Published guidelines have a limited impact on the first prescription of antiretroviral therapy for HIV-1-infected patients in Lyon, France.
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Drug Prescriptions↗
Biomedical subjects
C Colin
Publications and source records attributed to C Colin.
Negative regulation of central nervous system myelination by polysialylated-neural cell adhesion molecule.
Many factors have been shown to promote myelination, but few have been shown to be inhibitory. Here, we show that polysialylated-neural cell adhesion molecule (PSA-NCAM) can negatively regulate myelin formation. During development, PSA-NCAM is first expressed on all growing fibers; then, axonal expression is down-regulated and myelin deposition occurs only on PSA-NCAM-negative axons. Similarly, in cocultures of oligodendrocytes and neurons, PSA-NCAM expression on axons is initially high, but decreases as myelination proceeds. Importantly, if expression of PSA-NCAM is prematurely decreased in cultures, by either antibody-mediated internalization or enzymatic removal of the PSA moieties with endoneuraminidase N (endo-N), myelination increases 4- to 5-fold. In the optic nerve, premature cleavage of PSA moieties by intravitreous injection of endo-N also induces a transient increase in the number of myelinated internodes, but does not interfere with the onset of myelination. Previously, we showed that axonal electrical activity strongly induced myelination, which could be prevented by tetrodotoxin (TTX), an action potential blocker. Interestingly, removal of PSA moieties does not reverse the inhibition of myelination by TTX. Together, this suggests that myelination is tightly controlled by both positive (electrical activity) and negative (PSA-NCAM expression) regulatory signals.
Animals↗
In vivo bone metabolism and ex vivo bone marrow osteoprogenitors in vitamin D-deprived pigs.
Vitamin D insufficiency is still a concern in countries where there is no routine food supplementation, such as France. A low vitamin D status is clearly associated with an increased risk of fracture in the elderly, but the long-term consequences of latent vitamin D insufficiency in young people and adults are not known. We fed 26 growing pigs a high calcium diet (1.1%) with a 1000 IU cholecalciferol/kg diet (controls), or without vitamin D (0D) for 4 months. We then analyzed the overall impact of low vitamin D status on osteotropic hormones (calcitriol and immunoreactive parathyroid hormone), plasma markers of bone remodeling (alkaline phosphatase [ALP] activity, carboxyterminal propeptide of type I procollagen [PICP], osteocalcin, hydroxyproline), whole bone parameters (ash content, bending moment), histomorphometry, and the populations of marrow osteoblastic and osteoclastic precursors by ex vivo cultures. The fall in plasma 25-dihydroxyvitamin [25(OH)D] in the 0D pigs indicated severe depletion of their vitamin D stores. However, they remained normocalcemic, were mildly hyperparathyroid after 2 months of vitamin D deprivation, and showed only a slight decrease in plasma calcitriol. The bone mineral content and bending moment of metatarsals decreased and they had increased osteoblastic (+59%, p < 0.05 0D vs. controls) and osteoclastic (+31%, p < 0.1 0D vs. controls) surfaces. This was not paralleled by increased bone turnover, because plasma hydroxyproline and ALP were unchanged and PICP and osteocalcin were decreased. The adherent fraction of bone marrow cells showed a great increase in the number of total stromal colony-forming units (CFU-F; +93%, p < 0.05 0D vs. controls) and in the percent of ALP(+) CFU-F (+58%, p < 0.01 0D vs. controls) in cultures from 0D pigs. More tartrate-resistant acid phosphatase-positive (TRAP(+)) multinucleated cells were generated in cultures of nonadherent marrow cells from 0D pigs, and the area of resorption was 345% greater than in controls. Thus, vitamin D deprivation caused only moderate hormonal changes in growing pigs fed a high-calcium diet, but affected their bone characteristics and greatly enhanced the pool of osteoblasts and osteoclasts by stimulating the commitment of their precursors in bone marrow.
Animals↗
Unjustified variations in patient management for acute myocardial infarction in the Rhône-Alpes region of France. PRIMA Group.
