Syndrome d'encéphalopathie postériere réversible en réanimation (épidémiologie et facteurs pronostics)

Le syndrome d encéphalopathie postérieure réversible (PRES) peut induire des séquelles définitives, mais ses critères pronostics en réanimation n ont jamais été étudiés. Une enquête rétrospective a été menée dans 23 réanimations adultes entre 2001 et 2010 pour rechercher les déterminants du pronostic fonctionnel à 3 mois (Glasgow Outcome Scale < 5) et décrire les caractéristiques des 70 patients identifiés.Il s agissait de 45 femmes et 25 hommes âgés de 36 (25-52) ans. Les signes cliniques étaient : crises convulsives (81%), troubles de la conscience (94%), troubles visuels (36%), céphalées (51%), hypertension artérielle (83%). Les anomalies radiologiques d œdème vasogénique, toujours réversibles, impliquaient outre les régions postérieures, les lobes frontaux (9%), les noyaux gris centraux (36%), le cervelet (33%), le tronc cérébral (17%). Une aggravation hémorragique et/ou ischémique était notée chez 12 (17%) patients. Les étiologies, parfois associées, étaient : prise d agents toxiques (44%), encéphalopathie hypertensive (41%), éclampsie (23%), maladies auto-immunes (11%). Onze (16%) patients sont décédés.Un GOS < 5 à 3 mois était noté chez 37 (53%) patients. En analyse multivariée, 3 facteurs étaient indépendamment associés à cette évolution: l éclampsie (facteur protecteur), l hyperglycémie et la soustraction à la cause du PRES après H29 (facteurs aggravants).Une prise en charge précoce, intensive, diagnostique et thérapeutique permet une récupération fonctionnelle favorable à 3 mois chez près de la moitié des patients, et ce quelque soit la gravité des co-morbidités et de la présentation clinique initiale. Un contrôle prudent de l hyperglycémie est préconisé.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

Place de la radiotherapie dans le traitement des gliomes de bas grade de l'adulte: résultats préliminaire de l'étude EORTC randomisée de phase III

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Immediate postoperative radiotherapy in LGG improves progression free survival, but not overall survival: preliminary result of an EORTC/MRC randomized phase III study

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Randomized trial on the efficacy of radiotherapy for cerebral low-grade glioma in the adult: European Organization for Research and Treatment of Cancer Study 22845 with the Medical Research Council study BRO4: an interim analysis.

PURPOSE: There is no consensus on the treatment strategy for adult patients with cerebral low-grade glioma. The diagnosis and primary treatment are usually undertaken by surgery. Some investigators doubt the efficacy of postoperative radiotherapy (RT), whereas others advise routine postoperative RT. We report the primary results of a multicenter randomized trial on this controversy. METHODS AND MATERIALS: From 24 European centers, 311 adult patients with low-grade glioma were randomized centrally after surgery from March 1986 through September 1997, between the two arms of the trial. The irradiated group received 54 Gy in 6 weeks. The other patients did not receive any treatment after surgery until the tumor showed progression, defined as clinical-neurologic deterioration and evidence of progressive tumor on imaging. RESULTS: Of 290 eligible and assessable patients (93%), the irradiated group showed a significant (log-rank p = 0.02) improvement in time to progression but not in overall survival, with a median follow-up of 5 years. The 5-year estimate was, respectively, 63% vs. 66% (overall survival) and 44% vs. 37% (time to progression) for the treated and control arms. Different treatment modalities, including RT, were undertaken for the 85 controls when a progressive tumor was noted. CONCLUSION: Early postoperative conventional RT such as that used for this protocol appears to improve the time to progression or progression-free survival, but not overall survival, for patients with low-grade glioma.Clinical TrialJournal ArticleMulticenter StudyRandomized Controlled TrialResearch Support, U.S. Gov't, P.H.S.info:eu-repo/semantics/publishe

Citizen science in environmental health research: A comparison with conventional approaches and creation of a guidance tool issued from the LILAS initiative

