Mortalité d'une cohorte de 514 cyclistes de haut niveau

Objectif : L’impact de la pratique du cyclisme de compétition sur la mortalité n’est pas connu. L’objectif de cette étude a été d’étudier la mortalité et les causes de décès d’une cohorte constituée des 514 meilleurs cyclistes masculins ayant disputé, entre 1960 et 1990, l’épreuve du Triomphe Breton. Patients et résultats : Statut vital et causes de décès ont été obtenus auprès de l’Inserm et l’Insee. Les ratios standardisés de mortalité ont été calculés en utilisant la population masculine bretonne comme référence. Au 31/12/08, 508 sujets (98,8 %) étaient analysables : 476 étaient vivants après un suivi médian de 31 ans et 32 décédés (dont 19 de causes externes et huit de cancers), ce qui témoignait d’une sous-mortalité toutes causes et toutes pathologies, laquelle tendait toutefois à s’effacer pour les plus jeunes. Ce travail a permis la constitution d’une cohorte de référence de cyclistes de haut niveau et la démonstration d’une moindre mortalité de ces coureurs par rapport à la population générale. Conclusion : La mise en évidence d’une augmentation relative de la mortalité chez les plus jeunes justifie le suivi ultérieur de cette cohorte

Determination of capillary hemoglobin levels using the HemoCue system in intensive care patients.

International audiencePURPOSE: The study aimed to compare hemoglobin (Hb) values determined using the portable HemoCue system (HemoCue Hb 201+; HemoCue AB, Ängelholm, Sweden) with laboratory Hb level determination. MATERIALS AND METHODS: Adult patients hospitalized in our surgical intensive care unit who required an Hb level determination were included. To determine Hb level, one drop of arterial (A) or venous (V) blood was analyzed using HemoCue (HemoCue([A/V])), and also with an automated analyzer in the laboratory (Hb reference method, or Hb Lab([A/V])). Capillary blood (Cap) sample obtained simultaneously by fingerstick was analyzed using HemoCue (HemoCue([Cap])). Factors that could interfere with the accuracy of fingerstick measurements were also studied. Paired Hb level measurements were compared by Bland and Altman analysis (Hb Lab([A/V]) vs HemoCue([A/V]) and HemoCue([Cap])). RESULTS: One hundred fifty blood samples were obtained from 79 patients. The mean absolute differences between Hb Lab [A] and HemoCue [A], Hb Lab [V] and HemoCue [V] and Hb Lab [A/V] and HemoCue [Cap] were 0.1 g/dl (95% confidence interval, -1.9 to + 2.2 g/dl), 0.1 g/dl (95%CI, -2.5 to +2.6 g/dl) and 1.1 g/dl (95%CI, -3.6 to + 5.8 g/dl, respectively. Edema was the sole independent risk factor for discordance between HemoCue([Cap]) and Hb Lab([A/V]) (odds ratio, 6.65; 95% CI, 1.99-22.21; P < .001]. CONCLUSIONS: Hemoglobin level determination using HemoCue should not be used in critically patients, especially when capillary blood samples are used and/or in presence of edema

Long-term mortality and quality of life after septic shock: a follow-up observational study.

International audiencePURPOSE: In septic shock, short-term outcomes are frequently reported, while long-term outcomes are not. The aim of this study was to evaluate mortality and health-related quality of life (HRQOL) in survivors 6 months after an episode of septic shock. METHODS: This single-centre observational study was conducted in an intensive care unit in a university hospital. All patients with septic shock were included. Mortality was assessed 6 months after the onset of septic shock, and a comparison between patients who survived and those who died was performed. HRQOL was assessed using the MOS SF-36 questionnaire prior to hospital admission (baseline) and at 6 months in survivors. HRQOL at baseline and at 6 months were compared to the general French population, and HRQOL at baseline was compared to 6-month HRQOL. RESULTS: Ninety-six patients were included. Six-month mortality was 45 %. Survivors were significantly younger, had significantly lower lactate levels and SAPS II scores, required less renal support, received less frequent administration of corticosteroids, and had a longer length of hospital stay. At baseline (n = 39) and 6 months (n = 46), all of the components of the SF-36 questionnaire were significantly lower than those in the general population. Compared to baseline (n = 23), the Physical Component Score (CS) improved significantly at 6 months, the Mental CS did not differ. CONCLUSIONS: Mortality 6 months after septic shock was high. HRQOL at baseline was impaired when compared to that of the general population. Although improvements were noted at 6 months, HRQOL remained lower than that in the general population

Long-term course after initial iron removal of iron excess in patients with dysmetabolic iron overload syndrome.

