Impact of comorbidity indexes on non-relapse mortality.

Comorbidity indexes (CI) have been reported to predict non-relapse mortality (NRM) and overall survival after allogeneic hematopoietic stem cell transplantation (HSCT) (Charlson's comorbidity index (CCI), hematopoietic cell transplantation CI (HCT-CI) and the pre-transplantation assessment of mortality (PAM) score). Which of these indexes best predict survival is unknown yet. We retrospectively studied 286 patients who underwent allogeneic HSCT. HCT-CI and PAM scores required grading according to pre-transplant pulmonary function tests (PFTs), which were lacking for some patients. We thus designed a reduced HCT-CI and an adjusted PAM, without results of PFTs. Using CCI, 25% of patients had indexes of 1 or more; median reduced HCT-CI score was 1; median adjusted PAM score was 24. The discriminative properties of the three CIs were rather low in our population. Comparison of patients and transplant characteristics between our and Seattle group's cohorts, however, revealed significant differences in more children, in more cord blood HSCT and in HSCT for Fanconi anemia in St Louis. Finally, multivariate analysis of scoring items revealed that age, matched unrelated or mismatched donor and hepatic disease were associated with NRM in our cohort. Translating use for patient's counseling or decision to proceed to transplant of these CIs will need prospective studies in a large independent cohort

Unrelated donor bone marrow transplantation using a chemotherapy-only preparative regimen for adults with high-risk acute myelogenous leukemia

Limited data are available for adults undergoing unrelated donor (URD) BMT for AML using chemotherapy-only preparative regimens. Previous studies incorporated irradiation, included adults and children, and excluded secondary leukemia. Herein we report long-term outcomes for adults with poor-prognostic AML receiving a novel regimen of busulfan (16 mg/kg), cytarabine (8,000 mg/m 2 ), and cyclophosphamide (120 mg/kg) (BAC), followed by URD BMT. From June 1995 through October 2001, 45 adults were enrolled. Adverse features included unfavorable cytogenetics (49%), secondary AML (47%), leukemia at transplant (42%), and extramedullary disease (16%). At time of BMT, 23 were in remission (12 CR1) while 22 had leukemia. Four (9%) died early. Acute and chronic GVHD rates were 44 and 67%, respectively. Seventeen (38%) were disease-free 52 months post-BMT; 13 were leukemia-free (eight CR1) at transplant. Eleven relapsed. Three-year DFS and OS were 42 and 46%, respectively. DFS and OS were longer, and relapses less, for those in CR at time of BMT. Secondary leukemia, cytogenetics, cell dose, and GVHD did not influence outcome. In poor-risk AML, BAC provided cytoreduction comparable to reported TBI-containing regimens, when administered for URD BMT. With decreasing treatment-related mortality, it is justified to proceed early to URD BMT for patients with poor prognostic features. Am. J. Hematol., 2006. © 2006 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55885/1/20759_ftp.pd

Stream segregation of concurrent speech and the verbal transformation effect:influence of fundamental frequency and lateralization cues

Repeating a recorded word produces verbal transformations (VTs); perceptual regrouping of acoustic-phonetic segments may contribute to this effect. The influence of fundamental frequency (F0) and lateralization grouping cues was explored by presenting two concurrent sequences of the same word resynthesized on different F0s (100 and 178 Hz). In experiment 1, listeners monitored both sequences simultaneously, reporting for each any change in stimulus identity. Three lateralization conditions were used – diotic, ±680-μs interaural time difference, and dichotic. Results were similar for the first two conditions, but fewer forms and later initial transformations were reported in the dichotic condition. This suggests that large lateralization differences per se have little effect – rather, there are more possibilities for regrouping when each ear receives both sequences. In the dichotic condition, VTs reported for one sequence were also more independent of those reported for the other. Experiment 2 used diotic stimuli and explored the effect of the number of sequences presented and monitored. The most forms and earliest transformations were reported when two sequences were presented but only one was monitored, indicating that high task demands decreased reporting of VTs for concurrent sequences. Overall, these findings support the idea that perceptual regrouping contributes to the VT effect

