Liste des publications scientifiques du CHU de Clermont-Ferrand

Cette liste prend en compte l'ensemble des publications scientifiques du CHU référencées sur PubMed de 1973 au 31.12.2020

Auteurs : Fauconnier, A; Provot, J; Le Creff, I; Dumont, A; Bouvier-Colle, MH ; et al.

Revue : Obstetrics and gynecology - ISSN : 1873-233X - NLMID : 401101
Date de Publication : Novembre 2020
Vol. : 136 Numéro 5 Pages : 912-921

Résumé : To define and assess the prevalence of potentially life-threatening gynecologic emergencies among women presenting for acute pelvic pain for the purpose of developing measures to audit quality of care in emergency departments.We conducted a mixed-methods multicenter study at gynecologic emergency departments in France and Belgium. A modified Delphi procedure was first conducted in 2014 among health care professionals to define relevant combinations of potentially life-threatening conditions and near misses in the field of gynecologic emergency care. A prospective case-cohort study in the spring of 2015 then assessed the prevalence of these potentially life-threatening emergencies and near misses among women of reproductive age presenting for acute pelvic pain. Women in the case group were identified at 21 participating centers. The control group consisted of a sample of women hospitalized for acute pelvic pain not caused by a potentially life-threatening condition and a 10% random sample of outpatients.Eight gynecologic emergencies and 17 criteria for near misses were identified using the Delphi procedure. Among the 3,825 women who presented for acute pelvic pain, 130 (3%) were considered to have a potentially life-threatening condition. The most common diagnoses were ectopic pregnancies with severe bleeding (n=54; 42%), complex pelvic inflammatory disease (n=30; 23%), adnexal torsion (n=20; 15%), hemorrhagic miscarriage (n=15; 12%), and severe appendicitis (n=6; 5%). The control group comprised 225 hospitalized women and 381 outpatients. Diagnostic errors occurred more frequently among women with potentially life-threatening emergencies than among either hospitalized (odds ratio [OR] 1.7, 95% CI 1.1-2.7) or outpatient (OR 14.7, 95% CI 8.1-26.8) women in the control group. Of the women with potentially life-threatening conditions, 26 met near-miss criteria compared with six with not potentially life-threatening conditions (OR 25.6, 95% CI 10.9-70.7).Potentially life-threatening gynecologic emergencies are high-risk conditions that Mai serve as a useful framework to improve quality and safety in emergency care.

Mesh : Adult|Belgium/epidemiology|Case-Control Studies|Delphi Technique|Emergencies|Emergency Service, Hospital/standards/statistics & numerical data|Female|France/epidemiology|Gynecology/standards/statistics & numerical data|Humans|Near Miss, Healthcare/standards/statistics & numerical data|Pelvic Pain/epidemiology/therapy|Prospective Studies|Quality Assurance, Health Care|Quality Improvement|Quality Indicators, Health Care/standards/statistics & numerical data

Auteurs : Marano, RBM; Fernandes, T; Manaia, CM; Brown, C; Cytryn, E ; et al.

Revue : Environment international - ISSN : 1873-6750 - NLMID : 7807270
Date de Publication : Août 2020
Vol. : 144

Résumé : The World Health Organization Global Action Plan recommends integrated surveillance programs as crucial strategies for monitoring antibiotic resistance. Although several national surveillance programs are in place for clinical and veterinary settings, no such schemes exist for monitoring antibiotic-resistant bacteria in the environment. In this transnational study, we developed, validated, and tested a low-cost surveillance and easy to implement approach to evaluate antibiotic resistance in wastewater treatment plants (WWTPs) by targeting cefotaxime-resistant (CTX-R) coliforms as indicators. The rationale for this approach was: i) coliform quantification methods are internationally accepted as indicators of fecal contamination in recreational waters and are therefore routinely applied in analytical labs; ii) CTX-R coliforms are clinically relevant, associated with extended-spectrum ?-lactamases (ESBLs), and are rare in pristine environments. We analyzed 57 WWTPs in 22 countries across Europe, Asia, Africa, Australia, and North America. CTX-R coliforms were ubiquitous in raw sewage and their relative abundance varied significantly (<0.1% to 38.3%), being positively correlated (p < 0.001) with regional atmospheric temperatures. Although most WWTPs removed large proportions of CTX-R coliforms, loads over 103 colony-forming units per mL were occasionally observed in final effluents. We demonstrate that CTX-R coliform monitoring is a feasible and affordable approach to assess wastewater antibiotic resistance status.

