months were eligible. The study measured the CMV shedding prevalence in children's saliva and described CMV genotypes epidemiology. The risk factors for CMV shedding and high viral load were evaluated using multivariable models.

Results: A total of 93 DCCs participated. Among the 1770 enrolled children with evaluable samples, the CMV shedding prevalence was 40% (713/1770, 95% confidence interval, 34.6-46.1), independently associated with children aged between 12 and 18 months, history of CMV infection in ≥1 parents, a mid-level income. Prevalence increased with DCC staff workload and attending children number. Viral load was ≥5 log-copies CMV/mL in 48% (342/713). Risk factors for higher viral load included children aged between 12 and 18 months, and still being breastfed. The most frequent genotype combinations were gB1-gN4c-gH2 (6.9%), gB1-gN2-gH2 (6.3%), gB4a-gN3a-gH1 (6.3%), and gB1-gN3b-gH2 (5,7%). CMV awareness was low in parents: their serological status was unknown by 72% of mothers and 82% of fathers. Only 41% knew something about CMV.

Conclusions: CMV shedding was independently associated with risk factors related to the children, family and DCC. Some of these risk factors may influence prevention strategies, including through an improved information provided to parents.

Clinical Trials Registration: NCT01704222.
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http://dx.doi.org/10.1093/jpids/piz097DOI Listing
December 2020

Predictive factors for gastrostomy at time of diagnosis and impact on survival in patients with amyotrophic lateral sclerosis.

Clin Nutr 2020 Oct 31;39(10):3112-3118. Epub 2020 Jan 31.

INSERM, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France; CHU Limoges, Department of Nutrition, Limoges, France. Electronic address:

Background: Gastrostomy is recommended in patients with Amyotrophic Lateral Sclerosis (ALS) in the presence of weight loss over 10% as compared to usual weight, repeated aspirations or meal time duration longer than 45 min. Currently, the impact of gastrostomy on survival of ALS patients is not clear.

Aims: i) to describe diagnosis factors associated with the indication for gastrostomy ii) to evaluate survival of ALS patients with gastrostomy indication according to their acceptance of feeding tube placement.

Methods: Patients with ALS were included and followed in the ALS referral centre of Limoges's teaching hospital between 2006 and 2017. Neurological, nutritional and respiratory status was assessed prospectively from diagnosis to death. Statistical analysis was performed using Mann-Whitney test, Chi tests, Cox model and multivariate logistic regression.

Results: Two hundred and eighty-five patients were included. Among the 182 for whom gastrostomy was indicated, 63.7% accepted the placement. The median time was 7.3 months [IQR: 3.2-15.0] and 2.7 months [IQR: 0.9-5.8] respectively from diagnosis to indication and from indication to placement. Weight loss >5% significantly increased the risk of death by 17% (p < 0.0001). At time of diagnosis, bulbar onset, a loss of one point in the body mass index or on the bulbar functional scale were all positively associated with indication for gastrostomy (aOR = 10.0 [95%CI: 1.96-25.0]; p = 0.002, aOR = 1.17 [95%CI: 1.02-1.36]; p = 0.025 and aOR = 1.19 [95%CI: 1.06-1.32]; p = 0.002, respectively). However, gastrostomy placement did not have any impact on survival (aHR = 1.25 [95%CI: 0.88-1.79]; p = 0.22).

Conclusion: Both neurological and nutritional criteria were associated with an indication for gastrostomy at diagnosis. Gastrostomy placement had no impact on survival. The study of earlier gastrostomy placement might be of interest in further prospective studies.
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http://dx.doi.org/10.1016/j.clnu.2020.01.018DOI Listing
October 2020

Screening Questionnaires to Detect Neurological Disorders in Developing Countries: A Systematic Review.

Neuroepidemiology 2020 6;54(1):24-32. Epub 2019 Dec 6.

INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.

Introduction: Neurological disorders are an important cause of disability and death worldwide. The distribution of these disorders differs significantly in developing countries. Screening questionnaires have been used as an important tool to detect neurological illnesses. This systematic literature review aimed to report the validity of screening questionnaires for neurological disorders in developing countries.

Methods: The PubMed/MEDLINE, Scopus, Science-Direct, and PASCAL databases were searched. All published studies performed in developing countries were eligible. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. Summary measures of validity were reported (sensitivity and specificity).

Results: Eight hundred and thirty-five records were identified, and 49 articles that met eligibility criteria were selected. The most frequently neurological disorders detected with a screening tool were epilepsy, stroke, and neuropathies (77, 53, and 40%, respectively). Ten screening questionnaires were accessible. Two questionnaires were mainly used to detect neurological disorders: the World Health Organization Protocol for Epidemiologic Studies of Neurologic Disorders and the Ten Questions Questionnaire. The sensitivity of the questionnaires was ranged from 84 to 100% and 56 to 100%, respectively.