Interactions audiovisuelles pour l'analyse de scènes auditives

Perceive speech in noise is a complex operation for our perceptual system. To achieve this auditory scene analysis, we involve mechanisms of auditory streaming. We can also read lips to improve our understanding of speech. The intial hypothesis, presented in this thesis, is that visual benefit could be partly based on interactions between the visual input and the auditory streaming mechanisms. Studies conduced here shows that when the audiovisual coherence is strong, primary streaming mechanisms can be strengthened. Late segregation mechanisms, meanwhile, have been shown as involving attentional processes. These attentional processes could therefore be strengthened by the presentation of a visual cue linked perceptually to auditory signal. It appears that binding between a stream of vowels and a elementary visual cue can occur but is less strong than when the visual cue contained phonetic information. In conclusion, the results presented in this work suggest that the mechanisms of auditory streaming can be influenced by a visual cue as long as the audiovisual coherence is important as in the case of speech.Percevoir la parole dans le bruit représente une opération complexe pour notre système perceptif. Pour parvenir à analyser cette scène auditive, nous mettons en place des mécanismes de ségrégation auditive. Nous pouvons également lire sur les lèvres pour améliorer notre compréhension de la parole. L'hypothèse initiale, présentée dans ce travail de thèse, est que ce bénéfice visuel pourrait en partie reposer sur des interactions entre l'information visuelle et les mécanismes de ségrégation auditive. Les travaux réalisés montrent que lorsque la cohérence audiovisuelle est importante, les mécanismes de ségrégation précoce peuvent être renforcés. Les mécanismes de ségrégation tardives, quant à eux, ont été démontré comme mettant en jeu des processus attentionnels. Ces processus attentionnels pourraient donc être renforcés par la présentation d'un indice visuel lié perceptivement. Il apparaît que ce liage entre un flux de voyelles et un indice visuel élémentaire est possible mais cependant moins fort que lorsque l'indice visuel possède un contenu phonétique. En conclusion, les résultats présentés dans ce travail suggèrent que les mécanismes de ségrégation auditive puissent être influencés par un indice visuel pour peu que la cohérence audiovisuelle soit importante comme dans le cas de la parole

Audiovisual interactions for auditory scene analysis

Percevoir la parole dans le bruit représente une opération complexe pour notre système perceptif. Pour parvenir à analyser cette scène auditive, nous mettons en place des mécanismes de ségrégation auditive. Nous pouvons également lire sur les lèvres pour améliorer notre compréhension de la parole. L'hypothèse initiale, présentée dans ce travail de thèse, est que ce bénéfice visuel pourrait en partie reposer sur des interactions entre l'information visuelle et les mécanismes de ségrégation auditive. Les travaux réalisés montrent que lorsque la cohérence audiovisuelle est importante, les mécanismes de ségrégation précoce peuvent être renforcés. Les mécanismes de ségrégation tardives, quant à eux, ont été démontré comme mettant en jeu des processus attentionnels. Ces processus attentionnels pourraient donc être renforcés par la présentation d'un indice visuel lié perceptivement. Il apparaît que ce liage entre un flux de voyelles et un indice visuel élémentaire est possible mais cependant moins fort que lorsque l'indice visuel possède un contenu phonétique. En conclusion, les résultats présentés dans ce travail suggèrent que les mécanismes de ségrégation auditive puissent être influencés par un indice visuel pour peu que la cohérence audiovisuelle soit importante comme dans le cas de la parole.Perceive speech in noise is a complex operation for our perceptual system. To achieve this auditory scene analysis, we involve mechanisms of auditory streaming. We can also read lips to improve our understanding of speech. The intial hypothesis, presented in this thesis, is that visual benefit could be partly based on interactions between the visual input and the auditory streaming mechanisms. Studies conduced here shows that when the audiovisual coherence is strong, primary streaming mechanisms can be strengthened. Late segregation mechanisms, meanwhile, have been shown as involving attentional processes. These attentional processes could therefore be strengthened by the presentation of a visual cue linked perceptually to auditory signal. It appears that binding between a stream of vowels and a elementary visual cue can occur but is less strong than when the visual cue contained phonetic information. In conclusion, the results presented in this work suggest that the mechanisms of auditory streaming can be influenced by a visual cue as long as the audiovisual coherence is important as in the case of speech

Paralysie périodique thyrotoxique (à propos de trois cas personnels)

Trois observations personnelles de paralysie périodique thyrotoxique avec hypokaliémie sont rapportées, deux d'entre elles concernant des patients caucasiens de nationalité française. La rareté de cette observation justifiera la réalisation de ce travail. Afin de situer cette pathologie dans son contexte plus général, nous rappellerons les mécanismes physiopathologiques des hypokaliémies et décrirons, afin de les comparer à ces observations, les diverses étiologies de paralysie périodique familiale. Si le mécanisme physiopathologique commun essentiel reste l'hypokaliémie, l'étude de la littérature montre que ces affections peuvent être distinguées : d'autres facteurs déclenchants encore incomplètement identifiés sont nécessaires pour expliquer le caractère paroxystique de ces accès paralytiques. La quasi-absence de tout caractère familial et la guérison définitive de ces paralysies périodiques avec celle de l'hyperthyroïdie, restent les éléments les plus caractéristiquesAMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

TRAITEMENT DE LA THROMBASTHENIE DE GLANZMANN PAR ALLOGREFFE DE MOELLE OSSEUSE (A PROPOS DE DEUX OBSERVATIONS)

PARIS6-Bibl. St Antoine CHU (751122104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF