056: Biological efficacy of a 600mg loading dose of clopidogrel in ST-elevation myocardial infarction

BackgroundOptimal platelet reactivity (PR) inhibition is critical to prevent thrombotic events in primary percutaneous coronary intervention (PCI). We aimed to determine the relationship between high on-treatment platelet reactivity (HTPR) and ST-elevation myocardial infarction (STEMI) following a 600mg loading dose (LD) of clopidogrel.Methods and resultsWe performed a prospective monocentre study enrolling patients on clopidogrel undergoing PCI. The VASP index was used to assess PR inhibition after clopidogrel LD. HTPR was defined according to the consensus as a VASP index ≥50%. The present study included 833 patients undergoing PCI. Most patients had PCI for an acute coronary syndrome (58.7%). The mean VASP index was 50±23% with a large inter-individual variability (range: 1–94%). Patients with a VASP index ≥50% were significantly older (p=0.03), with a higher BMI (p<0.001), more often diabetic (p=0.03), taking omeprazole (p=0.03), admitted for an ACS and with a high fibrinogen level compared to good responders (VASP<50%). In multivariate analysis BMI, omeprazole use, acute coronary syndrome and high fibrinogen level (p<0.001) remained significantly associated with HTPR. Of importance, in this analysis STEMI was independently associated with HTPR when compared with the other forms of ACS (NSTEMI and unstable angina) with an odd ratio of 2.14 (95% CI: 1.3 –3.5; p=0.003).ConclusionSTEMI is associated with high on-treatment platelet reactivity following 600mg of clopidogrel. The present results suggest that 600mg of clopidogrel may not be able to achieve an optimal PR inhibition in STEMI patients undergoing PCI and more potent drugs may be preferred

A French Cohort of Childhood Leukemia Survivors: Impact of Hematopoietic Stem Cell Transplantation on Health Status and Quality of Life

AbstractThe late effects and quality of life (QoL) in childhood acute leukemia survivors were compared between hematopoietic stem cell transplantation (HSCT) recipients and patients who underwent conventional therapy. The study included 943 patients, 256 of whom underwent HSCT (27.1%). Medical visits were conducted to detect the occurrence of physical late effects. Based on patient age, different questionnaires were used to assess QoL. To evaluate the association between HSCT and each type of late effect or QoL dimension, the appropriate multivariate regressions were performed. QoL mean scores were compared with those obtained for age- and sex-matched French control subjects. Of all the survivors, 674 (71.5%) had at least 1 late effect, with the risk being 5.0 CI95 (3.0-8.6) times higher for transplantation survivors. For child survivors, scoring of QoL showed no significant differences between the treatment groups. The adult HSCT survivors reported lower physical dimension QoL scores than chemotherapy survivors. Compared with French norms, the survivor group reported a significantly lower mental composite score; however, the physical composite score showed no significant difference. Thus, transplanted survivors have a high risk of developing late effects, resulting in a decreased physical well-being in adulthood. However, long after treatment completion, childhood leukemia survivors report that effects on psychological well-being are more important than they are in physical QoL dimensions

Is the Concept of Quality of Life Relevant for Multiple Sclerosis Patients with Cognitive Impairment? Preliminary Results of a Cross-Sectional Study

Background: Cognitive impairment occurs in about 50 % of multiple sclerosis (MS) patients, and the use of self-reported outcomes for evaluating treatment and managing care among subjects with cognitive dysfunction has been questioned. The aim of this study was to provide new evidence about the suitability of self-reported outcomes for use in this specific population by exploring the internal structure, reliability and external validity of a specific quality of life (QoL) instrument, the Multiple Sclerosis International Quality of Life questionnaire (MusiQoL). Methods: Design: cross-sectional study. Inclusion criteria: MS patients of any disease subtype. Data collection: sociodemographic (age, gender, marital status, education level, and occupational activity) and clinical data (MS subtype, Expanded Disability Status Scale, disease duration); QoL (MusiQoL and SF36); and neuropsychological performance (Stroop color-word test). Statistical analysis: confirmatory factor analysis, item-dimension correlations, Cronbach’s alpha coefficients, Rasch statistics, relationships between MusiQoL dimensions and other parameters. Principal Findings: One hundred and twenty-four consecutive patients were enrolled. QoL scores did not differ between the 69 cognitively non-impaired patients and the 55 cognitively impaired patients, except for the symptoms dimension. The confirmatory factor analysis performed among the impaired subjects showed that the structure of the questionnaire matched with the initial structure of the MusiQoL. The unidimensionality of the MusiQoL dimensions was preserved, and th