Conclusion: This systematic review presents evidence that screening questionnaires are valid tools to detect neurological disorders in developing countries. Disease detection provides epidemiological data and the opportunity to implement secondary and tertiary prevention strategies that will contribute to reduce the global burden of neurological disorders.
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http://dx.doi.org/10.1159/000502234DOI Listing
February 2021

Associations of mental disorders and neurotropic parasitic diseases: a meta-analysis in developing and emerging countries.

BMC Public Health 2019 Dec 5;19(1):1645. Epub 2019 Dec 5.

INSERM, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, University of Limoges, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France.

Background: Although they are declining worldwide, neurotropic parasitic diseases are still common in developing and emerging countries. The aim of this study was to estimate the pooled prevalence and pooled association measures of comorbidities between mental disorders (anxiety, depression, bipolar disorder, and schizophrenia) and neurotropic parasitic diseases (malaria, cysticercosis, toxoplasmosis, human African trypanosomiasis, Chagas disease, and human toxocariasis) in developing and emerging countries.

Methods: As the first meta-analysis on this topic, this study was performed in accordance with PRISMA guidelines. The protocol was registered in PROSPERO (N°CRD42017056521). The Medline, Embase, Lilacs, and Institute of Epidemiology and Tropical Neurology databases were used to search for articles without any restriction in language or date. We evaluated the quality of studies independently by two investigators using the Downs and Black assessment grid and pooled estimates using the random-effects method from CMA (Comprehensive Meta Analysis) Version 3.0.

Results: In total, 18 studies published between 1997 and 2016 met our inclusion criteria. We found that the prevalence of anxiety and depression in people suffering from Chagas disease and/or neurocysticercosis was 44.9% (95% CI, 34.4-55.9). In 16 pooled studies that included 1782 people with mental disorders and 1776 controls, toxoplasmosis and/or toxocariasis were associated with increased risk of schizophrenia and/or bipolar disorders (odds ratio = 2.3; 95% CI, 1.7-3.2). Finally, toxocariasis and/or toxoplasmosis were associated with an increased risk of the onset of schizophrenia (odds ratio = 2.4; 95% CI, 1.7-3.4).

Conclusion: Our pooled estimates show that the associations between diseases studied are relatively high in developing and emerging countries. This meta-analysis supports the hypothesis that toxoplasmosis could be the cause of schizophrenia. These findings could prove useful to researchers who want to further explore and understand the associations studied.
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http://dx.doi.org/10.1186/s12889-019-7933-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6896488PMC
December 2019

Body mass index and peripheral arterial disease, a "U-shaped" relationship in elderly African population - the EPIDEMCA study.

Vasa 2020 Jan 17;49(1):50-56. Epub 2019 Oct 17.

INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France.

There is no study available concerning specifically the role of underweight in PAD prevalence. Individuals ≥ 65 years living in urban and rural areas of two countries in Central Africa (Central African Republic and the Republic of Congo) were invited. Demographic, clinical and biological data were collected, and ankle-brachial index measured. BMI was calculated as weight/height and participants were categorized according to the World Health Organization as with underweight (< 18.5 kg/m), normal weight (18.5-24.9 kg/m), overweight (25-29.9 kg/m), and obese (≥ 30 kg/m). Among the 1815 participants (age 73.0 years, 61.8 % females), the prevalence of underweight was 34.1 %, higher in subjects with PAD than in PAD free subjects (37.1 % vs. 33.5 %,  = 0.0333). The overall prevalence of PAD was 14.3 %. Underweight and obesity were still significantly associated with PAD after adjustment to all potential confounding factors (OR: 2.09,  = 0.0009 respectively OR: 1.90,  = 0.0336) while overweight was no more significantly associated with PAD after multivariate analysis. While obesity is a well-known PAD associated marker, low BMI provides novel independent and incremental information on African subject's susceptibility to present PAD, suggesting a "U-shaped" relationship between BMI and PAD in this population.
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http://dx.doi.org/10.1024/0301-1526/a000825DOI Listing
January 2020

[Socialization in a retirement home, an issue for the resident. An ethnosociological study useful for nurses].

Rech Soins Infirm 2019 06;137(2):77-90

Activity programs are described in institutional policies as an added benefit in the lives of residents in that such activities are assumed to maintain health through the process of socialization. The purpose of this study is to describe the determining factors in the socialization process of elderly residents in retirement homes. A qualitative study, in nursing study using anthropological methodology was carried out from April 2016 to May 2018 in ten retirement homes in the Limousin and on Reunion Island. territory. Fifty-eight semi-structured interviews have been analyzed using NVivo 11Plus® software. The socialization process of the elderly in the context of institutional regulation is complex. Attendance at social activities is often used to measure the degree of socialization and integration in the institution, but, on its own, it is not a significant indicator. Other elements involved in the complex socialization process of the elderly in retirement homes include : family, relations with other residents, and interaction with caregivers plays a major role. An elderly person can remain isolated in his or her room, never participate in activities, and yet feel perfectly integrated and socialized within the institution. Future research will focus on the relationship between residents and caregivers as a factor in the socialization process, including the knowledge and skills of the caregivers.
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http://dx.doi.org/10.3917/rsi.137.0077DOI Listing
June 2019

Continuous hemoglobin and plethysmography variability index monitoring can modify blood transfusion practice and is associated with lower mortality.