Mots clés auteurs : /Antibiotic resistance/Coliforms/ESBLs/Wastewater treatment/Water reuse

Auteurs : Payen, D; Cravat, M; Maadadi, H; Losser, MR; De Carvalho Bittencourt, M ; et al.

Revue : Frontiers in immunology - ISSN : 1664-3224 - NLMID : 101560960
Date de Publication : Octobre 2020
Vol. : 11 Pages : 580250

Résumé : Little is known about the time-dependent immune responses in severe COVID-19. Data of 15 consecutive patients were sequentially recorded from intensive care unit admission. Lymphocyte subsets and total monocyte and subsets counts were monitored as well as the expression of HLA-DR. For 5 patients, SARS-CoV-2-specific T-cell polyfunctionality was assessed against Spike and Nucleoprotein SARS-CoV-2 peptides. Non-specific inflammation markers were increased in all patients. Median monocyte HLA-DR expression was below the 8,000 AB/C threshold defining acquired immunodepression. A "V" trend curve for lymphopenia, monocyte numbers, and HLA-DR expression was observed with a nadir between days 11 and 14 after symptoms' onset. Intermediate CD14++CD16+ monocytes increased early with a reduction in classic CD14++CD16- monocytes. Polyfunctional SARS-Cov-2-specific CD4 T-cells were present and functional, whereas virus-specific CD8 T-cells were less frequent and not efficient. We report a temporal variation of both innate and adaptive immunity in severe COVID-19 patients, helpful in guiding therapeutic decisions (e.g. anti-inflammatory vs. immunostimulatory ones). We describe a defect in virus-specific CD8 T-cells, a potential biomarker of clinical severity. These combined data also provide helpful knowledge for vaccine design., identifier NCT04386395.

Mesh : Aged|Biomarkers|CD4-Positive T-Lymphocytes/immunology|CD8-Positive T-Lymphocytes/immunology|COVID-19/immunology/virology|Female|GPI-Linked Proteins/metabolism|HLA-DR Antigens/immunology|Humans|Immunity, Cellular|Lipopolysaccharide Receptors/metabolism|Longitudinal Studies|Male|Middle Aged|Monocytes/immunology|Prospective Studies|Receptors, IgG/metabolism|SARS-CoV-2/genetics/immunology|Severity of Illness Index

Mots clés auteurs : /SARS-CoV-2/antigen-specific polyfunctional T-cells/immunity/intensive care unit/monocyte HLA-DR

Auteurs : Biau, J; Thivat, E; Millardet, C; Bourhis, J; Lapeyre, M ; et al.

Revue : BMC cancer - ISSN : 1471-2407 - NLMID : 100967800
Date de Publication : Août 2020
Vol. : 20 Numéro 1 Pages : 730