What usefulness to implementation of a long-term follow-up of childhood leukemia survivors in decision making? : About the LEA cohort

Les progrès thérapeutiques réguliers ont transformé le pronostic des enfants atteints de leucémie aiguë, posant avec une grande acuité le problème des effets secondaires tardifs, de l'insertion sociale mais aussi de la qualité de vie des patients et de leur entourage, ainsi que des déterminants mis en jeu. L'ensemble des acteurs du système de soins ont la responsabilité de l'étude de ces effets secondaires tardifs et de leur prise en compte. En 2004, le projet LEA (Leucémie de l'Enfant et de l'Adolescent) a débuté avec pour objectif d'évaluer l'état de santé et la qualité de vie à moyen et long terme de patients traités pour une leucémie aiguë de l'enfance après 1980. La volonté était de mettre en oeuvre un système pouvant produire de la connaissance dans une démarche de recherche traditionnelle, mais aussi de s'inscrire rapidement dans une démarche pragmatique de production d'informations susceptibles de modifier les pratiques de prise en charge et de suivi. L'objectif général de ce travail cherche à démontrer l'utilité de dispositifs lourds comme la mise en oeuvre d'une cohorte, dans la double logique de fournir une information d'une part directement utile à la décision clinique, et d'autre part susceptible d'éclairer la décision publique. Les travaux scientifiques s'articulent autour de : 1. La visibilité de la cohorte LEA au regard des autres dispositifs existants au niveau international ; 2. Les conséquences à distance des traitements lourds reçus par les patients ; 3. La qualité de vie de l'entourage à distance de l'épisode aigu de la maladie ; 4. L'utilité d'un suivi systématisé dans la diminution des inégalités d'accès au système de santé entre les classes sociales.Regular advances in cancer treatment have dramatically improved the prognosis of children with acute leukemia, raising with a great acuity the problem of the late physical side effects, social integration, quality of life of the patients and their family as well as identification of the determinants of these outcomes. It is the responsibility of all the care system actors to consider these objective and subjective late effects. The LEA project (Leucémie de l'Enfant et de l'Adolescent - childhood and adolescent leukemia) was initiated in 2004 with the aim of studying the long-term health status and quality of life of children treated for leukemia after January 1980. As soon as the project began, the aim was to implement a system that can produce knowledge in a traditional research approach, but also to rapidly become a pragmatic approach of producing information that could affect both care and monitoring practices. The general objective of this manuscript seeks to demonstrate the utility of heavy plan such as the implementation of a cohort, in the double approach of providing information on the one hand directly relevant to clinical decision, and on the other hand likely to enlighten public decision. The present scientific works are based on: 1. The visibility of LEA in relation to other cohorts of childhood cancer survivors existing internationally; 2. The long-term impact of the heavy modalities of treatment, as the hematopoietic stem cell transplantation or irradiation; 3. The quality of life of the family long after the completion of cancer therapy; 4. The usefulness of a systematic follow-up in reducing inequalities in access to health care among social classes

Association of First-Week Nutrient Intake and Extrauterine Growth Restriction in Moderately Preterm Infants: A Regional Population-Based Study

International audienceThe purpose of this study was to determine the influence of first-week nutrition intake on neonatal growth in moderate preterm (MP) infants. Data on neonatal morbidity and nutrition intake on day of life 7 (DoL7) were prospectively collected from 735 MP infants (320/7–346/7 weeks gestational age (GA)). Multivariable regression was used to assess the factors associated with extrauterine growth restriction (EUGR) defined as a decrease of more than 1 standard deviation (SD) in the weight z-score during hospitalization. Mean (SD) gestational age and birth weight were 33.2 (0.8) weeks and 2005 (369) g. The mean change in the weight z-score during hospitalization was −0.64 SD. A total of 138 infants (18.8%) had EUGR. Compared to adequate growth infants, EUGR infants received 15% and 35% lower total energy and protein intake respectively (p < 0.001) at DoL7. At DoL7, each increase of 10 kcal/kg/d and 1 g/kg/d of protein was associated with reduced odds of EUGR with an odds ratio of 0.73 (95% CI, 0.66–0.82; p < 0.001) and 0.54 (0.44–0.67; p < 0.001), respectively. Insufficient energy and protein intakes on DoL7 negatively affected neonatal growth of MP infants. Nutritional support should be optimized from birth onwards to improve neonatal weight growth