J Clin Monit Comput 2020 Aug 3;34(4):683-691. Epub 2019 Aug 3.

Département d'Anesthésie Réanimation, CHU Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges, France.

To determine the effect of implementing an algorithm of fluid and blood administration based on continuous monitoring of hemoglobin (SpHb) and PVI (plethysmography variability index) on mortality and transfusion on a whole hospital scale. This single-center quality program compared transfusion at 48 h and mortality at 30 days and 90 days after surgery between two 11-month periods in 2013 and 2014 during which all the operating and recovery rooms and intensive care units were equipped with SpHb/PVI monitors. The entire team was trained to use monitors and the algorithm. Team members were free to decide whether or not to use devices. Each device was connected to an electronic wireless acquired database to anonymously acquire parameters on-line and identify patients who received the monitoring. All data were available from electronic files. Patients were divided in three groups; 2013 (G1, n = 9285), 2014 without (G2, n = 5856) and with (G3, n = 3575) goal-directed therapy. The influence of age, ASA class, severity and urgency of surgery and use of algorithm on mortality and blood use were analyzed with cox-proportional hazard models. Because in 2015, SpHb/PVI monitors were no longer available, we assessed post-study mortality observed in 2015 to measure the impact of team training to adjust vascular filling on a patient to patient basis. During non-cardiac surgery, blood was more often transfused during surgery in G3 patients as compared to G2 (66.6% vs. 50.7%, p < 0.001) but with fewer blood units per patient. After adjustment, survival analysis showed a lower risk of transfusion at 48 h in G3 [OR 0.79 (0.68-0.93), p = 0.004] but not in G2 [OR 0.90 (0.78-1.04) p = 0.17] as compared to G1. When adjusting to the severity of surgery as covariable, there was 0.5 and 0.7% differences of mortality at day 30 and 90 whether patients had goal directed therapy (GDT). After high risk surgery, the mortality at day 30 is reduced by 4% when using GDT, and 1% after intermediate risk surgery. There was no difference for low risk surgery. G3 Patients had a lower risk of death at 30 days post-surgery [OR 0.67 (0.49-0.92) p = 0.01] but not G2 patients [OR 1.01, (0.78-1.29), p = 0.96]. In 2015, mortality at 30 days and 90 days increased again to similar levels as those of 2013, respectively 2.18 and 3.09%. Monitoring SpHb and PVI integrated in a vascular filling algorithm is associated with earlier transfusion and reduced 30 and 90-day mortality on a whole hospital scale.
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http://dx.doi.org/10.1007/s10877-019-00367-zDOI Listing
August 2020

Residential exposure to ultra high frequency electromagnetic fields emitted by Global System for Mobile (GSM) antennas and amyotrophic lateral sclerosis incidence: A geo-epidemiological population-based study.

Environ Res 2019 09 11;176:108525. Epub 2019 Jun 11.

INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR 1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, 87000 Limoges, France. Electronic address:

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease of unknown etiology. Mobile communication antennas have increased over the last few decades. Consequently, there has been a steady increase in environmental exposure to ultra high frequency electromagnetic fields (UHF-EMFs) emitted by Global System for Mobile (GSM) communication antennas, which raises concerns about possible health risks in the general population. We aimed to evaluate the relationship between residential exposure to UHF-EMFs generated by GSM antennas and the risk of ALS in general population. A geo-epidemiological population-based study was performed in Limousin (France). ALS incident cases were identified through a register (FRALim, 2000-2012 period). A model to estimate UHF-EMF exposure was developed based on the distance and the power of GSM antennas. Exposure to multiple emissions from multiple directions was considered. A non-cumulative and a cumulative model were established. A geographic information system integrated the raster model of exposure, and the residential distribution of observed and expected cases. A generalized linear model was performed to test the association. Overall, 312 ALS cases were included. We estimated exposures below 1.72 V/m in urban areas and below 1.23 V/m in rural areas for 90% of the population. A gradient effect between UHF-EMF exposure and ALS incidence was apparent with a statistically significant trend. A significant increased risk of ALS was observed between the non-exposure category and the highest exposure category, with a relative risk of 1.78 (95% CI: 1.28-2.48) in the non-cumulative model and 1.83 (95% CI: 1.32-2.54) in the cumulative model. Our results suggest a possible association between residential UHF-EMF exposure and ALS. Ecological studies are a means of generating hypotheses. Further studies are needed to clarify the potential role of EMFs on neurodegeneration.
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http://dx.doi.org/10.1016/j.envres.2019.108525DOI Listing
September 2019

Pain experienced by infants and toddlers at urine collection bag removal: A randomized, controlled, clinical trial.

Int J Nurs Stud 2019 Jul 23;95:1-6. Epub 2019 Mar 23.

CHU de Limoges, Hôpital Dupuytren, Coordination Générale des Soins, 2 avenue Martin Luther-King, 87042 LIMOGES Cedex, France. Electronic address:

Background: In pre-continent children, collection bags are frequently used as a first-line option to obtain a urine specimen. This practice, acknowledged by several guidelines for the step of UTI screening, is driven by a perception of the technique as being more convenient and less painful. However, our own experience led us to consider bag removal as a painful experience.

Objective: Our aim was to determine whether the use of an oleo-calcareous liniment to aid bag removal reduced the acute pain expressed by young children.

Methods: This prospective, randomized, controlled, single blind study was carried out in two emergency pediatrics departments. Pre-continent children aged 0-36 months admitted with an indication for urine testing were eligible for the study. Urine for dipstick test screening was obtained using a collection bag. At micturition, the patients were randomized into bag removal with (intervention group) or without (control group) liniment. Bag removal was recorded on video in such a manner as to permit independent assessments of pain by two evaluators blinded to group allocation. Pain was assessed using the FLACC scale.

Findings: 135 patients were analyzed: 70 in the intervention group and 65 in the control group. The median FLACC scores [interquartile range] for the intervention and control groups, respectively 4.0 [2.0-7.0] and 4.0 [3.0-7.0], did not differ significantly (p = 0.5). A FLACC score ≥4 was obtained for 56% of the patients and a score ≥7 for 28%.

Conclusion: Removal of urine collection bags caused moderate to severe pain in half of the children included. The use of an oleo-calcareous liniment did not reduce this induced pain.
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http://dx.doi.org/10.1016/j.ijnurstu.2019.03.014DOI Listing
July 2019

Amyotrophic lateral sclerosis mortality rates among ethnic groups in a predominant admixed population in Latin America: a population-based study in Ecuador.

Amyotroph Lateral Scler Frontotemporal Degener 2019 08 2;20(5-6):404-412. Epub 2019 Apr 2.

a INSERM, U1094, Tropical Neuroepidemiology , Limoges , France.

Current evidence suggests heterogeneity of amyotrophic lateral sclerosis (ALS) among geographic areas and populations. Lower mortality rates have been reported in admixed populations compared to European origin populations. We aimed to describe and compare ALS mortality rates among ethnic groups using a population-based approach in a multiethnic country. Annual mortality cause registers were searched to determine ALS deaths from the National Institute of Statistics and Censuses in Ecuador (INEC) from 1990 to 2016. Mid-year population was considered for each year. The time trend was assessed using a negative binomial regression. Rate ratio statistics were performed to compare the age and sex standardized rates based on the 2010 US population among ethnic groups. Overall, 570 ALS deaths were identified. ALS mortality showed an age-related profile with a peak between 55 and 70 years. After age-sex standardization on the 2010 US population, mortality rate was 0.33 (CI 0.30-0.36) per 100,000. The time trend showed an increase of ALS mortality ( < 0.001). There was no statistical difference in age-sex standardized mortality rates per 100,000 when admixed was compared to white ( = 0.231) and black ( = 0.125). Differences reached statistical significance between admixed and other ethnics ( = 0.015). Our population-based study supports the hypothesis that ALS occurrence is lower in predominant admixed populations from Latin America compared to European and Northern American populations. Further studies are needed to clarify the role of ancestral origin in ALS susceptibility.
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http://dx.doi.org/10.1080/21678421.2019.1587632DOI Listing
August 2019

Co-morbidities of mental disorders and chronic physical diseases in developing and emerging countries: a meta-analysis.

BMC Public Health 2019 Mar 13;19(1):304. Epub 2019 Mar 13.

INSERM, Univ. Limoges, CHU Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France.

Background: As the data on the association of mental disorders and chronic physical diseases in developing and emerging countries is heterogeneous, this study aims to produce the first meta-analysis of these comorbidities.

Methodology: The meta-analysis protocol was registered in PROSPERO (N°CRD42017056521) and was performed in accordance with PRISMA guidelines. Initially, an article search was conducted on Medline, Embase, Lilacs and the Institut d'Epidémiologie et de Neurologie Tropicale database [Institute of Epidemiology and Tropical Neurology], as well as manually, with no restriction on language or date focusing on mental disorders, chronic diseases and neurotropic diseases. Two independent investigators assessed the quality of the studies which met the inclusion criteria using the Downs and Black assessment grid. The pooled estimates were calculated out using a random-effects method with CMA software Version 3.0. A meta-regression was then performed, and the significance level was set at 0.05.

Results: Of the 2604 articles identified, 40 articles involving 21,747 subjects met the inclusion criteria for co-morbidities between mental disorders and chronic physical diseases. Thirty-one articles were included in the meta-analysis of prevalence studies and 9 articles in that of the analytical studies. The pooled prevalence of mental disorders in patients with chronic physical diseases was 36.6% (95% CI, 31.4-42.1) and the pooled odds ratio was 3.1 (95% CI, 1.7-5.2). There was heterogeneity in all the estimates and in some cases, this was explained by the quality of the studies.