OBJECTIVES: To examine determinants of use of cardiac procedures after acute myocardial infarction and identify variation factors. METHODS: Observational prospective cohort study of 2,519 patients in 48 centers with a two-level logistic-regression analysis. RESULTS: Elderly patients were less likely to undergo pre- and inhospital thrombolysis (odds ratios, 0.71 and 0.64; 95% CI, 0.62-0.81 and 0.58-0.69, respectively). The elderly, females, and patients with heart failure on admission were less likely to undergo noninvasive tests (0.74, 0.62, and 0.51; 95% CI, 0.67-0.81, 0.46-0.83, and 0.38-0.68, respectively) and coronary angiography (0.38, 0.53, and 0.67; 95% CI, 0.34-0.42, 0.38-0.74, and 0.52-0.86, respectively) but not revascularization. Hospital factors were more difficult to interpret. CONCLUSIONS: Elderly, women, and heart failure patients underwent fewer cardiac procedures than lower-risk patients. Physicians should change their attitude toward these groups and use advanced procedures, bearing in mind the patients' needs rather than good procedural outcomes.
Age Factors↗
Epidemiology of hepatitis C virus infection in seven European Union countries: a critical analysis of the literature. HENCORE Group. (Hepatitis C European Network for Co-operative Research.
Hepatitis C is now recognized as the most common infection causing chronic liver disease in the European population. Our aim was to assess the prevalence of the antibody to hepatitis C virus (HCV), and the incidence of HCV seroconversion in the general population and the main risk groups, namely intravenous drug users, haemodialysis and transfused patients, in seven countries of the European Union, by carrying out a critical analysis of the literature. Data sources used were the Medline database and a manual search using the key words: hepatitis C, prevalence, incidence, transmission, risk factors and epidemiology. Articles published between January 1990 and March 1997 were reviewed. Articles were reviewed according to a critical analysis method regarding title, type of article, study design, period and population, tests, results and their consistency with data. The tests performed were mainly second- or third-generation serological tests. The average prevalence rate in blood donors was 1%, with a north-south gradient ranging from 0.04% to 2%. Prevalence varied from 20% to 30% in haemodialysis patients. The incidence in transfused patients was less than 1% after 1991. The prevalence in intravenous drug users was about 80%. Multicentre studies conducted in larger samples are needed to obtain more accurate and reliable results, in particular. However, the epidemiological studies available allowed us to assess the magnitude of HCV infection in Europe.
Europe↗
Fair comparison of mortality data following cardiac surgery.
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Cardiology Service, Hospital↗
Characteristics, management, and in-hospital mortality of acute myocardial infarction in the "real world" in France--data from a large unselected cohort of 2,519 consecutive patients in a French region.
OBJECTIVE: The prospective PRIMA study (Prise en charge de l'Infarctus du Myocarde Aigu; management of acute MI) sought to determine characteristics, management, and in-hospital mortality of myocardial infarction (MI), regardless of age and hospital facilities, in the "real world" in a region in France. METHODS AND RESULTS: Data were prospectively collected in all patients with MI admitted in all hospitals in three departments in the Rh ne-Alpes region between September 1, 1993 and January 31, 1995. 2,519 patients (68% men; mean +/- SD: 68 +/- 14 years) were included. Time from onset of symptoms to admission was < 6 h in 56% of the patients (median: 4 h 30 min). MI was non-Q wave in 12%. Among Q wave MI, location was anterior in 44%. At admission, Killip class was > 1 in 33%. The overall rate of thrombolysis was 36%. It was significantly higher in men than in women, in younger patients than in older patients, in lower Killip classes, in Q wave MI, and when the delay before initial medical intervention was < 6 hours. After age-adjustment, there was no difference between men and women for thrombolysis rate (odds ratio women/men: 0.92; p = 0.10). During the first 5 days, Killip class worsened in 17%. In-hospital mortality rate was 14%. Multivariate analysis identified age, anterior location, presence of Q waves, and higher Killip classes as significant predictors of in-hospital mortality. CONCLUSIONS: This large unselected cohort revealed that among patients with MI in a French region, there was a high proportion of elderly patients, a low rate of thrombolysis, and a high in-hospital mortality.
Age of Onset↗
[Supraconservative breast surgery].
Currently, 30% of the breast biopsies are performed for patients with nonpalpable lesions. The surgical management of these lesions had to evolve to a better three-dimensional targeting and a reduction of the tissue traumatism. The ABBI procedure allows the percutaneous one bloc excision of suspicious mammographically detected lesions with a diameter of less than 2cm. We prospectively evaluated this procedure as a therapeutic tool. Of the 10 malignant lesions with a pathologic size <10mm, 9 (90%) were completely resected with the ABBI device (no residual disease at re-excision of the biopsy site). The results of this preliminary study suggest a potential therapeutic role of the ABBI procedure in the therapeutic arsenal against mammary lesions.
Biopsy↗
[The Edinburgh Postnatal Depression Scale: the validity of its Quebec version for a population low socioeconomic status mothers].
This paper investigates the construct validity and reliability of a Quebec version of the Edinburgh Postnatal Depression Scale (EPDS) for a population of low-socioeconomic-status mothers. This scale was constructed for the specific purpose of measuring mothers' symptoms of depression during the postnatal period in an effort to alleviate the validity problems that could arise from depression scales intended for the general population. Two hundred and twenty-four mothers participating in a Quebec prevention program, "Naître égaux, grandir en santé" (Martin & Boyer, 1995) filled out the EPDS between the 22nd and the 35th day postpartum. A confirmatory factor analysis, conducted with LISREL, gives a 2-factor structure for the EPDS, the first representing symptoms of depression and the second symptoms of anxiety. This structure differs from the one presented by Cox, Holden, and Sagovsky (1987), authors of the EPDS. It corresponds, however to the results of other authors who looked at the EPDS with confirmatory factor analysis (Pop, Komproe, & van Son, 1992) and indicates a good construct validity. The reliability of the scale also appears satisfactory, with a Cronbach alpha co-efficient of 0.82.
Adolescent↗
[Audit on the quality of medical records in oncology at the Lyon civic hospices].
OBJECTIVE: Assess the quality of information contained in the medical files of patients with cancer pathology. PATIENTS AND METHODS: Eighty medical files from patients cared for in the cancerology units of the Lyons civil hospices were retrospectively analyzed to determine information quality. Prior to the audit, the health care teams established a set of consensus standards to compared with observed procedures. After data collection and analysis of the results, observed departures from the standards led to propositions for guidelines designed to improve points where significant deviations were observed. RESULTS: For certain items, the medical files did not always contain the expected data. Significant deviations were observed for important data such as postal code of birth, pTNM classification, presence of pathology report, codified evaluation of general status. CONCLUSION: Management of these patients requires more rigorous record keeping and classing of appropriate data. A unique data sheet is proposed for all cancer. This should be a computerized sheet with a cancerology reference in each medical unit.
Data Collection↗
[Interpretation of epidemiologic studies. Type of study, elements of bias, causality].
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Bias↗
[Program for medicalization of the information systems in France: tool for management and quality assessment?].
OBJECTIVE: We analyzed data reported in the scientific literature to assess how the program for medicalizing information systems employed in France for budget management and allocation could be used to evaluate health care quality. A MANAGEMENT TOOL: In France the PMSI (Programme de Médicalisation des Systèmes d'Information) is used outside health care facilities to plan an allocate health care budgets. Within each facility, it can be used to coordinate external and internal resource allocations. The goal is to medicalize management decisions. Certain methods are based on calculations of total costs per hospital stay and others on the construction of budgets for individual units. A QUALITY ASSESSMENT TOOL: Medical criteria of final outcome of health care, for example mortality, are widely used for inter-hospital comparisons. The PMSI can be a useful tool for monitoring inter-hospital comparisons if three prerequisites are met: comparable data, identification of convenient tracers of care episodes or clinical situations, and multifactorial adjustment to account for variations in rates. The most widely used adjustment factors concern patient characteristics: age, sex, case severity, comorbidity, socio-economic level and hospital characteristics: size and status, number of stays and interventions, emergency and intensive care activity, referral practices.
Delivery of Health Care↗
Calcium-regulating hormones, bone mineral content, breaking load and trabecular remodeling are altered in growing pigs fed calcium-deficient diets.
Studies on calcium nutrition in appropriate large animal models can be directly relevant to humans. We have examined the effect of dietary Ca deficiency on various bone and bone-related variables, including plasma markers, histomorphometry, mineral content and breaking strength in pigs. Three groups of eight 38-d-old female pigs were fed adequate (0.9%; control), low (0.4%; LCa) or very low (0.1%; VLCa) Ca diets for 32 d. Plasma Ca significantly decreased over time only in the VLCa-deficient pigs. The concentrations of the parathyroid hormones (PTH) and calcitriol increased as Ca deficiency developed, and the plasma PTH and calcitriol levels varied inversely with dietary Ca. The total bone ash contents, bending moments, trabecular bone volume and the mineral apposition rate all decreased as the calcium intake decreased. The osteoclast surface areas were greater than those of controls in both Ca-deficient groups, whereas the osteoblast surface areas were greater only in the VLCa group. The plasma osteoblast-related markers (alkaline phosphatase, carboxy-terminal propeptide of type I procollagen and osteocalcin) were either greater or unaffected in the Ca-deficient pigs. The results indicate that deficient bone mineralization combined with an increased bone resorption led to bone loss and fragility. The differences in the changes in bone cells (number and activity) between LCa and VLCa groups might be due to differences (time and extent) of circulating PTH and calcitriol. The defective mineralization in both Ca-depleted groups resulted mainly from the lack of Ca because their osteoblast activity was either maintained or stimulated. The results also underline the progressive sensitivity of pigs to Ca supply and the usefulness of this model.
Animals↗
[Economic impact of the consensus conference guidelines on postoperative artificial nutrition in the Rhone-Alps region].
OBJECTIVES: To assess the economic impact of the French guidelines produced by the 1994 consensus conference on postoperative artificial nutrition (AN) in elective surgery. STUDY DESIGN: Multicentre before-after study, conducted on a cost-containment model from the hospital perspective. PATIENTS AND METHODS: Ten hospitals were randomly selected in the Rhône-Alpes area, after a stratification of hospital category. Twenty consecutive patients, who underwent upper and lower abdominal surgery in each hospital, were included over each study period. Data were collected on site by investigators from patients' records before (1994) and after (1995) guidelines had been circulated. The calculated costs were direct and partial medical and non medical staff costs of a one-day parenteral nutrition. They included nutrients, disposable devices, staff time and laboratory tests. RESULTS: Between 1994 and 1995, the study showed a 7.4% decrease in the postoperative prescription rate of AN, a 4.7% increase in the duration of AN and a 3.6% (FF 74.07 constant francs per patient) increase in the total cost of AN in surgical patients. Guidelines had mainly a positive impact in patients suffering from denutrition, as the duration of postoperative AN increased by 23.7% in this group, leading to a 65.1% (FF 175.53) increase in cost in 1995. CONCLUSIONS: The cost variable is a valuable indicator of the impact of practice guidelines, as it includes the rate and duration of prescriptions. The consensus conference had a significant impact in patients suffering from denutrition. Conversely, only minor changes in practices concerning patients non suffering from denutrition have been observed, leading to a slight cost increase in AN.
Aged↗
[An internet mastology site].
Impact factors of a senologic french site on Internet produce after 33 months a result of 183 lectures by month with a mean of 17 different pages by session. The introduction of new french-english chapters with special attention for professionals gives an exponential growth of the audience.
Breast Neoplasms↗
[Mammary pathology].
Mammary pathology is dominated by breast cancer. We will successively review various therapeutic consensus, high risk factors, bordeline lesions and carcinomas in situ.
Breast↗
[Hidden factors of breast cancer: recommended follow-up for hyperplasia or carcinoma in situ].
After the diagnosis of breast epithelial hyperplasia or carcinoma in situ, the clinical follow-up must take into account several parameters. First, the adequacy of the diagnostic and the therapeutic approach is to be evaluated. Second, the patient must be informed of her risk of subsequent breast cancer. In such a protocol, one can recommend a program of close follow-up in an attempt at early detection. An annual clinical examination combined with a mammographic and a sonographic exam is considered as the method of choice. In between annual check-ups, clinical exam is encouraged. The potential benefits of magnetic-resonance imaging in these circumstances is currently evaluated. In rare instances, the absolute risk of breast cancer is so high that a prophylactic mastectomy can be considered.
Breast Neoplasms↗
Wound infection in open versus laparoscopic appendectomy. A meta-analysis.
The authors performed a meta-analysis to determine whether open or laparoscopic appendectomy would reduce wound infection incidence in adult patients with acute appendicitis. The meta-analysis included nine of seven patients from eight randomized controlled trials. Data were analyzed using the fixed effect-model method of Mantel-Haenszel. Wound infection incidence was lower in the laparoscopic group.
Acute Disease↗