Alpha-thalassemia trait and sickle trait are not commonly considered risk factors of ischemic heart disease.We report the case of a non-atherosclerotic silent myocardial infarction in a 46-year-old woman,carrier of th...Alpha-thalassemia trait and sickle trait are not commonly considered risk factors of ischemic heart disease.We report the case of a non-atherosclerotic silent myocardial infarction in a 46-year-old woman,carrier of the alphathalassemia trait(homozygous deletion of locus-3.7) combined with sickle cell trait.While the patient was included as healthy volunteer for a metabolic study,we performed cardiac magnetic resonance imagery showing a left ventricle apicolateral myocardial infarction.Coronary computed tomography angiography showed normal coronary arteries with a coronary calcium score of 0.The patient was treated with low-dose aspirin in secondary prevention afterwards.This case allows us to discuss cardiovascular risk among patients presenting with both alpha-thalassemia trait and sickle cell trait and the indication of cardiac imagery in such patients even when considered as low-cardiovascular risk.展开更多
Background:The Global Physical Activity Questionnaire(GPAQ)has been used to measure physical activity(PA)and sedentary time in France,but no study has assessed its psychometric properties.This study aimed to compare t...Background:The Global Physical Activity Questionnaire(GPAQ)has been used to measure physical activity(PA)and sedentary time in France,but no study has assessed its psychometric properties.This study aimed to compare the reliability as well as criterion and concurrent validity of the French version of the GPAQ with the French International Physical Activity Questionnaire long form(IPAQ-LF)and use of an accelerometer in a general adult population.Methods:We included 92 participants(students or staff)from the Medicine Campus at the University of Lorraine,Nancy(north-eastern France).The French GPAQ was completed twice,7 days apart,to study test-retest reliability.The IPAQ-LF was used to assess concurrent validity of the GPAQ,and participants wore an accelerometer(ActiGraph GT3X+)for 7 days to study criterion validity.Reliability as well as concurrent and criterion validity of the GPAQ were tested by the intraclass correlation coefficient(ICC),Spearman correlation coefficient for quantitative variables,and Kappa and Phi coefficients for qualitative variables.Both concurrent and criterion validity of GPAQ were assessed by Bland-Altman plots.Results:The GPAQ showed poor to good reliability(ICC=0.37-0.94;Kappa=0.50-0.62)and concurrent validity(Spearman r=0.41-0.86),but only poor criterion validity(Spearman r=-0.22-0.42).Limits of agreement for the GPAQ and accelerometer were wide,with differences between 286.5 min/week and 601.3 min/week.Conclusion:The French version of the GPAQ provides limited but acceptable reliability and validity for the measurement of PA and sedentary time.It may be used for assessing PA and sedentary time in a French adult population.展开更多
BACKGROUND FOLFIRINOX regimen is the first-line reference chemotherapy(L1)in advanced pancreatic ductal adenocarcinoma(aPDAC).FOLFOXIRI,a schedule with a lower dose of irinotecan and no bolus 5-fluorouracil,has demons...BACKGROUND FOLFIRINOX regimen is the first-line reference chemotherapy(L1)in advanced pancreatic ductal adenocarcinoma(aPDAC).FOLFOXIRI,a schedule with a lower dose of irinotecan and no bolus 5-fluorouracil,has demonstrated efficacy and feasibility in colorectal cancer.AIM To investigate the potential clinical value of FOLFOXIRI in patients with aPDAC in routine clinical practice.METHODS Analyses were derived from all consecutive aPDAC patients treated in L1 between January 2011 and December 2017 in two French institutions,with either FOLFOXIRI(n=165)or FOLFIRINOX(n=124)regimens.FOLFOXIRI consisted of irinotecan(165 mg/m2),oxaliplatin(85 mg/m2),leucovorin(200 mg/m2)and 5-fluorouracil(3200 mg/m2 as a 48-h continuous infusion)every 2 wk.Ninety-six pairs of patients were selected through propensity score matching,and clinical outcomes of the two treatment regimens were compared.RESULTS Median overall survival was 11.1 mo in the FOLFOXIRI and 11.6 mo in the FOLFIRINOX cohorts,respectively.After propensity score matching,survival rates remained similar between the two regimens in terms of overall survival(hazard ratio=1.22;P=0.219)and progression-free survival(hazard ratio=1.27;P=0.120).The objective response rate was 37.1%in the FOLFOXIRI group vs 47.8%in the FOLFIRINOX group(P=0.187).Grade 3/4 toxicities occurred in 28.7%of patients in the FOLFOXIRI cohort vs 19.5%in the FOLFIRINOX cohort(P=0.079).FOLFOXIRI was associated with a higher incidence of grade 3/4 digestive adverse events.Hematopoietic growth factors were used after each chemotherapy cycle and the low hematological toxicity rates were below 5%with both regimens.CONCLUSION FOLFOXIRI is feasible in L1 in patients with aPDAC but does not confer any therapeutic benefit as compared with FOLFIRINOX.The low hematological toxicity rates strengthened the relevance of primary prophylaxis with hematopoietic growth factors.展开更多
<strong><em>Introduction:</em></strong> Several studies demonstrate the effects of the oral supplementations on the skin while there are limited data for their effects on the nail quality in he...<strong><em>Introduction:</em></strong> Several studies demonstrate the effects of the oral supplementations on the skin while there are limited data for their effects on the nail quality in healthy individuals. Only placebo controlled double blind studies could provide the reliable data considering the physiologic nail growth. <strong><em>Objective:</em></strong> The objective of this study was to evaluate the efficacy of consumption of a micronutrient supplementation on linear nail growth and thickness. <strong><em>Subjects and Method:</em></strong> 60 healthy female volunteers aged 35 to 65 years old were enrolled, randomized blindly in treatment and placebo groups, taking one tablet per day for 3 months. The evaluation was performed on D0 and D90 ± 3 days by measuring the linear nail growth, nail thickness by high frequency ultrasound imaging and also subjects’ self-assessment. <strong><em>Results:</em></strong> All 60 subjects finished the study without any serious adverse event. At D90 both groups revealed a significant linear nail growth (5.20 ± 0.35 for treatment group (p = 0.001) and 5.15 ± 0.30 for placebo group (p = 0.001)). However, the difference between the treatment and placebo group was statistically significant (p = 0.01) demonstrating the efficacy of oral supplementation on linear nail growth. No significant difference was observed at D90 for nail thickness measured with HFUS between 2 groups. The self-assessment score regarding ?brittle nails? and ?split nails? was diminished non-significantly in both groups. <strong><em>Conclusion:</em></strong> The results observed in this trial revealed that the oral micronutrient supplementation can provide beneficial effect on nail growth. This result may be due to the whole formula as the single vitamin treatment like biotin was shown to be non-effective. A longer study would be needed to confirm the efficacy on nail thickness.展开更多
AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a...AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a first direct-acting antiviral （DAA） regimen before February 2016 and included in the French ANRS CO13 HEPAVIH cohort were eligible. Failure was defned as： （1） non-response [HCV-RNA remained detectable during treatment, at end of treatment （EOT）]; and （2） relapse （HCV-RNA suppressed at EOT but detectable thereafter）. Sequencing analysis was performed to describe prevalence of drug class-specifc RAS. Factors associated with failure were determined using logistic regression models.RESULTSAmong 559 patients, 77% had suppressed plasmaHIV-RNA 〈 50 copies/mL at DAA treatment initiation41% were cirrhotic, and 68% were HCV treatmentexperienced. Virological treatment failures occurred in22 patients and were mainly relapses （17, 77%） thenundefined failures （3, 14%） and non-responses （29%）. Mean treatment duration was 16 wk overall. Posttreatment NS3, NS5A or NS5B RAS were detected in10/14 patients with samples available for sequencinganalysis. After adjustment for age, sex, ribavirin useHCV genotype and treatment duration, low platelecount was the only factor signifcantly associated with ahigher risk of failure （OR： 6.5; 95%CI： 1.8-22.6）. CONCLUSIONOnly 3.9% HIV-HCV coinfected patients failed DAAregimens and RAS were found in 70% of those failingLow platelet count was independently associated withvirological failure.展开更多
Background:Coronavirus disease 2019(COVID-19)has been frequently complicated by severe acute respiratory distress syndrome(ARDS)with prolonged invasive ventilation.While respiratory system compliance and lung recruita...Background:Coronavirus disease 2019(COVID-19)has been frequently complicated by severe acute respiratory distress syndrome(ARDS)with prolonged invasive ventilation.While respiratory system compliance and lung recruitability have been described within the first days after ICU admission,data about their longitudinal changes are still limited.Therefore,we conducted this study to assess the evolution of respiratory system compliance and lung recruitability in patients with COVID-19–related ARDS.Method:We conducted a prospective single-center study in patients admitted for COVID-19–related ARDS during the first wave of the pandemic,from March 16,2020 to April 10,2020.Respiratory system compliance was calculated daily at clinical positive end-expiratory pressure(PEEP)during passive breathing.The potential for lung recruitment was assessed by measuring the volume derecruited between PEEP 15 cmH2 O and 5 cmH2 O,and using the calculation of the recruitment-to-inflation ratio(R/I ratio).Recruitable lung was considered when the R/I ratio was at least 0.5.The primary outcome was the evolution of respiratory mechanics over time.The secondary outcome was the evolution of lung recruitability over time.Results:Thirty-two patients were included in this study.The respiratory mechanics were assessed 222 times(7±5 times per patient).Respiratory system compliance at clinical PEEP was 29.1 mL/cmH2 O(interquartile range[IQR]:24.1–33.9 mL/cmH2 O)and decreased significantly over time(P<0.0001).Lung recruitability was assessed in 22 out of the 32 patients(60 assessments).The median volume derecruited between PEEP 15 cmH2 O and 5 cmH2 O was 246.8 mL(IQR:180.8–352.2 mL)and the median R/I ratio was 0.56(IQR:0.39–0.73).Neither changed significantly over time.The proportion of patients with recruitable lung was 50.0%(6/12)within the first 3 days after intubation,69.2%(9/13)between day 4 and day 7,and 66.7%(8/12)after day 7(P=0.7934).Conclusions:In our cohort,respiratory system compliance was low and decreased over time.The potential for lung recruitment was high and persisted despite prolonged mechanical ventilation,suggesting that maintaining high PEEP levels in the later course of COVID-19 could be adequate.展开更多
文摘Alpha-thalassemia trait and sickle trait are not commonly considered risk factors of ischemic heart disease.We report the case of a non-atherosclerotic silent myocardial infarction in a 46-year-old woman,carrier of the alphathalassemia trait(homozygous deletion of locus-3.7) combined with sickle cell trait.While the patient was included as healthy volunteer for a metabolic study,we performed cardiac magnetic resonance imagery showing a left ventricle apicolateral myocardial infarction.Coronary computed tomography angiography showed normal coronary arteries with a coronary calcium score of 0.The patient was treated with low-dose aspirin in secondary prevention afterwards.This case allows us to discuss cardiovascular risk among patients presenting with both alpha-thalassemia trait and sickle cell trait and the indication of cardiac imagery in such patients even when considered as low-cardiovascular risk.
文摘Background:The Global Physical Activity Questionnaire(GPAQ)has been used to measure physical activity(PA)and sedentary time in France,but no study has assessed its psychometric properties.This study aimed to compare the reliability as well as criterion and concurrent validity of the French version of the GPAQ with the French International Physical Activity Questionnaire long form(IPAQ-LF)and use of an accelerometer in a general adult population.Methods:We included 92 participants(students or staff)from the Medicine Campus at the University of Lorraine,Nancy(north-eastern France).The French GPAQ was completed twice,7 days apart,to study test-retest reliability.The IPAQ-LF was used to assess concurrent validity of the GPAQ,and participants wore an accelerometer(ActiGraph GT3X+)for 7 days to study criterion validity.Reliability as well as concurrent and criterion validity of the GPAQ were tested by the intraclass correlation coefficient(ICC),Spearman correlation coefficient for quantitative variables,and Kappa and Phi coefficients for qualitative variables.Both concurrent and criterion validity of GPAQ were assessed by Bland-Altman plots.Results:The GPAQ showed poor to good reliability(ICC=0.37-0.94;Kappa=0.50-0.62)and concurrent validity(Spearman r=0.41-0.86),but only poor criterion validity(Spearman r=-0.22-0.42).Limits of agreement for the GPAQ and accelerometer were wide,with differences between 286.5 min/week and 601.3 min/week.Conclusion:The French version of the GPAQ provides limited but acceptable reliability and validity for the measurement of PA and sedentary time.It may be used for assessing PA and sedentary time in a French adult population.