Conclusion: Some estimates regarding the prevalence of mental disorders in people with chronic physical diseases living in developing and emerging countries were similar to those in developed countries. Mental disorders are a burden in these countries. In order to respond effectively and efficiently to the morbidity and mortality associated with them, mental health care could be integrated with physical care.
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http://dx.doi.org/10.1186/s12889-019-6623-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417021PMC
March 2019

Lack of association between and multiple sclerosis: A population-based case-control study.

Mult Scler 2020 02 11;26(2):258-259. Epub 2019 Feb 11.

Department of Medical and Surgical Sciences and Advanced Technologies 'G.F. Ingrassia', Section of Neurosciences, University of Catania, Catania, Italy.

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http://dx.doi.org/10.1177/1352458518825394DOI Listing
February 2020

Cumulative incidence of restenosis in the endovascular treatment of extracranial carotid artery stenosis: a meta-analysis.

J Neurointerv Surg 2019 Sep 31;11(9):916-923. Epub 2019 Jan 31.

CHU Limoges, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France.

Objective: To assess the cumulative incidence of restenosis and stroke after stenting for cervical carotid artery stenosis.

Methods: We reviewed PubMed, ScienceDirect, and Scopus and included all studies reporting restenosis after stenting. The cumulative incidence of restenosis at 6 and 12 months was calculated. We also estimated the cumulative incidence of ipsilateral stroke within 30 days after stenting. Random effect meta-analysis and meta-regression were performed using relevant study level covariates. Sources of heterogeneity were investigated.

Results: Among 7765 records, 40 studies were selected. 15 943 patients and 16 337 carotid arteries were considered. The overall pooled cumulative incidence of restenosis >50% at 12 months was 5.7% (95% CI 3.8% to 8.6%), >70% at 12 months was 5.2% (95% CI 3.3% to 8.2%), >50% at 6 months was 3.9% (95% CI 2.2% to 6.8%), and ipsilateral stroke within 30 days after stenting was 1.6% (95% CI 1.0% to 2.5%) without association with the use of an embolic protection device. We did not identify any relevant source of heterogeneity of the cumulative incidence of restenosis >50% at 12 months. Mean age explained 80.9% (R=80.9%, p=0.01) of heterogeneities of restenosis >70% at 12 months. The presence of hostile neck explained 53.9% (R=53.9%, p=0.03) of heterogeneities of restenosis >50% at 6 months.

Conclusion: This meta-analysis showed a low cumulative rate of restenosis at 12 months and ipsilateral stroke within 30 days after stenting. Older patients and those with hostile neck present a lower risk of in-stent restenosis. The use of an embolic protection device was not associated with a lower risk of stroke.
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http://dx.doi.org/10.1136/neurintsurg-2018-014534DOI Listing
September 2019

Resting energy expenditure equations in amyotrophic lateral sclerosis, creation of an ALS-specific equation.

Clin Nutr 2019 08 25;38(4):1657-1665. Epub 2018 Aug 25.

Nutrition Unit, University Hospital of Limoges, 87000 Limoges, France; INSERM, U1094, Tropical Neuroepidemiology, 87000 Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000 Limoges, France.

Introduction: Resting energy expenditure (REE) formulas for healthy people (HP) are used to calculate REE (cREE) in amyotrophic lateral sclerosis (ALS) patients. In 50-60% of ALS cases an increase of measured REE (mREE) in indirect calometry (IC) compared to cREE is found. The aims here were (i) to assess the accuracy of cREE assessed using 11 formulas as compared to mREE and (ii) to create (if necessary) a specific cREE formula for ALS patients.

Method: 315 Patients followed in the ALS expert center of Limoges between 1996 and 2014 were included. mREE assessed with IC and cREE calculated with 11 predictive formulas (Harris Benedict (HB) 1919, HB 1984, WSchofield, De Lorenzo, Johnstone, Mifflin, WHO/FAO, Owen, Fleisch, Wang and Rosenbaum) were determined at the time of diagnosis. Fat free mass (FFM) and fat mass (FM) were measured with impedancemetry. A Bland and Altman analysis was carried out. The percentage of accurate prediction ±10% of mREE, and intraclass correlation coefficients (ICC) were calculated. Using a derivation sample, a new REE formula was created using multiple linear regression according to sex, age, FFM and FM. Accuracy of this formula was assessed in a validation sample.

Results: ICC ranged between 0.60 and 0.71 (moderate agreement), and percentage of accurate prediction between 27.3% and 57.5%. Underestimation was found from 31.7% to 71.4% of cases. According to these unsatisfactory results we created an ALS-specific formula in a derivation sample (130 patients). ICC and percentage of accurate prediction increased in a validation sample (143 patients) to 0.85 (very good agreement) and 65.0% respectively, with 17.5% underestimation.

