Publications by authors named "Julie Berbis"

57 Publications

Drug-Drug Interactions in Patients with COVID-19 in Nursing Homes.

Drugs Aging 2021 Mar 31. Epub 2021 Mar 31.

Internal Medicine, Geriatry and Therapeutic Department, Timone and Sainte Marguerite Hospital, AP-HM, Aix-Marseille University, CHU Timone, 264 Rue Saint Pierre, 13384, Marseille, France.

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http://dx.doi.org/10.1007/s40266-021-00854-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009758PMC
March 2021

Centenarians in nursing homes during the COVID-19 pandemic.

Aging (Albany NY) 2021 03 2;13(5):6247-6257. Epub 2021 Mar 2.

Internal Medicine, Geriatry and Therapeutic Unit, AP-HM, Marseille, France.

Background: Centenarians are known to be successful agers compared to other older adults.

Objective: The objective of the present study was to compare coronavirus disease (COVID-19) symptoms and outcomes in centenarians and other residents living in nursing homes. Design-Setting-Subjects-Methods: A retrospective multicenter cohort study was conducted using data from 15 nursing homes in the Marseille area. Older residents with confirmed COVID-19 between March and June 2020 were enrolled. The clinical and biological characteristics, the treatment measures, and the outcomes in residents living in these nursing homes were collected from the medical records.

Results: A total of 321 residents were diagnosed with COVID-19 including 12 centenarians. The median age was 101 years in centenarians and 89 years in other residents. The most common symptoms were asthenia and fever. Three centenarians (25%) experienced a worsening of pre-existing depression (vs. 5.5% of younger residents; = 0.032). Mortality was significantly higher in centenarians than in younger residents (50% vs. 21.3%, respectively; = 0.031). A quarter of the younger residents and only one centenarian were hospitalized. However, 33.3% of the centenarians received treatment within the context of home hospitalization.

Conclusion: Worsening of pre-existing depression seems to be more frequent in centenarians with COVID-19 in nursing homes. This population had a higher mortality rate but a lower hospitalization rate than younger residents.
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http://dx.doi.org/10.18632/aging.202743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993710PMC
March 2021

Association of First-Week Nutrient Intake and Extrauterine Growth Restriction in Moderately Preterm Infants: A Regional Population-Based Study.

Nutrients 2021 Jan 14;13(1). Epub 2021 Jan 14.

Department of Neonatology, Hôpital La Conception, Hôpitaux Universitaires de Marseille, 13005 Marseille, France.

The purpose of this study was to determine the influence of first-week nutrition intake on neonatal growth in moderate preterm (MP) infants. Data on neonatal morbidity and nutrition intake on day of life 7 (DoL7) were prospectively collected from 735 MP infants (32-34 weeks gestational age (GA)). Multivariable regression was used to assess the factors associated with extrauterine growth restriction (EUGR) defined as a decrease of more than 1 standard deviation () in the weight -score during hospitalization. Mean () gestational age and birth weight were 33.2 (0.8) weeks and 2005 (369) g. The mean change in the weight -score during hospitalization was -0.64 . A total of 138 infants (18.8%) had EUGR. Compared to adequate growth infants, EUGR infants received 15% and 35% lower total energy and protein intake respectively ( < 0.001) at DoL7. At DoL7, each increase of 10 kcal/kg/d and 1 g/kg/d of protein was associated with reduced odds of EUGR with an odds ratio of 0.73 (95% CI, 0.66-0.82; < 0.001) and 0.54 (0.44-0.67; < 0.001), respectively. Insufficient energy and protein intakes on DoL7 negatively affected neonatal growth of MP infants. Nutritional support should be optimized from birth onwards to improve neonatal weight growth.
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http://dx.doi.org/10.3390/nu13010227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7830065PMC
January 2021

Bone Mineral Density Evolution and Its Determinants in Long-term Survivors of Childhood Acute Leukemia: A Leucémies Enfants Adolescents Study.

Hemasphere 2021 Feb 12;5(2):e518. Epub 2021 Jan 12.

Department of Paediatric Haematology and Oncology and EA3279, Timone Children Hospital and Aix-Marseille University, Marseille, France.

This prospective study aimed to analyze determinants that can influence bone mineral density evolution in childhood acute leukemia survivors. Patients included were selected from the long-term follow-up LEA cohort and had dual energy radiograph absorptiometry scan between 10 and 18 years and after the age of 18. All scans were centrally reviewed. Bone mineral density was measured at the lumbar spine, femoral neck, total hip, and whole body, and expressed as z-score. Eighty-nine patients (female 39, lymphoblastic leukemia 68, relapse 25, hematopoietic stem cell transplantation 44, and mean age 15.4 and 20.1 years at the first and second scans, respectively) were studied. The first and second scan z-scores were significantly correlated ( < 10). Mean femoral neck and total hip z-scores improved significantly between the first and second scans, whereas no significant evolution occurred at the lumbar spine and whole-body level. On the second evaluation, 14.6% of patients had z-score <-2 at the lumbar spine and 4.3% at the femoral neck level. Gender, type of leukemia, transplantation, relapse, cumulative corticosteroid doses, or growth hormone deficiency did not have any significant impact on z-score variation. Younger age at diagnosis (≤8.5 years) proved an unfavorable risk factor for z-score evolution at the lumbar spine ( = 0.041); the trend did not reach statistical significance for metabolic syndrome ( = 0.054). At the femoral neck, both were associated with unfavorable z-score evolution ( = 0.003 and 0.025, respectively). Patients treated at a younger age and those with metabolic syndrome seem to be at higher risk of bone mineral density decline and should benefit from specific interventions.
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http://dx.doi.org/10.1097/HS9.0000000000000518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7806242PMC
February 2021

Testosterone deficiency in men surviving childhood acute leukemia after treatment with hematopoietic stem cell transplantation or testicular radiation: an L.E.A. study.

Bone Marrow Transplant 2021 Jan 16. Epub 2021 Jan 16.

Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille University, Marseille, France.