Impact of moderate-to-severe endometriosis on IVF cumulative live birth rate: a retrospective matched cohort study

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Evaluation of “Energy Resonance by Cutaneous Stimulation” Among Women Treated by In Vitro Fertilization

International audienceObjectives: Pregnancy rate in in vitro fertilization (IVF) depends on many factors, such as the characteristics of the couple and the clinicobiological parameters. Interest in alternative and complementary medicine (ACM) for IVF is discussed because of the lack of scientific evidence. Energy resonance by cutaneous stimulation (ERCS), an acupuncture-like technique, consists of skin stimulation to transmit vibratory messages. The aim of this study was to evaluate the effect of ERCS on live birth rates (LBRs) in IVF. Design: A prospective observation study was performed in the Unit of Assisted Reproductive Technologies of a University Teaching Hospital. Every woman who agreed to participate in this study and received a fresh embryo transfer (ET) after IVF or Intracytoplasmic Sperm Injection (ICSI) was included. Patients randomly underwent an ERCS session on the day of ET according to the schedule of the midwife performing this technique. The control group consisted of women undergoing ET under usual conditions. The main outcome measure was the LBR per transfer. Results: Three-hundred-eighteen women were included, 120 in the ERCS + ET group and 198 in the ET without ERCS group. None of the women dropped out. The clinical characteristics in both groups were comparable. There was a significant difference in the clinical pregnancy rates, 31.7% in the ERCS group versus 21.7% in the No ERCS group (p = 0.037). The LBR in the ERCS group was nearly significantly higher, 29.2% versus 20.7% in the No ERCS group (p = 0,059). Conclusions: Women undergoing ERCS on the day of ET had a significantly higher IVF pregnancy rate. However, this methodology made not possible to draw conclusions about the mechanisms that induced the increase of IVF LBRs: placebo effect, ''cocooning,'' or ERCS self-effect? Further well-conducted studies are strongly needed to assess ERCS efficacy

Pregnancy outcomes after in vitro fertilization for moderate and severe endometriosis. A case-control study

International audienceIntroductionPrevious international studies showed that endometriosis could have a link with obstetrical complications, as an increased risk of preterm birth, gestational diabetes mellitus, and cesarean section. However, the results are difficult to interpret because biases are common, such as heterogeneity in the severity of the endometriosis cases included. That's why some complications as risk of miscarriage and post-partum hemorrhage are still debated. Our objective was to study pregnancy outcome after In Vitro Fertilization (IVF) in women suffering from rAFS stage III and IV endometriosis.MethodsWe conducted a case-control study between 2009 and 2019. We compared pregnancy outcomes after IVF in two groups of women matched by age, body mass index and smoking in two hospital centers. Group A was constituted by singleton pregnancies following ART for moderate and severe endometriosis (rAFS stage III and IV endometriosis). Group B was composed of singleton pregnancies in women with no endometriosis following ART for another reproductive disease. All women achieved pregnancy after 22 weeks.ResultsA total of 240 pregnant women were included: 80 singleton IVF pregnancies (group A) were compared with 160 singleton IVF pregnancies (group B). We observed an increased risk of placenta previa (12.5% Vs 1.9%; p = 0,001), and cesarean section (49.4% (n = 39) Vs 29.6% (n = 47) p = 0,004). Rate of postpartum hemorrhage was not significantly different in endometriosis group (11.2% Vs 7.5% p = 0.47).ConclusionDespite conflicting results in literature due to a lot of confounding variables, the impact of endometriosis on pregnancy is still debated in women suffering from rAFS III and IV endometriosis. In our study, we observed statistically higher rates of placenta previa and cesarean section but not an increased risk of postpartum hemorrhage. Further larger series are needed to confirm our findings and a possible link with other obstetrical complications. However, we think that an ART pregnancy in a context of severe endometriosis should be considered at risk of adverse obstetrical outcomes

Impact of a positive Chlamydia trachomatis serology on cumulative IVF live birth rate

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