Conclusion: REE formulas for HP underestimate REE in ALS patients compared to mREE. Our new ALS-specific formula produced better results than formulas for HP. This formula can be used to estimate REE in ALS patients if IC is not accessible.
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http://dx.doi.org/10.1016/j.clnu.2018.08.014DOI Listing
August 2019

Clinical features and prognosis of amyotrophic lateral sclerosis in Africa: the TROPALS study.

J Neurol Neurosurg Psychiatry 2019 01 21;90(1):20-29. Epub 2018 Sep 21.

INSERM, U1094, Tropical Neuroepidemiology, Limoges, France

Objective: We describe and compare the sociodemographic and clinical features, treatments, and prognoses and survival times of patients with amyotrophic lateral sclerosis (ALS) in Africa.

Methodology: We conducted a multicentre, hospital-based cohort study in Africa. Patients with ALS diagnosed in the neurology departments of participating hospitals from 2005 to 2017 were included. Subgroup analysis was performed by subcontinent. Survival analyses were conducted using the Cox proportional hazards model.

Results: Nine centres from eight African countries participated. A total of 185 patients with ALS were included: 114 from Northern Africa, 41 from Western Africa and 30 from Southern Africa. A male predominance (male to female ratio 2.9) was evident. The median age at onset was 53.0 years (IQR 44.5-64.0 years). The onset was bulbar in 22.7%. Only 47 patients (26.3%) received riluzole, mainly in Northern and Western Africa. The median survival from the time of diagnosis was 14.0 months (95% CI 10.7 to 17.2 months). The median survival was longer in Northern Africa (19.0 months, 95% CI 10.8 to 27.2 months) than in Western (4.0 months, 95% CI 0.8 to 7.1 months) and Southern (11.0 months, 95% CI 5.6 to 16.4 months) Africa (Breslow test, p<0.0001). Both subcontinental location and riluzole treatment independently affected survival.

Conclusion: More African patients with ALS were male and younger and exhibited a lower proportion of bulbar onset compared with patients with ALS from Western nations. Survival was consistent with that in Western registers but far shorter than what would be expected for young patients with ALS. The research improves our understanding of the disease in Africa.
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http://dx.doi.org/10.1136/jnnp-2018-318469DOI Listing
January 2019

Meta-analysis of perinatal factors associated with epilepsy in tropical countries.

Epilepsy Res 2018 10 18;146:54-62. Epub 2018 Jul 18.

INSERM, University of Limoges, University Hospital Centre, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, 2 rue du Dr. Marcland, 87 025 Limoges Cedex, France; University of Health Sciences, DEBIM, EA NEMIT, Faculty of Medicine, BP: 4009 Libreville, Gabon. Electronic address:

Most people with epilepsy live in tropical countries. Perinatal factors seem to play a significant role in the occurrence of epilepsy. Available data provide different and sometimes contradictory conclusions on the role and the burden of these factors. The aim of our study was to evaluate the effect of these perinatal factors on the development of epilepsy in tropical countries. The main databases were screened, regardless the language, for all eligible studies published up to March 2017. Exposures were perinatal factors whilst the disease was epilepsy. After selection and data extraction, we calculated a pooled measure of association for each perinatal factor using fixed or random-effect models. We tested the heterogeneity and the publication bias. The degree of significance was 5%. We screened 22,581 articles and identified 13 studies. Among the perinatal factors studied, home birth (OR 1.36, 95%CI: 1.21-1.54), complicated delivery (OR 2.10, 95%CI: 1.05-4.20) and premature birth (OR 2.80, 95%CI: 2.07-3.78) were associated with the occurrence of epilepsy. The attributable risk of premature birth and home birth was estimated to be responsible for 17% and 20% of the cases of epilepsy, respectively, in tropical countries. Despite the limited number of studies identified, we demonstrated that some perinatal factors are risk factors for epilepsy in tropical countries. The three most studied risk factors are modifiable. Therefore, prevention strategies should target them. Further studies are essential to improve the understanding of the burden of these factors in the development of epilepsy.
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http://dx.doi.org/10.1016/j.eplepsyres.2018.07.004DOI Listing
October 2018

Updated evidence of the association between toxocariasis and epilepsy: Systematic review and meta-analysis.

PLoS Negl Trop Dis 2018 07 20;12(7):e0006665. Epub 2018 Jul 20.

INSERM, U1094, Tropical Neuroepidemiology, Limoges, France.

Objective: To gain further insight on the association between human toxocariasis and epilepsy in light of the new evidence in the last years.

Methods: A systematic review was conducted without date and language restriction in the following electronic databases: MEDLINE (PubMed), Ingenta Connect, Science Direct (Elsevier), RefDoc, Scopus, HighWire, Scielo and the database of the Institute of Neuroepidemiology and Tropical Neurology of the Limoges University (IENT). Two investigators independently conducted the search up to November 2017. A pooled odds ratio (OR) was estimated using a random effects model. Meta-regression was conducted to investigate potential sources of heterogeneity.