International audienceInitial venesection therapy in dysmetabolic iron overload syndrome (DIOS) was shown to improve insulin resistance. However, no data are available on the long-term outcome of iron store, thus questioning the relevance of maintenance therapy. The aim of the study was to describe the long-term evolution of iron overload after successful iron removal in patients with DIOS. Patients diagnosed with DIOS from 1998 to 2003 and having completed venesection therapy were proposed an outpatient visit in 2009. Inclusion criteria were as follows: confirmation of the DIOS diagnosis, absence of iron-related treatment or bloodletting since the end of the initial venesection treatment, at least 2 years of follow-up since last phlebotomy. Clinical and biological data were recorded at diagnosis and at inclusion. A total of 58 patients were included. The mean liver iron content at diagnosis was 80±43 µmol/g and the mean amount of iron removed was 2.2±1.2 g. The mean follow-up time was 71±23 months since end of treatment. At inclusion, 64% of patients had recurrence of iron overload. Serum ferritin at diagnosis was the only parameter associated with recurrence of iron overload. In patients with DIOS, the course of iron loading after initial iron removal supports periodical follow-up to detect those patients with recurrence of iron overload who could benefit from maintenance therapy

Pulse oximetry and high-dose vasopressors: a comparison between forehead reflectance and finger transmission sensors.

International audiencePURPOSE: Pulse oximetry (SpO(2)) measured at finger site via transmission mode may fail in situations of hypoperfusion. Forehead sensors using reflectance technology might be useful in these circumstances. We hypothesized that reflectance SpO(2) would be more accurate than finger SpO(2) in patients with severe shock. METHODS: A prospective observational study was conducted in an intensive care unit of a university hospital of patients in shock who were treated with high norepinephrine and/or epinephrine doses (≥0.1 μg kg(-1) min(-1)). When blood gas determinations were requested, forehead SpO(2) and finger SpO(2) values were simultaneous recorded. Agreement between SpO(2) measurements with arterial saturation (SaO(2)), obtained by blood analysis with a co-oximeter, was assessed using the Bland-Altman method. The number of outliers, defined by the formula SaO(2) - SpO(2) > ±3 %, indicated the proportion of measurements considered to be clinically unacceptable. RESULTS: Thirty-two patients were enrolled in the study. With the forehead sensor no reading failure occurred, and 140 paired data sets (forehead SpO(2) vs. SaO(2)) were obtained. Bias and precision were +1.0 and +2.5 %, respectively, and the limits of agreement ranged from -4.0 to 6.0 %. The finger sensor failed to give a value in four cases, thus providing 136 paired data sets (finger SpO(2) vs. SaO(2)) for analysis. Bias and precision were +1.4 and +4.8 %, respectively, and the limits of agreement ranged from -8.0 to 10.9 %. There were 21 (15 %) outliers for the forehead sensor and 43 (32 %) for the finger sensor (P < 0.001). CONCLUSIONS: Forehead SpO(2) measurements were more accurate than finger SpO(2) when compared with SaO(2) in critically ill patients requiring high-dose vasopressor therapy and should therefore be the preferred method considered

Patient-reported outcomes and their relation with iron parameters in HFE haemochromatosis during maintenance therapy: A prospective cohort study