文摘BACKGROUND FOLFIRINOX regimen is the first-line reference chemotherapy(L1)in advanced pancreatic ductal adenocarcinoma(aPDAC).FOLFOXIRI,a schedule with a lower dose of irinotecan and no bolus 5-fluorouracil,has demonstrated efficacy and feasibility in colorectal cancer.AIM To investigate the potential clinical value of FOLFOXIRI in patients with aPDAC in routine clinical practice.METHODS Analyses were derived from all consecutive aPDAC patients treated in L1 between January 2011 and December 2017 in two French institutions,with either FOLFOXIRI(n=165)or FOLFIRINOX(n=124)regimens.FOLFOXIRI consisted of irinotecan(165 mg/m2),oxaliplatin(85 mg/m2),leucovorin(200 mg/m2)and 5-fluorouracil(3200 mg/m2 as a 48-h continuous infusion)every 2 wk.Ninety-six pairs of patients were selected through propensity score matching,and clinical outcomes of the two treatment regimens were compared.RESULTS Median overall survival was 11.1 mo in the FOLFOXIRI and 11.6 mo in the FOLFIRINOX cohorts,respectively.After propensity score matching,survival rates remained similar between the two regimens in terms of overall survival(hazard ratio=1.22;P=0.219)and progression-free survival(hazard ratio=1.27;P=0.120).The objective response rate was 37.1%in the FOLFOXIRI group vs 47.8%in the FOLFIRINOX group(P=0.187).Grade 3/4 toxicities occurred in 28.7%of patients in the FOLFOXIRI cohort vs 19.5%in the FOLFIRINOX cohort(P=0.079).FOLFOXIRI was associated with a higher incidence of grade 3/4 digestive adverse events.Hematopoietic growth factors were used after each chemotherapy cycle and the low hematological toxicity rates were below 5%with both regimens.CONCLUSION FOLFOXIRI is feasible in L1 in patients with aPDAC but does not confer any therapeutic benefit as compared with FOLFIRINOX.The low hematological toxicity rates strengthened the relevance of primary prophylaxis with hematopoietic growth factors.
文摘<strong><em>Introduction:</em></strong> Several studies demonstrate the effects of the oral supplementations on the skin while there are limited data for their effects on the nail quality in healthy individuals. Only placebo controlled double blind studies could provide the reliable data considering the physiologic nail growth. <strong><em>Objective:</em></strong> The objective of this study was to evaluate the efficacy of consumption of a micronutrient supplementation on linear nail growth and thickness. <strong><em>Subjects and Method:</em></strong> 60 healthy female volunteers aged 35 to 65 years old were enrolled, randomized blindly in treatment and placebo groups, taking one tablet per day for 3 months. The evaluation was performed on D0 and D90 ± 3 days by measuring the linear nail growth, nail thickness by high frequency ultrasound imaging and also subjects’ self-assessment. <strong><em>Results:</em></strong> All 60 subjects finished the study without any serious adverse event. At D90 both groups revealed a significant linear nail growth (5.20 ± 0.35 for treatment group (p = 0.001) and 5.15 ± 0.30 for placebo group (p = 0.001)). However, the difference between the treatment and placebo group was statistically significant (p = 0.01) demonstrating the efficacy of oral supplementation on linear nail growth. No significant difference was observed at D90 for nail thickness measured with HFUS between 2 groups. The self-assessment score regarding ?brittle nails? and ?split nails? was diminished non-significantly in both groups. <strong><em>Conclusion:</em></strong> The results observed in this trial revealed that the oral micronutrient supplementation can provide beneficial effect on nail growth. This result may be due to the whole formula as the single vitamin treatment like biotin was shown to be non-effective. A longer study would be needed to confirm the efficacy on nail thickness.
