Malnutrition impact on stroke outcome: an analysis of a patient cohort 3 months after recanalization treatment

Background: Malnutrition is thought to affect 30% to 70% of hospitalized patients. Little is known about consequences of undernutrition during the acute phase of stroke. We would like to assess the impact of pre-infarction malnutrition on stroke patients treated with thrombolysis and/ or thrombectomy. Material and methods: We performed a retrospective observational study on a cohort of stroke patients who benefited from thrombolysis and/ or thrombectomy during 2015 in Saint Joseph Hospital’s Stroke Unit. The main objective of our research was to observe the clinical course of undernourished patients compared to the non-undernourished ones, using the NIHSS score at the stroke unit discharged and the 3 months modified Rankin score. Undernutrition was defined by a body mass index of (BMI) ≤ 21. Results: A total of 81 patients with thrombolysis and/or thrombectomy treatment were included. The median BMI in < 70-year-old patients was 24.5 and 25 in > 70-year-old patients. Initial severity measured by baseline NIHSS score was comparable among the undernourished and non-undernourished patients. Undernourished patients over 70 had a more severe neurological state at discharge (NIHSS 8.5 versus 3.9, NS) and were more disabled 3 months after discharge (Rankin 3.1 versus 2, NS). Conclusions: Undernutrition prior to stroke seems to have an impact on the functional prognosis of cerebral infarction, especially in patients > 70 years of age. Lack of significant results may be explained by the limited statistical means. A complementary study with a larger cohort is planned in order to assess this hypothesis

De l'hypertension artérielle à l'accident vasculaire cérébral (mécanique et pharmacologie de l'athérosclérose carotidienne : approche fondamentale vers la prise en charge éducative du patient convalescent d'un accident vasculaire cérébral)

PARIS-BIUP (751062107) / SudocSudocFranceF

Pharmacologie et mécanique de la plaque d'athérosclérose

Nos travaux portent sur le rôle de la rigidité artérielle (RA) dans la mécanique de la paroi athéroscléreuse carotidienne pour comprendre le phénomène de rupture de plaque chez l hypertendu essentiel. Nous mesurons les paramètres mécaniques de l artère carotide commune (ACC) grâce à une nouvelle technique non invasive d échotracking haute résolution, l Artlab®. Nous avons quantifié les changements des microconstituants intra-pariétaux en fonction de l âge et de l hypertension artérielle (HTA) grâce à un modèle mécanique de l ACC. La RA explique les altérations dues à l HTA et pourrait aussi avoir un rôle majeur sur le comportement d un segment artériel porteur de plaque. Deux types opposés de contraintes de courbure ont été mis en évidence sur l ACC: le type A (paroi avec plaque plus distensible que la paroi adjacente) et le type B. Nous avons défini les déterminants du type B au niveau de la plaque d athérosclérose (Beaussier, Hypertension 2008): l HTA, le remodelage externe et l absence de traitement par les antagonistes du système rénine angiotensine (ASRA). Les patients hypertendus essentiels ont une paroi carotidienne plus rigide au niveau de la plaque (risque accru de rupture); les ASRA protégeraient contre le type B. Nous avons corrélé les propriétés mécaniques (échotracking) à la composition de la plaque d athérosclérose (IRM). Le type B est plus souvent associé à des plaques de composition complexe , riches en lipide et à un remodelage externe. Ces caractéristiques sont celles de la plaque vulnérable , à plus fort risque de rupture. Le type B pourrait donc être une caractéristique mécanique des plaques vulnérablesOur research is based on the role of arterial stiffness in the atherosclerotic carotid wall mechanics to understand plaque rupture in essential hypertensive patients. All mechanical parameters were measured on the common carotid artery (CCA) segment by a non-invasive echotracking system, the ArtLab®. We have modelled the in vivo mechanical behavior of human CCAs to quantify contributions of micro-constituents with age and hypertension. Arterial stiffness could explain changes in mechanical characteristics of wall micro-constituents in hypertension and atherosclerotic arterial wall behaviour in response to mechanical strains. Two opposite patterns of longitudinal bending strain (BS) has been shown in atherosclerotic plaques on the CCA: inward BS (pattern B), i.e. lower radial strain at the plaque level than adjacent segment, and outward BS (pattern A). We have defined determinants of the pattern B (Beaussier, Hypertension 2008): essential hypertension, outer remodelling and absence of renin-angiotensin system (RAS) blockers. Arterial wall of hypertensive patients are less elastic at the site of the plaque, exposing the plaque to a greater risk of rupture. RAS blockers could protect against inward BS. We have correlated the arterial mechanics of carotid atherosclerotic plaques (echotracking) with their composition (MRI). We have shown that inward BS pattern are more often associated with complex plaques, with lipid rich core and with an outer remodelling; these are structural characteristics of vulnerable plaque, prone to rupture. This suggested that inward BS is a mechanical feature of vulnerable plaquesPARIS-BIUP (751062107) / SudocSudocFranceF

Acétate d'abiratérone (optimisation de la prise en charge des patients et anticipation du passage en ville de cette nouvelle hormonothérapie)

PARIS-BIUP (751062107) / SudocSudocFranceF

Electrochemical Skin Conductance as a Marker of Painful Oxaliplatin-Induced Peripheral Neuropathy

Purpose. Oxaliplatin is a platinum compound widely used in gastrointestinal cancer treatment but produces dose-limiting peripheral neuropathy. New insights into oxaliplatin-induced peripheral neuropathy (OIPN) assessment are needed to detect more effectively this condition. In this context, we conducted Canaloxa study, a prospective preliminary clinical trial that aimed to investigate how Electrochemical Skin Conductance (ESC), a parameter used in small fiber neuropathy assessment, could be helpful in OIPN diagnosis. Methods. Cancer patients treated for at least three months with oxaliplatin and suffering from clinically OIPN were included. Electrochemical Skin Conductance, thermal thresholds, and neuropathic pain were assessed in all included patients. Results. During one year, 36 patients were included. The main result was the correlation between ESC and Neuropathic Pain Symptom Inventory score for hands (rho value = -0.69, p < 0.0001) and feet (rho value = -0.79, p < 0.0001). ESC values were lower in neuropathic patients with painful symptoms than in ones without painful symptoms (p = 0.0003 and p < 0.0001 for hands and feet, respectively). No correlation was observed between ESC and thermal thresholds. Conclusion. These preliminary data suggest that ESC could be a useful objective marker of painful oxaliplatin-induced neuropathy and could complement the use of subjective clinical scales. This study was prospectively registered on clinicaltrials.gov (NCT02827916) before patient recruitment has begun

Assessment of Bowel Wall Enhancement for the Diagnosis of Intestinal Ischemia in Patients with Small Bowel Obstruction: Value of Adding Unenhanced CT to Contrast-enhanced CT

International audiencePurpose To determine whether adding unenhanced computed tomography (CT) to contrast material-enhanced CT improves the diagnostic performance of decreased bowel wall enhancement as a sign of ischemia complicating mechanical small bowel obstruction (SBO). Materials and Methods This retrospective study was approved by the institutional review board, which waived the requirement for informed consent. Two gastrointestinal radiologists independently performed retrospective assessments of 164 unenhanced and contrast-enhanced CT studies from 158 consecutive patients (mean age, 71.2 years) with mechanical SBO. The reference standard was the intraoperative and/or histologic diagnosis (in 80 cases) or results from clinical follow-up in patients who did not undergo surgery (84 cases). Decreased bowel wall enhancement was evaluated with contrast-enhanced images then and both unenhanced and contrast-enhanced images 1 month later. Diagnostic performance of decreased bowel wall enhancement and confidence in the diagnosis were compared between the two readings by using McNemar and Wilcoxon signed rank tests. Interobserver agreement was assessed by using κ statistics and compared with bootstrapping. Results Ischemia was diagnosed in 41 of 164 (25%) episodes of SBO. For both observers, adding unenhanced images improved decreased bowel wall enhancement sensitivity (observer 1: 46.3% [19 of 41] vs 65.8% [27 of 41], P = .02; observer 2: 56.1% [23 of 41] vs 63.4% [26 of 41], P = .45), Youden index (from 0.41 to 0.58 for observer 1 and from 0.42 to 0.61 for observer 2), and confidence score (P < .001 for both). Specificity significantly increased for observer 2 (84.5% [104 of 123] vs 94.3% [116 of 123], P = .002), and interobserver agreement significantly increased, from moderate (κ = 0.48) to excellent (κ = 0.89; P < .0001). Conclusion Adding unenhanced CT to contrast-enhanced CT improved the sensitivity, diagnostic confidence, and interobserver agreement of the diagnosis of ischemia, a complication of mechanical SBO, on the basis of decreased bowel wall enhancement. (©) RSNA, 2016

Computer-based tailored dietary counseling improves the nutrient adequacy of the diet of French pregnant women: a randomized controlled trial

International audienceDuring pregnancy, mothers-to-be should adapt their diet to meet increases in nutrient requirements. Pregnant women appear to be keener to adopt healthier diets, but not always successful.The objective of this study was to determine whether a guided, stepwise and tailored dietary counseling program, designed using an optimization algorithm, could improve the nutrient adequacy of the diet of pregnant women, beyond generic guidelines.80 pregnant women who attended Notre-Dame-de-Bon-Secours Maternity Clinic were randomly allocated to the control or intervention arms. Dietary data were obtained twice from an online 3-day dietary record. The nutrient adequacy of the diet was calculated using the PANDiet score, a 100-point diet quality index adapted to the specific nutrient requirements for pregnancy. Women were supplied with generic dietary guidelines in a reference booklet. In the intervention arm, they also received nine sets of tailored dietary advice identified by an optimization algorithm as best improving their PANDiet score.78 pregnant women completed the 12-week dietary follow-up. Initial PANDiet scores were similar in the control and intervention arms (60.4±7.3 vs 60.3±7.3, P=0.92). The PANDiet score increased in the intervention arm (+3.6±9.3, P=0.02) but not in the control arm (-0.3±7.3, P=0.77), and these changes differed between arms (P=0.04). In the intervention arm, there were improvements in the probabilities of adequacy for ALA, thiamin, folate and cholesterol intakes (P<0.05).Tailored dietary counseling using a computer-based algorithm is more effective than generic dietary counseling alone in improving the nutrient adequacy of the diet of French women in mid-pregnancy

Epidemiological Study to Assess the Prevalence of Lung Cancer in patients with smoking-associated atherosclerotic cardiovascular diseases: PREVALUNG study protocol

International audienceEligibility criteria definition for a lung cancer screening (LCS) is an unmet need. We hypothesised that patients with a history of atheromatous cardiovascular disease (ACVD) associated with tobacco consumption are at risk of lung cancer (LC). The main objective is to assess LC prevalence among patients with ACVD and history of tobacco consumption by using low-dose chest CT scan. Secondary objectives include the evaluation LCS in this population and the constitution of a biological biobank to stratify risk of LC

Prevalence and characteristics of pulmonary embolism in 1042 COVID-19 patients with respiratory symptoms: A nested case-control study

International audienceIntroduction: Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular complications and coagulation disorders. Previous studies reported pulmonary embolism (PE) in severe COVID-19 patients. Aim of the study was to estimate the prevalence of symptomatic PE in COVID-19 patients and to identify the clinical, radiological or biological characteristics associated with PE.Patients/methods: We conducted a retrospective nested case-control study in 2 French hospitals. Controls were matched in a 1:2 ratio on the basis of age, sex and center. PE patients with COVID-19 were compared to patients in whom PE was ruled out (CTPA controls) and in whom PE has not been investigated (CT controls).Results: PE was suspected in 269 patients among 1042 COVID-19 patients, and confirmed in 59 patients (5.6%). Half of PE was diagnosed at COVID-19 diagnosis. PE patients did not differ from CT and CTPA controls for thrombosis risk factors. PE patients more often required invasive ventilation compared to CTPA controls (odds ratio (OR) 2.79; 95% confidence interval (CI) 1.33-5.84) and to CT controls (OR 8.07; 95% CI 2.70-23.82). PE patients exhibited more extensive parenchymal lesions (>50%) than CT controls (OR 3.90; 95% CI 1.54-9.94). D-dimer levels were 5.1 (95% CI 1.90-13.76) times higher in PE patients than CTPA controls.Conclusions: Our results suggest a PE prevalence in COVID-19 patients close to 5% in the whole population and to 20% of the clinically suspected population. PE seems to be associated with more extensive lung damage and to require more frequently invasive ventilation