International audienceBackground and Aims The standard of care for haemochromatosis is regular phlebotomy in order to maintain low ferritin levels. Many patients report fatigue or joint pain despite serum ferritin within the therapeutic targets. We evaluated Patient-Reported Outcomes, and their relation with iron parameters, in C282Y homozygous patients undergoing maintenance phlebotomy. Methods Patients were prospectively enrolled in a French referral care centre. At each phlebotomy, patients completed a numeric fatigue scale, a joint pain questionnaire and SF-36 Mental Component Score (MCS) and Physical Component Score (PCS). Haemoglobin, iron, TS and ferritin were collected concomitantly. Results About 701 visits were performed in 259 patients. The median fatigue score was 3/10; 171 (66%) patients reported joint pain. Age and worsening of joint pain were associated with fatigue (p &lt; .0001 for both). Female gender (p &lt; .037), age (p &lt; .003), and a decrease of TS (p = .050) were associated with joint pain. Main features associated with PCS &lt;50 were worsening of joint pain and age (p &lt; .001 for both) and TS &lt;20% (p &lt; .02). Conclusions Fatigue was independent from iron parameters. The main factor impacting quality of life was joint pain, which was more severe in patients with low TS values. Then, a more precise monitoring of TS should be proposed during haemochromatosis maintenance therapy; while less stringent monitoring of serum ferritin levels could be tested

One-step nucleic acid amplification for detecting lymph node metastasis of head and neck squamous cell carcinoma

International audienceBackground - In head and neck squamous cell carcinoma (HNSCC) 30% of cN0 patients have occult metastasis. LN invasion is a major prognostic factor. Sentinel lymph node (SLN) is an option for cN0 neck management. One-step nucleic acid amplification (OSNA) used to analyze SLN in breast cancer is also a candidate to get more reliable intraoperative HNSCC lymph node (LN) staging. Objective - To compare OSNA analysis to pathological analysis in cN0 HNSCC. Materials and methods - 157 LN from 26 cN0 HNSCC patients were prospectively analyzed (6.3LN/patient). Exclusion criteria were previous surgery or radiotherapy. Each node was cut into 4 equal pieces alternatively sent to pathological analysis and OSNA technique. IHC CK19 was performed on the primary tumor biopsy and RT-qPCR of CK19, PVA and EPCAM on the LN lysate of discordant cases. Results - OSNA was able to provide intraoperative result in all patients. OSNA detected 21 metastases. There were 139 concordant LN (88.5%). There were 18 initial discordant LN (11.5%), 13 (8.3%) were OSNA positive/pathological analysis negative, 5 (3.2%) were OSNA negative/pathological analysis positive. After elimination of allocation bias, false negative rate was 1.3%, sensitivity and specificity were 90% and 95.6%, PPV and NPV were 75% and 98.5%. Conclusion - Our results suggest that OSNA should be considered to improve SNB analysis both for increasing micro metastasis diagnosis and offer extemporaneous results. Study registered under clinicaltrials.gov database number NCT02852343

A prospective survey of Streptococcus pyogenes infections in French Brittany from 2009 to 2017: Comprehensive dynamic of new emergent emm genotypes

International audienceStreptococcus pyogenes or group A Streptococcus (GAS) causes diseases ranging from uncomplicated pharyngitis to life-threatening infections. It has complex epidemiology driven by the diversity, the temporal and geographical fluctuations of the circulating strains. Despite the global burden of GAS diseases, there is currently no available vaccination strategy against GAS infections. This study, based on a longitudinal population survey, aimed to understand the dynamic of GAS emm types and to give leads to better recognition of underlying mechanisms for the emergence of successful clones. From 2009 to 2017, we conducted a systematic culture-based diagnosis of GAS infections in a French Brittany population with a prospective recovery of clinical data. The epidemiological analysis was performed using emm typing combined with the structural and functional cluster-typing system for all the recovered strains. Risk factors for the invasiveness, identified by univariate analysis, were computed in a multiple logistic regression analysis, and the only independent risk factor remaining in the model was the age (OR for the entire range [CI95%] = 6.35 [3.63, 11.10]; p&lt;0.0001). Among the 61 different emm types identified, the most prevalent were emm28 (16%), emm89 (15%), emm1 (14%), and emm4 (8%), which accounted for more than 50% of circulating strains. During the study period, five genotypes identified as emm44, 66, 75, 83, 87 emerged successively and belonged to clusters D4, E2, E3, and E6 that were different from those gathering &quot;Prevalent&quot; emm types (clusters A-C3 to 5, E1 and E4). We previously reported significant genetic modifications for emm44, 66, 83 and 75 types resulting possibly from a short adaptive evolution. Herein we additionally observed that the emergence of a new genotype could occur in a susceptible population having specific risk factors or probably lacking a naturally-acquired cluster-specific immune cross-protection. Among emergent emm types, emm75 and emm87 tend to become prevalent with a stable annual incidence and the risk of a clonal expansion have to be considered

Worse Outcomes of Patients With HFE Hemochromatosis With Persistent Increases in Transferrin Saturation During Maintenance Therapy

International audienceBACKGROUND and AIMS: Even if patients with hemochromatosis maintain low serum levels of ferritin, they still have an increased risk of general and joint symptoms, which reduce quality of life. This could be related to persistently increased transferrin saturation. We assessed whether duration of exposure to increased transferrin saturation during maintenance therapy is associated with more severe general and joint symptoms.METHODS: We performed a longitudinal cohort study of 266 individuals homozygous for the C282Y substitution in HFE, seen at a tertiary reference center in Rennes, France, and followed for 3 or more years after initial iron removal. Serum ferritin and transferrin saturation were measured at the same time points; values were used to calculate duration of exposure to serum ferritin 50 mu g/L or more (FRT50exp) and to determine transferrin saturation 50% or greater (SAT50exp). Clinical and biochemical follow-up data were recorded from log books completed during maintenance therapy. The primary outcome was change in general and joint symptoms, determined from answers to a self-administered questionnaire.RESULTS: Patients were followed for 13.5 +/- 5.9 years. FRT50exp (3.2 +/- 3.5 years) and SAT50exp (4.5 +/- 3.4 years) values correlated (r = 0.38; P less than .0001), but each associated with different variables in multivariate analysis. We found independent associations, regardless of follow-up time, between SAT50exp >= 6 years and worsened joint symptoms (odds ratio [OR], 4.19; 95% confidence interval [CI], 1.88-9.31), and between SAT50exp >= 6 years and decreased athletic ability (OR, 2.35; 95% CI, 1.16-4.73). SAT50exp >= 8 years associated independently with decreased work ability (OR, 3.20; 95% CI, 1.40-7.30) and decreased libido (OR, 3.49; 95% CI, 1.56-7.80).CONCLUSIONS: In a longitudinal study of patients treated for hemochromatosis, we associated duration of exposure to increased transferrin saturation (longer than 6 years) with more severe general and joint symptoms. Maintenance of serum levels of ferritin at 50 mu g/L or less does not indicate control of transferrin saturation, so guidelines on the management of hemochromatosis require revision

The iron reabsorption index: a new phenotypic and pathophysiological descriptor in HFE hemochromatosis.

International audienceBACKGROUND: The current phenotypic descriptors of high Fe gene hemochromatosis are hardly specific and time dependent in a context of highly variable expressivity. We hypothesized that the rate of iron removed during maintenance therapy and corresponding to the iron reabsorption index (IRI) could be patient specific and may then represent a new useful phenotypic marker. AIM: The present study aimed to describe IRI with respect to its phenotypic specificity and to its potential usefulness. METHODS: We studied a cohort of 316 p.Cys282Tyr homozygous patients with stable low serum ferritin levels on maintenance therapy for at least 12 months. Characteristics at diagnosis, date and volume of phlebotomies, and parameters of iron metabolism throughout maintenance therapy were determined. RESULTS: IRI ranged from 1.3 to 6.1 mg/day (median: 2.44). It was lower in women (difference: 1.26 mg/day), mainly explained by physiological blood loss, weight, and alcohol consumption. IRI was correlated to iron burden and fibrosis stage at diagnosis, was stable over time (variation: 11.5%), and depended on serum ferritin level during therapy. CONCLUSION: Its independence from disease duration, its stability, its wide distribution, and its significant correlation with iron burden markers make IRI a valuable potential phenotypic indicator of the daily iron overabsorption in hemochromatosis. Moreover, IRI provides a conceptual frame for empiric adaptation of maintenance therapy