基金Supported by Inserm-ANRS(French National Institute for Health and Medical Research-ANRS/France REcherche Nord and Sud Sida-hiv Hépatites)
文摘AIMTo describe factors associated with treatment failure and frequency of resistance-associated substitutions （RAS）.METHODSHuman immunodefciency virus （HIV）/hepatitis C virus （HCV） coinfected patients starting a first direct-acting antiviral （DAA） regimen before February 2016 and included in the French ANRS CO13 HEPAVIH cohort were eligible. Failure was defned as： （1） non-response [HCV-RNA remained detectable during treatment, at end of treatment （EOT）]; and （2） relapse （HCV-RNA suppressed at EOT but detectable thereafter）. Sequencing analysis was performed to describe prevalence of drug class-specifc RAS. Factors associated with failure were determined using logistic regression models.RESULTSAmong 559 patients, 77% had suppressed plasmaHIV-RNA 〈 50 copies/mL at DAA treatment initiation41% were cirrhotic, and 68% were HCV treatmentexperienced. Virological treatment failures occurred in22 patients and were mainly relapses （17, 77%） thenundefined failures （3, 14%） and non-responses （29%）. Mean treatment duration was 16 wk overall. Posttreatment NS3, NS5A or NS5B RAS were detected in10/14 patients with samples available for sequencinganalysis. After adjustment for age, sex, ribavirin useHCV genotype and treatment duration, low platelecount was the only factor signifcantly associated with ahigher risk of failure （OR： 6.5; 95%CI： 1.8-22.6）. CONCLUSIONOnly 3.9% HIV-HCV coinfected patients failed DAAregimens and RAS were found in 70% of those failingLow platelet count was independently associated withvirological failure.
文摘Background:Coronavirus disease 2019(COVID-19)has been frequently complicated by severe acute respiratory distress syndrome(ARDS)with prolonged invasive ventilation.While respiratory system compliance and lung recruitability have been described within the first days after ICU admission,data about their longitudinal changes are still limited.Therefore,we conducted this study to assess the evolution of respiratory system compliance and lung recruitability in patients with COVID-19–related ARDS.Method:We conducted a prospective single-center study in patients admitted for COVID-19–related ARDS during the first wave of the pandemic,from March 16,2020 to April 10,2020.Respiratory system compliance was calculated daily at clinical positive end-expiratory pressure(PEEP)during passive breathing.The potential for lung recruitment was assessed by measuring the volume derecruited between PEEP 15 cmH2 O and 5 cmH2 O,and using the calculation of the recruitment-to-inflation ratio(R/I ratio).Recruitable lung was considered when the R/I ratio was at least 0.5.The primary outcome was the evolution of respiratory mechanics over time.The secondary outcome was the evolution of lung recruitability over time.Results:Thirty-two patients were included in this study.The respiratory mechanics were assessed 222 times(7±5 times per patient).Respiratory system compliance at clinical PEEP was 29.1 mL/cmH2 O(interquartile range[IQR]:24.1–33.9 mL/cmH2 O)and decreased significantly over time(P<0.0001).Lung recruitability was assessed in 22 out of the 32 patients(60 assessments).The median volume derecruited between PEEP 15 cmH2 O and 5 cmH2 O was 246.8 mL(IQR:180.8–352.2 mL)and the median R/I ratio was 0.56(IQR:0.39–0.73).Neither changed significantly over time.The proportion of patients with recruitable lung was 50.0%(6/12)within the first 3 days after intubation,69.2%(9/13)between day 4 and day 7,and 66.7%(8/12)after day 7(P=0.7934).Conclusions:In our cohort,respiratory system compliance was low and decreased over time.The potential for lung recruitment was high and persisted despite prolonged mechanical ventilation,suggesting that maintaining high PEEP levels in the later course of COVID-19 could be adequate.