We included 255 patients from the L.E.A. French long-term follow-up cohort. All had received hematopoietic stem cell transplantation (HSCT) and/or testicular radiation for childhood acute leukemia and were older than 18 years at last L.E.A. evaluation. Total testosterone deficiency was defined as a <12 nmol/l level or by substitutive therapy, partial deficiency as normal testosterone with elevated luteinizing hormone (>10 UI/l). After myeloablative total body irradiation (n = 178), 55.6% had total deficiency, 15.7% partial deficiency, and 28.7% were normal. A 4-6 Gy testicular boost and a younger age at HSCT increased significantly the risk. After a Busulfan-containing myeloablative conditioning regimen (n = 53), 28.3% had total deficiency, 15.1% partial deficiency, 56.6% were normal (62.5% vs. 0% in patients without or with additional testicular radiation). A 24-Gy testicular radiation without HSCT induced total or partial deficiency in 71.4% and 28.6%, respectively (n = 21). Total testosterone deficiency increased the risk of metabolic syndrome: 25% vs. 12.1% in men with partial testosterone deficiency and 8.8% when Leydig cell function was normal (p = 0.031).
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http://dx.doi.org/10.1038/s41409-020-01180-yDOI Listing
January 2021

Impact of care pathway for nursing home residents treated for cancer: ONCO-EHPAD study.

Support Care Cancer 2021 Jan 3. Epub 2021 Jan 3.

Division of Internal Medicine, Geriatric and Therapeutic, University Hospital of Marseille (AP-HM), Marseille, France.

Purpose: Few data are known about cancer management in frail nursing home residents.

Methods: Objective of our prospective, interventional study was to set up in the Marseille area, a care pathway for nursing homes residents with a suspected cancer. It combined cancer diagnosis procedures and comprehensive geriatric assessment (CGA), both made in our geriatric oncology outpatient unit, before oncologic advice for treatment decision. In standard care, CGA is carried out after therapeutic decision, to determine whether the planned treatment is compatible with the patient's frailties. CGA and quality of life were performed at enrolment and at 6 months. This study was registered in ClinicalTrials.gov (NCT03103659).

Results: Between April 2017 and March 2020, 48 residents from 38 nursing homes were included: 24 had the care pathway (PP), and 24 the standard care (NPP). Six were excluded (no cancer). PP had more frailties than NPP. All PP and 75% of NPP had outpatient care. Curative treatment was given to 77% of NPP (including chemotherapy in 10 cases), and 25% of PP (surgery, radiotherapy, hormone therapy). A majority of PP (75%) had supportive care. At 6 months, 16 patients died (11 NPP, 5 PP). Quality of life evolution was available for 11 PP and 7NPP: it showed stability in PP and degradation in NPP.

Conclusion: Even if part of residents were too frail to get curative treatment, the care pathway enabled them to benefit from oncologic advice and appropriate supportive care while preserving their quality of life. Further investigations are needed to confirm these findings.
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http://dx.doi.org/10.1007/s00520-020-05973-1DOI Listing
January 2021

Late Effects in Childhood Cancer Survivors: Early Studies, Survivor Cohorts, and Significant Contributions to the Field of Late Effects.

Pediatr Clin North Am 2020 12;67(6):1033-1049

Childhood Cancer Research Group, Danish Cancer Society Research Center, Strandboulevarden 49, 2100 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health, Incuba Skejby, building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark.

With improvement in cure of childhood cancer came the responsibility to investigate the long-term morbidity and mortality associated with the treatments accountable for this increase in survival. Several large cohorts of childhood cancer survivors have been established throughout Europe and North America to facilitate research on long-term complications of cancer treatment. The cohorts have made significant contributions to the understanding of early mortality, somatic late complications, and psychosocial outcomes among childhood cancer survivors, which has been translated into the design of new treatment protocols for pediatric cancers, with the goal to reduce the potential risk and severity of late effects.
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http://dx.doi.org/10.1016/j.pcl.2020.07.002DOI Listing
December 2020

Quality of life in parents of childhood leukemia survivors. A French Childhood Cancer Survivor Study for Leukemia study.

Pediatr Blood Cancer 2020 10 15;67(10):e28419. Epub 2020 Aug 15.

Aix-Marseille Univ, EA 3279: CERESS-Health Service Research and Quality of Life Center, Marseille, France.

Introduction: Our objectives were to assess the quality of life (QoL) of parents of childhood leukemia survivors compared with population norms and to identify the determinants of parents' long-term QoL.

Methods: Parents of minors who had survived childhood leukemia participating in the French LEA cohort (Leucémie de l'Enfant et de l'Adolescent-French Childhood Cancer Survivor Study for Leukemia) were asked to complete the French version of the WHOQOL-BREF. Results were compared with age- and sex-matched values from a French reference population. Parents' and survivors' characteristics likely to be associated with QoL, long after the child's leukemia diagnosis, were explored using multivariate analysis.

Results: We included 487 parents (mean age 42.9 ± 6.0 years, mean follow-up time from diagnosis 7.3 ± 3.3 years). Compared with the reference population, scores for physical health and social relationships for parents of childhood leukemia survivors were significantly lower (P < 0.001, effect size = 0.24 and P < 0.001, effect size = 0.29, respectively) contrary to scores for psychological health which were significantly higher (P < 0.001, effect size = 0.29). Even if health- and cancer-related characteristics were associated with parents' QoL in some dimensions, the only factor associated with each of the three dimensions (social relationships, physical health, and psychological) in the multivariate analysis was the parent's financial situation.

Conclusions: Long after leukemia diagnosis, the parents reported lower scores in the physical health and social relationship domains. Despite the difficulties of actually influencing socioeconomic characteristics, it is important to consider the social situation of each family in the long-term care of survivors and their families.
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http://dx.doi.org/10.1002/pbc.28419DOI Listing
October 2020

Health Status of French Young Patients with Inborn Errors of Metabolism with Lifelong Restricted Diet.

J Pediatr 2020 05 4;220:184-192.e6. Epub 2020 Mar 4.

Department of Epidemiology and Health Economics, AP-HM/EA 3279 CEReSS (Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie), Aix-Marseille Univ, Marseille, France.

Objective: To describe the health status of young patients affected by inborn errors of metabolism that require adherence to a restricted diet (IEMRDs) and to describe and compare their self- and proxy (parent)-reported quality of life (QoL) with reference values.

Study Design: A cross-sectional study was conducted in 2015-2017 in patients affected by IEMRDs (except phenylketonuria) younger than 18 years. Data collection was based on medical records, clinical examinations, parents' and children's interviews, and self-reported questionnaires. Measurements included clinical and healthcare data, child and family environment data, and self- and proxy (parent)-reported QoL.

Results: Of the 633 eligible participants, 578 were recruited (50.3% boys; mean age: 8.7 years); their anthropometric status did not differ from the general population. Approximately one-half of them had at least 1 complication of the disease. Their self-reported global QoL did not differ from that of the general population. However, relations with friends and leisure activities QoL domains were negatively impacted, whereas relations with medical staff, relations with parents, and self-esteem QoL domains were positively impacted. Their proxy (parent)-reported QoL was negatively impacted.