Résumé : Primary surgery is usually the mainstay treatment in early-stage oropharyngeal and oral cavity cancer. Typically, neck surgery is performed. Negative tumor margins are recommended (>?5?mm). If feasible, re-resection of any positive margin is preferred. Otherwise, postoperative radiotherapy is required. Adjuvant postoperative radiotherapy can be limited to the primary site for patients with pT1-T2 tumors and negative neck exploration. Currently, both fractionated external beam radiotherapy and brachytherapy can have a role in the postoperative management of early-stage oropharyngeal and oral cavity cancer with high risk margins. Another possible alternative could be postoperative stereotactic body radiotherapy (SBRT). The aim of this study is to evaluate postoperative SBRT in the treatment of early-stage oropharyngeal and oral cavity cancer with high risk margins.The STEREO POSTOP study is a national, open-label, non-randomized phase II trial within the GORTEC network. Patients with early-stage oropharyngeal and oral cavity cancers with high risk margins indicating the need for postoperative radiation are eligible for enrollment. SBRT consists of a total dose of 36?Gy in 6 fractions over 2?weeks. The primary endpoint is severe late toxicity defined as 2-year toxicity of grade???3 according to CTCAE V4.03 classification. The secondary endpoints include acute toxicity (? 3?months), local and locoregional control, disease-free and overall survival, quality of life of patients, nutritional impact and predictive factors of toxicity. The experimental design chosen is a one-step Fleming plan design without interim analysis as the primary endpoint will be evaluated at a 2-year follow-up. Ninety patients will be recruited. The study was started in January 2018 with a 4-year enrollment period and an estimated completion in January 2024.This study is the first prospective trial to evaluate head and neck cancer postoperative SBRT in the setting of early-stage oropharyngeal and oral cavity cancers with high risk margins. SBRT is an attractive option because it delivers a highly conformal dose of radiation in a limited number of fractions (like brachytherapy but with less contraindication), with steep dose gradients resulting in reduced normal tissue irradiation and with a short overall treatment : NCT03401840 , registered on 17-1-2018. Identifier in French National Agency for the Safety of Medicines and Health Products (ANSM): N°ID - RCB 2017-A02058-45, registered on July 2017. Protocol version: Version 3 dated from 25th November 2019.

Mesh : Adult|Dose Fractionation, Radiation|France|Humans|Margins of Excision|Mouth Neoplasms/pathology/radiotherapy/surgery|Non-Randomized Controlled Trials as Topic|Oropharyngeal Neoplasms/pathology/radiotherapy/surgery|Prospective Studies|Radiosurgery/adverse effects/methods|Radiotherapy, Adjuvant|Squamous Cell Carcinoma of Head and Neck/pathology/radiotherapy/surgery

Mots clés auteurs : /Hypofractionated stereotactic body radiotherapy (SBRT)/Oropharyngeal and Oral cavity cancers/Postoperative radiotherapy

Auteurs : Roche, J; Corgosinho, FC; Isacco, L; Dâmaso, AR; Thivel, D ; et al.

Revue : Sleep medicine - ISSN : 1878-5506 - NLMID : 100898759
Date de Publication : Novembre 2020
Vol. : 75 Pages : 225-235

Résumé : Pediatric obesity and sleep-disordered breathing (SDB) are strongly associated, and both promote metabolic impairments. However, the effects of a lifestyle intervention on the overall metabolic syndrome (MetS) are unknown. The objectives were i) to evaluate the effects of a lifestyle intervention on cardiometabolic risk (CMR), assessed with a dichotomous (MetS) and a continuous (MetScoreFM) instrument, in obese adolescents with and without SDB and ii) to compare the post-intervention cardiometabolic responses between adolescents with persistent (apnea-hypopnea index; AHI?2) or normalized-SDB (AHI<2).Seventy-six adolescents with obesity recruited from two specialized institutions underwent a 9-12month diet and exercise intervention. Sleep and SDB (AHI?2) were studied by polysomnography. Anthropometric parameters, fat mass (FM), glucose, insulin, lipid and leptin profiles, blood pressure (BP), MetScoreFM and MetS were assessed pre- and post-intervention. We performed comparisons between Non-SDB and SDB groups and between Normalized-SDB and Persistent-SDB subgroups.Fifty participants completed the study. Pre-intervention, twenty youth had SDB (40%) with higher insulin concentrations and systolic BP than Non-SDB participants (p < 0.01), for a similar degree of obesity. Post-intervention, MetScoreFM (p < 0.001) and MetS prevalence (p < 0.05) were decreased in both groups. Eleven participants (55%) normalized SDB along with a decrease in insulin concentrations and BP (p < 0.05). Triglycerides, total cholesterol and LDL-cholesterol concentrations (p < 0.01) improved equally in the Normalized and Persistent-SDB subgroups.SDB was associated with lower insulin sensitivity and higher BP but did not affect the lipid profile. A diet and exercise lifestyle intervention is effective in decreasing the CMR whether or not SDB was normalized in obese adolescents.

Mots clés auteurs : /Cardiometabolic risk/Chronic exercise/Leptin resistance/Pediatric obesity/Polysomnography/Sleep apnea