Results: Database search produced 204 publications. Eleven case-control studies were included that were carried out in 13 countries worldwide. A total number of 4740 subjects were considered (2159 people with epilepsy and 2581 people without epilepsy). The overall pooled OR was 1.69 (95% CI 1.42-2.01) for the association between epilepsy and Toxocara spp. seropositivity. A positive association was constantly reported in the restricted analysis (WB as confirmatory or diagnostic test, younger population, and population-based studies). Meta-regression showed no statistically significant association between covariates and outcome.

Conclusion: The updated meta-analysis provides epidemiological evidence of a positive association between Toxocara seropositivity and epilepsy. New surveys supported the association, mainly population-based studies. On this basis, health strategies to reduce the impact of Toxocara spp are strongly advised. Further research should be performed to understand the physiopathological mechanisms of toxocara-associated epileptogenesis.
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http://dx.doi.org/10.1371/journal.pntd.0006665DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6070292PMC
July 2018

Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function.

Endoscopy 2019 01 12;51(1):40-49. Epub 2018 Jun 12.

Service de Médecine Nucléaire, CHU Limoges, Limoges, France.

Background: Gastroparesis is a functional disorder with a variety of symptoms that is characterized by delayed gastric emptying in the absence of mechanical obstruction. A recent series of retrospective studies has demonstrated that peroral endoscopic pyloromyotomy (G-POEM) is a promising endoscopic procedure for treating patients with refractory gastroparesis. The aim of this prospective study was to evaluate the feasibility, safety, and efficacy of G-POEM.

Methods: 20 patients with refractory gastroparesis (10 diabetic and 10 nondiabetic) were prospectively included in the trial. Patients were treated by G-POEM after evaluation of pyloric function using an endoscopic functional luminal imaging probe. Clinical responses were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and quality of life was assessed using the Patient Assessment of Upper Gastrointestinal Disorders - Quality of Life scale and the Gastrointestinal Quality of Life Index scores. Gastric emptying was measured using 4-hour scintigraphy before G-POEM and at 3 months.

Results: Feasibility of the procedure was 100 %. Compared with baseline values, G-POEM significantly improved symptoms (GCSI: 1.3 vs. 3.5;  < 0.001), quality of life, and gastric emptying (T½: 100 vs. 345 minutes,  < 0.001; %H2: 56.0 % vs. 81.5 %,  < 0.001; %H4: 15.0 % vs. 57.5 %,  = 0.003) at 3 months. The clinical success of G-POEM using the functional imaging probe inflated to 50 mL had specificity of 100 % and sensitivity of 72.2 % ( = 0.04; 95 % confidence interval 0.51 - 0.94; area under the curve 0.72) at a distensibility threshold of 9.2 mm/mmHg.

Conclusion: G-POEM was efficacious and safe for treating refractory gastroparesis, especially in patients with low pyloric distensibility.
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http://dx.doi.org/10.1055/a-0628-6639DOI Listing
January 2019

Age-specific ALS incidence: a dose-response meta-analysis.

Eur J Epidemiol 2018 Jul 23;33(7):621-634. Epub 2018 Apr 23.

Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy.

To evaluate the association between worldwide ALS incidence rates and age, using a dose-response meta-analysis. We reviewed Medline and Embase up to July 2016 and included all population-based studies of newly-diagnosed cases, using multiple sources for case ascertainment. A dose-response meta-analysis was performed. A meta-regression investigated potential sources of heterogeneity. Of 3254 articles identified in the literature, we included 41 incidence studies covering 42 geographical areas. Overall, the fit between observed and predicted age-specific rates was very good. The expected variation of ALS incidence with age was characterized, in each study, by a progressive increase in the incidence from the 40s leading to a peak in the 60s or 70s, followed by a sharp decrease. Cochran's Q test suggested a significant heterogeneity between studies. Overall, estimated patterns of ALS age-specific incidence (at which the peak was reached) were similar among subcontinents of Europe and North America: peak of ALS incidence ranged in these areas between 6.98 and 8.17/100,000 PYFU, which referred to age in the range 71.6-77.4 years. The relationship between age and ALS incidence appeared different for Eastern Asia which was characterized by a peak of ALS incidence at 2.20/100,000 PYFU around 75 years of age. This study confirms the consistency of the age-specific ALS incidence pattern within different subcontinents. Age-specific incidence appears lower in Eastern Asia as compared to Europe and North America.
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http://dx.doi.org/10.1007/s10654-018-0392-xDOI Listing
July 2018

Pectoral I Block Does Not Improve Postoperative Analgesia After Breast Cancer Surgery: A Randomized, Double-Blind, Dual-Centered Controlled Trial.

Reg Anesth Pain Med 2018 Aug;43(6):596-604

Department of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Montréal.

Background And Objectives: General anesthesia for breast surgery may be supplemented by using a regional anesthetic technique. We evaluated the efficacy of the first pectoral nerve block (Pecs I) in treating postoperative pain after breast cancer surgery.

Methods: A randomized, double-blind, dual-centered, placebo-controlled trial was performed. One hundred twenty-eight patients scheduled for unilateral breast cancer surgery were recruited. A multimodal analgesic regimen and surgeon-administered local anesthetic infiltration were used for all patients. Ultrasound-guided Pecs I was performed using bupivacaine or saline. The primary outcome was the patient pain score (numerical rating scale [NRS]) in the recovery unit 30 minutes after admission or just before the morphine administration (NRS ≥4/10). The secondary outcomes were postoperative opioid consumption (ie, in the recovery unit and after 24 hours).

Results: During recovery, no significant difference in NRS was observed between the bupivacaine (n = 62, 3.0 [1.0-4.0]) and placebo (n = 65, 3.0 [1.0-5.0]) groups (P = 0.55). However, the NRS was statistically significantly different, although not clinically significant, for patients undergoing major surgeries (mastectomies or tumorectomies with axillary clearance) (n = 29, 3.0 [0.0-4.0] vs 4.0 [2.0-5.0], P = 0.04). Morphine consumption during recovery did not differ (1.5 mg [0.0-6.0 mg] vs 3.0 mg [0.0-6.0 mg], P = 0.20), except in the major surgery subgroup (1.5 mg [0.0-6.0 mg] vs 6.0 mg [0.0-12.0 mg], P = 0.016). Intraoperative sufentanil and cumulative morphine consumption up to 24 hours did not differ between the 2 groups. Three patients experienced complications related to the Pecs I.

Conclusions: Pecs I is not better than a saline placebo in the presence of multimodal analgesia for breast cancer surgery. However, its role in extended (major) breast surgery may warrant further investigation.

Clinical Trial Registration: This study was registered at ClinicalTrials.gov, identifier NCT01670448.
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http://dx.doi.org/10.1097/AAP.0000000000000779DOI Listing
August 2018

Referral bias in ALS epidemiological studies.

PLoS One 2018 16;13(4):e0195821. Epub 2018 Apr 16.

Laboratorio di Malattie Neurologiche, Dipartimento di Neuroscienze, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy.

Background: Despite concerns about the representativeness of patients from ALS tertiary centers as compared to the ALS general population, the extent of referral bias in clinical studies remains largely unknown. Using data from EURALS consortium we aimed to assess nature, extent and impact of referral bias.

Methods: Four European ALS population-based registries located in Ireland, Piedmont, Puglia, Italy, and Limousin, France, covering 50 million person-years, participated. Demographic and clinic characteristics of ALS patients diagnosed in tertiary referral centers were contrasted with the whole ALS populations enrolled in registries in the same geographical areas.

Results: Patients referred to ALS centers were younger (with difference ranging from 1.1 years to 2.4 years), less likely to present a bulbar onset, with a higher proportion of familial antecedents and a longer survival (ranging from 11% to 15%) when compared to the entire ALS population in the same geographic area.

Conclusions: A trend for referral bias is present in cohorts drawn from ALS referral centers. The magnitude of the possible referral bias in a particular tertiary center can be estimated through a comparison with ALS patients drawn from registry in the same geographic area. Studies based on clinical cohorts should be cautiously interpreted. The presence of a registry in the same area may improve the complete ascertainment in the referral center.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0195821PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5901916PMC
July 2018

Ankle-Brachial Index: An Ubiquitous Marker of Cognitive Impairment-The EPIDEMCA Study.

Angiology 2018 Jul 2;69(6):497-506. Epub 2017 Nov 2.

1 INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France.

Epidemiological research on the implication of atherosclerosis in the development of cognitive impairment is lacking in low- and middle-income countries, where two-thirds of the individuals affected by dementia live. Individuals aged ≥65 years living in urban and rural areas of 2 countries in Central Africa were invited. Demographic, clinical, and biological data were collected, and the ankle-brachial index (ABI) was measured. Cognitive impairment was defined according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Among 1662 participants (age 72.9 years, 59.3% females), the prevalence of cognitive impairment was 13.6%, which is higher in individuals with ABI ≤ 0.90 and ABI ≥ 1.40 than those with 0.90 < ABI < 1.40 (20.1% and 17% vs 12%, P = .0024). Cognitive impairment was significantly associated with the factors such as age (odds ratio [OR]: 1.09; 95% confidence interval [CI]: 1.07-1.12, P < .0001), female gender (OR: 2.36, 95% CI: 1.59-3.49, P < .0001), smoking (OR: 1.54, 95% CI: 1.06-2.23, P = .0026), and low ABI (≤0.90; OR: 1.52, 95% CI: 1.03-2.25, P = .0359). The ABI, a ubiquitous marker of atherosclerosis, provides independent and incremental information on susceptibility to present with cognitive disorders.
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http://dx.doi.org/10.1177/0003319717736608DOI Listing
July 2018