Conclusions: Young patients affected by IEMRDs present a high rate of clinical complications. Although their proxy (parent)-reported QoL was negatively impacted, their self-reported QoL was variably impacted (both positively and negatively). These results may inform counseling for those who care for affected patients and their families.
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http://dx.doi.org/10.1016/j.jpeds.2020.01.059DOI Listing
May 2020

Specific cognitive correlates of the quality of life of extremely preterm school-aged children without major neurodevelopmental disability.

Pediatr Res 2020 10 12;88(4):642-652. Epub 2020 Feb 12.

EA3279, Self-Perceived Health Assessment Research Unit, Faculty of Medicine, Marseille, 13385, France.

Background: We examined how specific cognitive behavioral impairments impacted quality of life (QoL) within a large multicenter cohort of 7-10 year olds surviving extremely preterm (EPT) without major neurodevelopmental disability.

Methods: Between 7 and 10 years of age, two generic, self-proxy, and parental evaluations were obtained. QoL measurement questionnaires (Kidscreen-10/VSPA (Vécu et Santé Perçue de l'Enfant et de l'Adolescent)) were used and compared to a reference population. The general and specific cognitive functions, such as executive functions, behavior and anxiety, and clinical neurologic examination, were also assessed.

Results: We analyzed 211 school-aged EPT children. The mean gestational age was 26.2 (±0.8) weeks, birth weight was 879 g (±181) and the mean age was 8.4 years (±0.87). Children with a Full-Scale Index Quotient ≥89, who were considered as normal, had a lower QoL. Specific cognitive impairments: comprehensive language delay, visuo-spatial integration defect, and dysexecutive disorders) were the QoL correlates in the domains of school performance and body image.

Conclusions: School and health care professionals need to increase their focus on EPT children's lower so as to recognize the preterm behavioral/cognitive phenotype and their potential need for supportive measures. Research on preventive interventions is warranted to investigate if these long-term effects of an EPT birth can be attenuated in neonatal period and after.
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http://dx.doi.org/10.1038/s41390-020-0795-8DOI Listing
October 2020

Lateral decubitus chest radiography or chest ultrasound to predict pleural adhesions before medical thoracoscopy: a prospective study.

J Thorac Dis 2019 Oct;11(10):4292-4297

Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, France.

Background: Medical thoracoscopy (MT) is the gold-standard to investigate unexplained pleural exudates. However, the major prerequisite is an easy pleural access obtained by creating an artificial pneumothorax at the beginning of the procedure which can be a challenge in case of pleural adhesions and make the procedure unsafe. The detection of pleural adhesions prior to MT is necessary. Nowadays chest ultrasonography (CUS) is considered the best procedure to detect pleural adhesions. However, this technique is not available in all countries where the assessment of the pleural cavity is only based on chest radiography. Therefore, we conducted this study to compare the performance of lateral decubitus chest radiography (LDCR) and CUS to predict pleural adhesions.

Methods: LDCR and CUS were performed prior MT in consecutive patients presenting exudative pleural effusion to detect pleural adhesions. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for each pre thoracoscopy procedure were calculated.

Results: Data analysis for the sixty-six enrolled patients showed a higher superiority to detect pleural adhesions for CUS in comparison to LDCR for all the parameters analyzed.

Conclusions: These results confirm that pre-MT CUS is the cornerstone to evaluate the access to the pleural cavity and justify educational program in this field in all centers which intends to develop interventional pulmonology.
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http://dx.doi.org/10.21037/jtd.2019.09.54DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837969PMC
October 2019

Diagnostic Value of Computed Tomography Imaging Features in Malignant Pleural Mesothelioma.

Respiration 2020;99(1):28-34. Epub 2019 Oct 25.

Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonary Medicine, Hôpital Nord, Marseille, France.

Background: Medical history, thoracentesis, and imaging features are usually the first steps in the investigation of a possible malignant pleural effusion (MPE). Unfortunately, the diagnostic yield of thoracentesis in this situation is suboptimal even if the procedure is repeated, especially in the context of malignant pleural mesothelioma (MPM). The next step for confirming the diagnosis, if clinically appropriate, is thoracoscopy, but not all patients are fit to undergo this procedure, so the diagnosis is then based on the medical history and imaging features only.

Objectives: Our objective was to evaluate the diagnostic value of the medical history and imaging features in MPM.

Methods: We reviewed the imaging and medical charts of 92 patients with a final diagnosis of MPE included in our prospective medical thoracoscopy database. The clinical characteristics and imaging features of patients with primary MPE were compared with those of patients with secondary MPE.

Results: Male sex (82 vs. 59%, p = 0.02), asbestos exposure (58 vs. 10%, p < 0.001), and mediastinal (68 vs. 33%, p = 0.04), diaphragmatic (75 vs. 31%, p = 0.001) and circumferential pleural thickening (55 vs. 19% p = 0.001) were significantly more frequent in MPM patients. In a multivariate linear regression model, only asbestos exposure (OR 11.2; 95% CI 3.4-36.9) and circumferential pleural thickening (OR 4.7; 95% CI 1.6-13.9) were significantly associated with a diagnosis of MPM.

Conclusion: In situations where it is impossible to obtain adequate pleural samples to differentiate MPM from a secondary pleural malignancy, the combination of circumferential pleural thickening and a history of asbestos exposure may be sufficient to make a clinical diagnosis.
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http://dx.doi.org/10.1159/000503239DOI Listing
April 2021

Quality of life in adolescents with chronic kidney disease who initiate haemodialysis treatment.

BMC Nephrol 2019 05 14;20(1):163. Epub 2019 May 14.

Aix-Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: - CEReSS Health Service Research and Quality of Life Center, Marseille, France.

Background: To describe the quality of life of adolescents initiating haemodialysis, to determine the factors associated with quality of life, and to assess coping strategies and their impact on quality of life.

Methods: All adolescents initiating haemodialysis between September 2013 and July 2015 in French paediatric haemodialysis centres were included. Quality of life data were collected using the "Vécu et Santé Perçue de l'Adolescent et l'Enfant" questionnaire, and coping data were collected using the Kidcope questionnaire. Adolescent's quality of life was compared with age- and sex-matched French control.

Results: Thirty-two adolescents were included. Their mean age was 13.9 ± 2.0 years. The quality of life score was lowest in leisure activities and highest in relationships with medical staff. Compared with the French control, index, energy-vitality, relationships with friends, leisure activities and physical well-being scores were significantly lower in haemodialysis population. In multivariate analyses, active coping was positively associated with quality of life and especially with energy-vitality, relationships with parents and teachers, and school performance. In contrast, avoidant and negative coping were negatively associated with energy-vitality, psychological well-being and body image for avoidant coping, and body image and relationships with medical staff for negative coping.

Conclusions: The quality of life of haemodialysis adolescents, and mainly the dimensions of leisure activities, physical well-being, relationships with friends and energy-vitality, were significantly altered compared to that of the French population. The impact of coping strategies on quality of life seems to be important. Given the importance of quality of life and coping strategies in adolescents with chronic disease, health care professionals should integrate these aspects into care management.
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http://dx.doi.org/10.1186/s12882-019-1365-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6515621PMC
May 2019

Adolescence and Socioeconomic Factors: Key Factors in the Long-Term Impact of Leukemia on Scholastic Performance-A LEA Study.

J Pediatr 2019 02 13;205:168-175.e2. Epub 2018 Nov 13.

Department of Pediatric Onco-Hematology, University Hospital of Rennes, Rennes1 University, Rennes, France.

Objective: To evaluate the association between medical and social environmental factors and the risk of repeating a grade in childhood leukemia survivors.

Study Design: A cross-sectional study of childhood leukemia survivors, recruited through the LEA cohort (Leucémie de l'Enfant et de l'Adolescent [French Childhood Cancer Survivor Study for Leukemia]) in 2014. An adjusted logistic regression model was used to identify variables linked to repeating a grade after the diagnosis among the survivors, and the rates of repeating a grade were compared between the survivors and their siblings using a multilevel logistic regression model.

Results: The mean age at inclusion of the 855 participants was 16.2 ± 7.0 years, and the mean duration of follow-up from diagnosis to evaluation was 10.2 ± 6.2 years. After disease onset, 244 patients (28.5%) repeated a grade, with a median interval of 4 years (IQR, 2-8 years). Independent factors associated with repeating a grade were male sex (OR, 1.78; 95% CI, 1.21-2.60), adolescence (OR, 2.70; 95% CI, 1.63-4.48), educational support during the treatment period (OR, 3.79; 95% CI, 2.45-5.88), low parental education level (OR, 2.493; 95% CI, 1.657-3.750), and household financial difficulties (OR, 2.62; 95% CI, 1.607-4.28). Compared with siblings, survivors were at greater risk of repeating a grade (OR, 1.87; 95% CI, 1.48-2.35).

Conclusions: The most vulnerable patients seemed to be adolescents and those with parents of low socioeconomic status. Improving the schooling career of leukemia survivors will require that the medical community more carefully consider the social status of patients.
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http://dx.doi.org/10.1016/j.jpeds.2018.09.047DOI Listing
February 2019

Clinical, Economic, and Organizational Impact of the Clinical Pharmacist in an Orthopedic and Trauma Surgery Department.

J Patient Saf 2018 Oct 25. Epub 2018 Oct 25.

Centre Hospitalier Universitaire de Montpellier, Hôpital Lapeyronie, Département de Chirurgie Orthopédique du Membre Inferieur et de Traumatologie.

Aim: The aim of this study was to evaluate the clinical, economic, and organizational impact of clinical pharmacist services added to an adult orthopedic and trauma surgery unit in a university hospital.

Methods: This was a prospective, observational study performed from January to February 2017. All pharmacists' interventions were documented, and their clinical, economic, and organizational impact and the probability of adverse drug events (ADEs) were assessed using the clinical, economic and organizational scale three-dimensional scale. An expert panel composed of three clinical pharmacists, one surgeon and one anesthetist classified the pharmacist intervention. The potential clinical impact was determined through a consensus by the expert panel. Cost avoidance was calculated for serious ADEs with a major impact by avoiding an additional cost of &OV0556;4912 per event and taking into account the probability of ADE occurrence.

Results: The pharmacists performed 1014 interventions for 28 days with a 95.3% acceptance rate by prescribers. Thirty-nine interventions were rated to have a major clinical impact (3.8%). The organizational impact was estimated favorable for 856 (84.4%) pharmacist interventions. Cost avoidance was estimated at &OV0556;24,364, and the indirect costs benefit was estimated at &OV0556;11,864 during the study. The cost-benefit ratio of the clinical pharmacist intervention was &OV0556;1.94 in savings for every &OV0556;1 invested.

Conclusions: Clinical pharmacist services in an orthopedic and trauma surgery department have the potential to improve patient outcomes and avoid healthcare costs. Furthermore, the presence of a pharmacist in surgical units allows for communication between the unit and the pharmacy, which produces better fluidity and improves the quality of care.
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http://dx.doi.org/10.1097/PTS.0000000000000539DOI Listing
October 2018

Quality of life of extremely preterm school-age children without major handicap: a cross-sectional observational study.

Arch Dis Child 2019 04 30;104(4):333-339. Epub 2018 Jun 30.

Public Health Department-Research Unit EA3279, Aix-Marseille University, Marseille, France.

Objective: To determine the quality of life (QoL) of school-aged children who were born <28 weeks of gestation and who have no resultant major disabilities.

Design, Setting And Patients: A cross-sectional multicentre study of extremely preterm (EPT) infants born <28 weeks, discharged alive and free from severe impairments (cerebral palsy, autism, major cognitive disabilities). Two generic, self-evaluation and hetero-evaluation (by parent) QoL measurement questionnaires (Kidscreen 10/VSP-A) were used and then compared with French population reference.

Main Outcome Measures: Clinical examination, an assessment of cognitive functions and QoL between 7 and 10 years of age.

Results: 40 (7.5%) severely disabled children were excluded. Among those 471 eligible, the lost to follow-up group (169 (36%)) paralleled those 302 (64%) included in the study. The mean gestational age was 26.2 (±0.8), birth weight was 879 (±181) g and the mean age was 8.4 (±0.87) years. 48% of participants had minor or moderate cognitive disabilities based on their Full-Scale Index Quotient. Working memory, attention and mental flexibility scored as low-average. Except for family relationships, the EPT QoL VSP-A and Kidscreen 10 assessment were significantly lower based on the children's and parent's perspectives. Children reported the most significant QoL decline as (1) friends' relationships, (2) self-esteem and (3) leisure, while parents indicated (1) psychological well-being, (2) schoolwork and (3) vitality.

Conclusion: The QoL of a school-age EPT child without severe impairment was lower relative to a reference population from both the parents' and child's points of view. This evaluation should help to better understand the long-term outcomes and to provide better support for them and their families.

Trial Registration Number: NCT01675726, pre-results.
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http://dx.doi.org/10.1136/archdischild-2018-315046DOI Listing
April 2019

Diagnostic Accuracy of Lateral Decubitus Chest Radiography before Pleural Maneuvers for the Management of Pleurisies in the Era of Chest Ultrasound.

Respiration 2018;95(6):449-453. Epub 2018 May 3.

Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France.

Background: Chest ultrasound (CUS) is the gold standard to detect pleural adhesions before pleural maneuvers. However, the CUS technique is not available in all countries where the assessment is only based on clinical examination and chest radiography.

Objective: To assess the value of lateral decubitus chest radiography (LDCR) to detect pleural adhesions.

Methods: Consecutive patients with pleural effusions undergoing LCDR followed by medical thoracoscopy the day after were identified from an institutional database. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for LDCR were calculated.

Results: Eighty-six patients were included in the study. The sensitivity, specificity, PPV, and NPV of LDCR for the presence of adhesions taking into account the shape of the horizontal level were 71.2% (56.7-82.5), 44.1% (27.6-61.9), 66.1% (52.1-77.8), and 50% (31.7-68.3), respectively. The accuracy to predict pleural adhesions for the sign "incomplete horizontal level" was 60.5 (49.3-70.7). The accuracy to predict pleural adhesions in case of irregular aspect of the horizontal level was 53.5 (42.5-64.2).

Conclusions: The accuracy of LDCR for the detection of pleural adhesions is low in patients with pleural effusion and LDCR is not sufficient before pleural maneuvers. This has to be taken into account in countries with a high prevalence of pleural tuberculosis which usually lead to loculated pleural effusions. CUS has to be urgently included in dedicated educational programs in these areas in order to decrease the complications related to unexpected pleural adhesions and achieve better planning for the management of pleural effusions.
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http://dx.doi.org/10.1159/000487999DOI Listing
November 2018

Evaluation of "Energy Resonance by Cutaneous Stimulation" Among Women Treated by In Vitro Fertilization.

J Altern Complement Med 2018 Jun 19;24(6):578-583. Epub 2018 Mar 19.

1 Department of Gynecology-Obstetric and Reproductive Medicine , AP-HM, Hôpital La Conception-Hôpital Nord, Marseille, France .

Objectives: Pregnancy rate in in vitro fertilization (IVF) depends on many factors, such as the characteristics of the couple and the clinicobiological parameters. Interest in alternative and complementary medicine (ACM) for IVF is discussed because of the lack of scientific evidence. Energy resonance by cutaneous stimulation (ERCS), an acupuncture-like technique, consists of skin stimulation to transmit vibratory messages. The aim of this study was to evaluate the effect of ERCS on live birth rates (LBRs) in IVF.

Design: A prospective observation study was performed in the Unit of Assisted Reproductive Technologies of a University Teaching Hospital. Every woman who agreed to participate in this study and received a fresh embryo transfer (ET) after IVF or Intracytoplasmic Sperm Injection (ICSI) was included. Patients randomly underwent an ERCS session on the day of ET according to the schedule of the midwife performing this technique. The control group consisted of women undergoing ET under usual conditions. The main outcome measure was the LBR per transfer.

Results: Three-hundred-eighteen women were included, 120 in the ERCS + ET group and 198 in the ET without ERCS group. None of the women dropped out. The clinical characteristics in both groups were comparable. There was a significant difference in the clinical pregnancy rates, 31.7% in the ERCS group versus 21.7% in the No ERCS group (p = 0.037). The LBR in the ERCS group was nearly significantly higher, 29.2% versus 20.7% in the No ERCS group (p = 0,059).

Conclusions: Women undergoing ERCS on the day of ET had a significantly higher IVF pregnancy rate. However, this methodology made not possible to draw conclusions about the mechanisms that induced the increase of IVF LBRs: placebo effect, "cocooning," or ERCS self-effect? Further well-conducted studies are strongly needed to assess ERCS efficacy.
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http://dx.doi.org/10.1089/acm.2017.0155DOI Listing
June 2018

Prevalence and characteristics of metabolic syndrome in adults from the French childhood leukemia survivors' cohort: a comparison with controls from the French population.

Haematologica 2018 04 19;103(4):645-654. Epub 2018 Jan 19.

Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille University, Marseille, France

The prevalence of the metabolic syndrome among adults from the French LEA childhood acute leukemia survivors' cohort was prospectively evaluated considering the type of anti-leukemic treatment received, and compared with that of controls. The metabolic profile of these patients was compared with that of controls. A total of 3203 patients from a French volunteer cohort were age- and sex-matched 3:1 to 1025 leukemia survivors (in both cohorts, mean age: 24.4 years; females: 51%). Metabolic syndrome was defined according to the National Cholesterol Education Program's Adult Treatment Panel III criteria. Metabolic syndrome was found in 10.3% of patients (mean follow-up duration: 16.3±0.2 years) and 4.5% of controls, (OR=2.49; <0.001). Patients transplanted with total body irradiation presented the highest risk (OR=6.26; <0.001); the other treatment groups also showed a higher risk than controls, including patients treated with chemotherapy only. Odd Ratios were 1.68 (=0.005) after chemotherapy only, 2.32 (=0.002) after chemotherapy and cranial irradiation, and 2.18 (=0.057) in patients transplanted without irradiation. Total body irradiation recipients with metabolic syndrome displayed a unique profile compared with controls: smaller waist circumference (91 99.6 cm; =0.01), and increased triglyceride levels (3.99 1.5 mmol/L; <0.001), fasting glucose levels (6.2 5.6 mmol/L; =0.049), and systolic blood pressure (137.9 132.8 mmHg; =0.005). By contrast, cranial irradiation recipients with metabolic syndrome had a larger waist circumference (109 99.6 cm; =0.007) than controls. Regardless of the anti-leukemic treatment, metabolic syndrome risk was higher among childhood leukemia survivors. Its presentation differed depending on the treatment type, thus suggesting a divergent pathophysiology. This study is registered at .
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http://dx.doi.org/10.3324/haematol.2017.176123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5865433PMC
April 2018

Surgery for pancreatic neoplasms: How accurate are our surgical indications?

Surgery 2017 07 23;162(1):112-119. Epub 2017 Feb 23.

AP-HP, Hôpital Beaujon, Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), DHU Unity, Clichy, France; Université Paris Diderot, Paris, France. Electronic address:

Background: Accurate preoperative diagnosis is critical for the determination of appropriate surgical indications. The aim of this study was to assess the accuracy of preoperative diagnosis and indications for operative therapy for presumed pancreatic neoplasms.

Methods: From 2005 to 2013, 851 patients underwent pancreatectomies for presumed pancreatic neoplasms. A formal preoperative diagnosis was established during a multidisciplinary tumor board and compared to the final pathologic examination. The preoperative diagnosis and its accuracy were assessed according to demographics, symptoms, and diagnostic workup.

Results: Tumors were benign in 8% of patients (n = 67), premalignant in 43% (n = 370), and malignant in 49% (n = 414). The mean number of preoperative examinations was 3.2; 27% (n = 144) of patients had computed tomography, magnetic resonance imaging, endoscopic ultrasonography, and fine needle examination all performed together. Preoperative diagnosis was confirmed in 89% of patients (n = 754). The morbidity and mortality rates were 65% and 1%, respectively. Of the 97 patients (11%) with a misdiagnosis, operative resection was ultimately relevant (premalignant, malignant tumor, or symptomatic benign tumor) in 51 (6%) but inappropriate in 46 (5%). The rate of misdiagnosis was increased for cystic lesions and in patients under 50 years of age. For lesions <2 cm, diagnostic accuracy was increased when computed tomography, magnetic resonance imaging, endoscopic ultrasonography, and fine needle examination were all performed together.

Conclusion: Misdiagnosis can lead to an inappropriate resection in 5% of patients with presumed pancreatic neoplasms. For lesions difficult to characterize, such as small and cystic lesions, association of several modalities of preoperative workup could help to decrease the rate of inappropriate operative care.
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http://dx.doi.org/10.1016/j.surg.2017.01.015DOI Listing
July 2017

Employment in French young adult survivors of childhood leukemia: an LEA study (for Leucemies de l'Enfant et de l'Adolescent-childhood and adolescent leukemia).

J Cancer Surviv 2016 12 17;10(6):1058-1066. Epub 2016 May 17.

EA 3279 - Public Health, Chronic Diseases and Quality of Life - Research Unit, Aix-Marseille University, Marseille, 13284, France.

Purpose: Our principal aim was to assess the occupational outcomes of French survivors of childhood leukemia, compared to national population. The secondary objective was to identify determinants linked with employment stability after childhood leukemia.

Methods: All survivors aged 15 and over enrolled in the French LEA Cohort (Childhood and Adolescent Leukemia) were included. Occupational data were self-reported. The occupational distributions expected in the cohort for each age range were established based on the distribution in France as reference, and comparisons between observed and expected distributions were performed. Logistic regression model was used to explore determinants of stability of survivors' employment.

Results: The questionnaire was completed by 845 eligible survivors (response rate 87.8 %), with a mean age of 22.3 ± 5.4 years and a mean follow-up duration of 14.3 ± 6.3 years. Among the 361 survivors currently in the labor market, 36 (10.0 %) were seeking a job, which is significantly lower than expected (19.3 %) compared to French population. Conversely, among those currently employed, the number of survivors in unstable employment (43.9 %) was significantly higher than expected (33.5 %). Younger age and higher number of late effects were risk factors for unstable employment.

Conclusions: While the employment rate of the young French adult population of childhood leukemia survivors seems rather positive, access to a steady job appears to be compromised for some survivors.

Implications For Cancer Survivors: A strategy to better identify particular subgroups of survivors at greatest risk for difficulties in their professional achievement will help ensure the development of specific intervention strategies and support procedures.
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http://dx.doi.org/10.1007/s11764-016-0549-0DOI Listing
December 2016

Corrigendum to "Challenges in war-related thoracic injury faced by French military surgeons in Afghanistan (2009-2013)" [Injury 47 (2016) 1939-1944].

Injury 2016 12 12;47(12):2841. Epub 2016 Oct 12.

Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France.

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http://dx.doi.org/10.1016/j.injury.2016.09.033DOI Listing
December 2016

Lack of information received by a French female cohort regarding prevention against exposure to reprotoxic agents during pregnancy.

Eur J Obstet Gynecol Reprod Biol 2016 Oct 3;205:15-20. Epub 2016 Aug 3.

Pôle Femmes-Mères-Enfants, AP-HM La Conception, Marseille, France; Aix Marseille Université, CNRS, IRD, Avignon Université, IMBE UMR 7263, 13397, Marseille, France. Electronic address:

Objective: The aim of this study was to evaluate the information pregnant women received regarding possible exposures to five recognized reprotoxic agents during their pregnancy.

Study Design: A cohort study was conducted using two postnatal units in France. Women hospitalized in postnatal units were requested to complete a self-administered two part questionnaire. The first part gathered information about the patient's socio-professional level and the type of pregnancy follow-up. The second part examined the information the patient received regarding daily products containing the following known reprotoxic agents: bisphenol A, toluene, n-hexane, cis-chloroallyl-triaza-azonia-adamantane-chloride and O-phenyl-phenol. The women cited the sources of information. We combined the employment status and educational level to separate the women into two groups. The groups were then compared using the Chi Square test or Fisher's exact test.

Result(s): There were 390 women in this study. Our results showed the women received information regarding the following: 21.6% (n=84) regarding tin cans, 21.9% (n=85) concerning plastic meal boxes when heated in microwave ovens, 8.8% (n=32) about water in gas-bottles, 27.4% (n=106) about non-organic foods, 39.3% (n=152) about hair dyes, 17% (n=66) about nail polishes, 23.4% (n=103) about insect repellents, 34.4% (n=133) about "do-it-yourself" products, 2.1% (n=8) about gardening products, 26.7% (n=103) about electric plug-in repellents, 21.1% (n=81) about housekeeping products, and 6.8% (n=26) about register receipts. Women with a higher level of education and a qualified occupation were better informed about these daily products. These women were more likely to learn the information on their own (internet, media).

Conclusion(s): Our study showed French women did not receive sufficient information regarding potential exposures to reprotoxic agents during pregnancy.
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http://dx.doi.org/10.1016/j.ejogrb.2016.07.504DOI Listing
October 2016

The Impact of Donor Type on Long-Term Health Status and Quality of Life after Allogeneic Hematopoietic Stem Cell Transplantation for Childhood Acute Leukemia: A Leucémie de l'Enfant et de L'Adolescent Study.

Biol Blood Marrow Transplant 2016 11 10;22(11):2003-2010. Epub 2016 Aug 10.

Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille University, Marseille, France; Research Unit EA 3279 and Department of Public Health, Aix-Marseille University and Timone Hospital Marseille, France.

We compared the long-term impact of donor type (sibling donor [SD] versus matched unrelated donor [MUD] or umbilical cord blood [UCB]) on late side effects and quality of life (QoL) in childhood acute leukemia survivors treated with hematopoietic stem cell transplantation. We included 314 patients who underwent transplantation from 1997 to 2012 and were enrolled in the multicenter French Leucémie de l'Enfant et de L'Adolescent ("Leukemia in Children and Adolescents") cohort. More than one-third of the patients were adults at last visit; mean follow-up duration was 6.2 years. At least 1 late effect was observed in 284 of 314 patients (90.4%). The average number of adverse late effects was 2.1 ± .1, 2.4 ± .2, and 2.4 ± .2 after SD, MUD, and UCB transplantation, respectively. In a multivariate analysis, considering the SD group as the reference, we did not detect an impact of donor type for most sequelae, with the exception of increased risk of major growth failure after MUD transplantation (odds ratio [OR], 2.42) and elevated risk of osteonecrosis after UCB transplantation (OR, 4.15). The adults and children's parents reported comparable QoL among the 3 groups. Adult patient QoL scores were lower than age- and sex-matched French reference scores for almost all dimensions. We conclude that although these patients are heavily burdened by long-term complications, donor type had a very limited impact on their long-term health status and QoL.
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http://dx.doi.org/10.1016/j.bbmt.2016.08.004DOI Listing
November 2016

Metabolic syndrome in long-term survivors of childhood acute leukemia treated without hematopoietic stem cell transplantation: an L.E.A. study.

Haematologica 2016 12 11;101(12):1603-1610. Epub 2016 Aug 11.

Department of Pediatric Hematology and Oncology, Timone Enfants Hospital, APHM and Aix-Marseille University, Marseille, France.

Cardiovascular conditions are serious long-term complications of childhood acute leukemia. However, few studies have investigated the risk of metabolic syndrome, a known predictor of cardiovascular disease, in patients treated without hematopoietic stem cell transplantation. We describe the overall and age-specific prevalence, and the risk factors for metabolic syndrome and its components in the L.E.A. (Leucémie de l'Enfant et de l'Adolescent) French cohort of childhood acute leukemia survivors treated without hematopoietic stem cell transplantation. The study included 650 adult patients (mean age at evaluation: 24.2 years; mean follow-up after leukemia diagnosis: 16.0 years). The prevalence of metabolic syndrome was 6.9% (95% CI 5.1-9.2). The age-specific cumulative prevalence at 20, 25, 30 and 35 years of age was 1.3%, 6.1%, 10.8% and 22.4%, respectively. The prevalence of decreased high-density lipoprotein cholesterol, increased triglycerides, increased fasting glucose, increased blood pressure and increased abdominal circumference was 26.8%, 11.7%, 5.8%, 36.7% and 16.7%, respectively. Risk factors significantly associated with metabolic syndrome in the multivariate analysis were male sex (OR 2.64; 95% CI 1.32-5.29), age at last evaluation (OR 1.10; 95% CI 1.04-1.17) and body mass index at diagnosis (OR 1.15; 95% CI 1.01-1.32). The cumulative steroid dose was not a significant risk factor. Irradiated and non-irradiated patients exhibited different patterns of metabolic abnormalities, with more frequent abdominal obesity in irradiated patients and more frequent hypertension in non-irradiated patients. Survivors of childhood acute leukemia are at risk of metabolic syndrome, even when treated without hematopoietic stem cell transplantation or central nervous system irradiation. A preventive approach with regular screening for cardiovascular risk factors is recommended. clinicaltrials.gov identifier:01756599.
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http://dx.doi.org/10.3324/haematol.2016.148908DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479621PMC
December 2016

Challenges in war-related thoracic injury faced by French military surgeons in Afghanistan (2009-2013).

Injury 2016 09 10;47(9):1939-44. Epub 2016 Jun 10.

Department of Thoracic and Vascular Surgery, Sainte Anne Military Teaching Hospital, Toulon, France; French Military Health Service Academy, Ecole du Val-de-Grace, Paris, France. Electronic address:

Background: This study reports the challenges faced by French military surgeons in the management of thoracic injury during the latest Afghanistan war.

Methods: From January 2009 to April 2013, all of the civilian, French and Coalition casualties admitted to French NATO Combat Support Hospital situated on Kabul were prospectively recorded in the French Military Health Service Registry (OPEX(®)). Only penetrating and blunt thoracic trauma patients were retrospectively included.

Results: Eighty-nine casualties were included who were mainly civilian (61%) and men (94%) with a mean age of 27.9 years old. Surgeons dealt with polytraumas (78%), severe injuries (mean Injury Severity Score=39.2) and penetrating wounds (96%) due to explosion in 37%, gunshot in 53% and stabbing in 9%. Most of casualties were first observed or drained (n=56). In this non-operative group more than 40% of casualties needed further actions. In the operative group, Damage Control Thoracotomy (n=22) was performed to stop ongoing bleeding and air leakage and Emergency Department Thoracotomy (n=11) for agonal patient. Casualties suffered from hemothorax (60%), pneumothorax (39%), diaphragmatic (37%), lung (35%), heart or great vessels (20%) injuries. The main actions were diaphragmatic sutures (n=25), lung resections (wedge n=6, lobectomy n=4) and haemostasis (intercostal artery ligation n=3, heart injury repairs n=5, great vessels injury repairs n=5). Overall mortality was 11%. The rate of subsequent surgery was 34%.

Conclusions: The analysis of the OPEX(®) registry reflects the thoracic surgical challenges of general (visceral) surgeons serving in combat environment during the latest Afghanistan War.
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http://dx.doi.org/10.1016/j.injury.2016.06.008DOI Listing
September 2016

Potential mechanism of acute stent thrombosis with bivalirudin following percutaneous coronary intervention in acute coronary syndromes.

Int J Cardiol 2016 Oct 28;220:496-500. Epub 2016 Jun 28.

Service de cardiologie, Centre hospitalo-universitaire, Aix-Marseille université, Assistance-Publique Hôpitaux de Marseille, Marseille, France; MARS cardio, Mediterranean Association for Research and Studies in Cardiology, Hôpital Nord, Marseille, France; Service d'hématologie Biologique, Centre hospitalo-universitaire Timone, Assistance-Publique Hôpitaux de Marseille, Marseille, France. Electronic address:

Background: Clinical trials have demonstrated an excess of acute stent thrombosis (AST) in acute coronary syndromes patients (ACS) undergoing percutaneous coronary intervention (PCI) with bivalirudin compared to heparin. We aimed to investigate the potential mechanisms responsible for thrombus formation under bivalirudin.

Methods: We compared heparin and bivalirudin during PCI for ACS in a prospective monocentre randomized study. Twenty patients were included after coronary angiography and received a loading dose (LD) of 180mg of ticagrelor at the time of PCI. They were randomly assigned to heparin (70UI/kg) intra-venous (IV) bolus or bivalirudin IV bolus of 0.75mg/kg followed by an infusion of 1.75mg/kg/h until the end of the PCI. The VASP index and thrombin generation test were used to assess the course of platelet reactivity (PR) and thrombin generation.

Results: Thrombin generation and PR were identical in both groups at baseline. There was no difference in the course of PR following the LD over time. An optimal PR inhibition was reached 4h after the LD of ticagrelor. Heparin and bivalirudin infusion effectively inhibited thrombin generation during PCI. However, 4h after the end of bivalirudin infusion, thrombin generation had returned to its baseline value whereas in the heparin group it remained significantly inhibited compared to baseline and to the bivalirudin group 4h after the end of the infusion (p<0.01 and p<0.02 respectively).

Conclusions: The present study suggests that the short half-life of bivalirudin and the quick restoration of thrombin activity at a time when optimal PR is not reached may be responsible for acute stent thrombosis. Clinicaltrial.gov: NCT02428725.
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http://dx.doi.org/10.1016/j.ijcard.2016.06.247DOI Listing
October 2016

Difficulties encountered by general practitioners during acute behavioral disturbances of their dementia patients.

Geriatr Psychol Neuropsychiatr Vieil 2016 Jun;14(2):167-74

Court séjour Alzheimer, Unité cognitivo-comportementale, Centre gérontologique départemental, Marseille, France.

Alzheimer diseases and related disorders (ADRD) remain a major public health issue. The progression of the disease is dominated by behavioral and psychological symptoms of dementia (BPSD) which are frequent and burdensome for caregivers. The aim of our survey was to study how the general practionner managed these behavioral disturbances (particularly agitation and aggressiveness) in community living patients with ADRD and support of their main caregivers. We based our study on a medical survey sent to all general practitioners (GP) practicing in four districts in Marseille near from a secure unit. Ninety five out of 260 answered to the survey and 57 had already been exposed to patients' behavioral decompensation. For these BPSD management, atypical neuroleptics and benzodiazepines were mostly prescribed, and according to the literature and guidelines. Half of the GP's recognized the weak effectiveness of this strategy. Almost all of them are interested in having a document summarizing the main strategy to be set up or a possibility to call a specialized mobile team with doctors and professionals caregivers. A few dedicated consultations were devoted to informal caregivers whereas GP were aware of negative effects of these decompensations on them. This study point out difficulties for GP to provide appropriate management for their patients with ADRD living at home and for their informal caregivers, particularly during acute behavioral disturbance, despite their practical knowledges.
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http://dx.doi.org/10.1684/pnv.2016.0601DOI Listing
June 2016

Platelet reactivity in patients receiving a maintenance dose of P2Y12-ADP receptor antagonists undergoing elective percutaneous coronary intervention.

Int J Cardiol 2016 Aug 1;216:190-3. Epub 2016 May 1.

Vascular Research Center of Marseille, INSERM UMR-S 1076, Aix-Marseille Université, Marseille, France; MARS Cardio, Mediterranean Academic association for Research and Studies in Cardiology, Marseille, France.

Background: P2Y12-ADP receptor blockade during percutaneous coronary intervention (PCI) is critical to prevent thrombotic events. In patients under chronic P2Y12 blockers, the use of additional loading dose (LD) before an elective PCI is debated. We aimed to investigate the rate of high on-treatment platelet reactivity (HTPR) in patients undergoing elective PCI during chronic clopidogrel or ticagrelor therapy.

Methods And Results: We performed a sub-group analysis of a randomized trial comparing ticagrelor and clopidogrel in acute coronary syndrome (ACS) patients undergoing PCI. Multi-vessel disease patients requiring a staged PCI one month after the ACS were included. The VASP (vasodilatatory phosphoprotein) index, which is a specific and reproducible platelet assay to measure P2Y12-ADP receptor activity, was used to assess the biological efficacy of the maintenance dose (MD) of ticagrelor and clopidogrel before PCI. Forty-one patients in each group of randomization required a staged PCI. They were similar regarding the baseline demographic, clinical and angiographic characteristics. The mean VASP index in the ticagrelor group was 20.7±8.8% compared to 51.8±17% in the clopidogrel group (p<0.001) before PCI. No patients had a VASP index ≥50% in the ticagrelor group compared to 56% in the clopidogrel group (p<0.001). Following PCI the rate of peri-procedural MI was higher in the clopidogrel group (p=0.02).

Conclusions: Unlike clopidogrel MD, ticagrelor MD achieves an optimal PR inhibition in all patients during a staged PCI.
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http://dx.doi.org/10.1016/j.ijcard.2016.04.165DOI Listing
August 2016

Late thyroid complications in survivors of childhood acute leukemia. An L.E.A. study.

Haematologica 2016 06 11;101(6):747-56. Epub 2016 Mar 11.

Department of Pediatric Hematology and Oncology, Timone Enfants Hospital and Aix-Marseille University, France Research Unit EA 3279 and Department of Public Health, Aix-Marseille University and Timone Hospital Marseille, France.

Thyroid complications are known side effects of irradiation. However, the risk of such complications in childhood acute leukemia survivors who received either central nervous system irradiation or hematopoietic stem cell transplantation is less described. We prospectively evaluated the incidence and risk factors for thyroid dysfunction and tumors in survivors of childhood acute myeloid or lymphoid leukemia. A total of 588 patients were evaluated for thyroid function, and 502 individuals were assessed for thyroid tumors (median follow-up duration: 12.6 and 12.5 years, respectively). The cumulative incidence of hypothyroidism was 17.3% (95% CI: 14.1-21.1) and 24.6% (95% CI: 20.4-29.6) at 10 and 20 years from leukemia diagnosis, respectively. Patients who received total body irradiation (with or without prior central nervous system irradiation) were at higher risk of hypothyroidism (adjusted HR: 2.87; P=0.04 and 2.79, P=0.01, respectively) as compared with transplanted patients who never received any irradiation. Patients transplanted without total body irradiation who received central nervous system irradiation were also at higher risk (adjusted HR: 3.39; P=0.02). Patients irradiated or transplanted at older than 10 years of age had a lower risk (adjusted HR: 0.61; P=0.02). Thyroid malignancy was found in 26 patients (5.2%). Among them, two patients had never received any type of irradiation: alkylating agents could also promote thyroid cancer. The cumulative incidence of thyroid malignancy was 9.6% (95% CI: 6.0-15.0) at 20 years. Women were at higher risk than men (adjusted HR: 4.74; P=0.002). In conclusion, thyroid complications are frequent among patients who undergo transplantation after total body irradiation and those who received prior central nervous system irradiation. Close monitoring is thus warranted for these patients. Clinicaltrials.gov identifier: NCT 01756599.
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http://dx.doi.org/10.3324/haematol.2015.140053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013950PMC
June 2016