International audienceContext: Public interest for citizen science (CS) in environmental health is growing. The goals of environmental health research projects are diverse, as are the methods used to reach these goals. Opportunities for greater implication of the civil society and related challenges differ at each step of such projects. These methodological aspects need to be widely shared and understood by all stakeholders. The LILAS initiative (acronym for "application of citizen science approaches such as LIving LAbS to research on environmental exposures and chronic risks") aimed to 1) favor a mutual understanding of the main issues and research methods in environmental health, of their stakes for different actors, but also of the requirements, strengths and limitations of these methods and to 2) identify expected benefits and points of attention related to stronger degrees of participation as part of environmental health research projects.Methods: The LILAS initiative gathered institutional researchers, academics and civil society representatives interested in environmental exposures. Five meetings allowed to collectively identify different types of environmental health research studies and reflect about the benefits, limitations, and methodological issues related to the introduction of growing citizen participation as part of such studies. An analytic table matrix summarizing these aspects was co-created and filled by participants, as a tool devoted to help stakeholders with the definition of future CS research projects in environmental health.Results: For different fields of research (e.g.: studies for assessment of environmental exposures, interventions on these exposures, quantitative risk assessment, epidemiological studies), the matrix lists expected benefits for various stakeholders, the fundamental principles of research methods and related practical constraints, but also advantages and limitations related to the use of CS or conventional research approaches.Conclusion: The LILAS initiative allowed to develop a tool which provides consolidated grounds for the co-creation of research projects on environmental exposures involving CS

Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial.

BACKGROUND: Postoperative policies of "wait-and-see" and radiotherapy for low-grade glioma are poorly defined. A trial in the mid 1980s established the radiation dose. In 1986 the EORTC Radiotherapy and Brain Tumor Groups initiated a prospective trial to compare early radiotherapy with delayed radiotherapy. An interim analysis has been reported. We now present the long-term results. METHODS: After surgery, patients from 24 centres across Europe were randomly assigned to either early radiotherapy of 54 Gy in fractions of 1.8 Gy or deferred radiotherapy until the time of progression (control group). Patients with low-grade astrocytoma, oligodendroglioma, mixed oligoastrocytoma, and incompletely resected pilocytic astrocytoma, with a WHO performance status 0-2 were eligible. Analysis was by intention to treat, and primary endpoints were overall and progression-free survival. FINDINGS: 157 patients were assigned early radiotherapy, and 157 control. Median progression-free survival was 5.3 years in the early radiotherapy group and 3.4 years in the control group (hazard ratio 0.59, 95% CI 0.45-0.77; p<0.0001). However, overall survival was similar between groups: median survival in the radiotherapy group was 7.4 years compared with 7.2 years in the control group (hazard ratio 0.97, 95% CI 0.71-1.34; p=0.872). In the control group, 65% of patients received radiotherapy at progression. At 1 year, seizures were better controlled in the early radiotherapy group. INTERPRETATION: Early radiotherapy after surgery lengthens the period without progression but does not affect overall survival. Because quality of life was not studied, it is not known whether time to progression reflects clinical deterioration. Radiotherapy could be deferred for patients with low-grade glioma who are in a good condition, provided they are carefully monitored.Clinical TrialComparative StudyJournal ArticleMulticenter StudyRandomized Controlled TrialResearch Support, N.I.H. ExtramuralResearch Support, Non-U.S. Gov'tResearch Support, U.S. Gov't, P.H.S.info:eu-repo/semantics/publishe

Living Labs and other participatory approaches applied to research on multiple environnemental exposures and chronic risks

International audienceBACKGROUND AND AIM: Participatory research in environmental health is still rare in France. The objectives of environmental health research, in general, can be very diverse (e.g.: identifying situations associated with risks estimating exposures and effects, testing the effectiveness of preventive actions) and related methods are diverse as well. Opportunities for greater implication of the civil society and related challenges differ at each step of research activities. These aspects need to be better known and shared collectively. The LILAS project aimed to 1) co-construct, among institutional researchers, academics and civil society representatives, a mutual understanding of the main problematics and research methods in environmental health, their stakes for different actors, but also the requirements, strengths and limitations of these methods 2) identify expected benefits and points of vigilance related to stronger degrees of participation as part of such environmental health research projects. METHODS: LILAS gathered institutional researchers, academics and civil society representatives interested in multiple exposures (chemical, radiological). Several meetings allowed to collectively identify different types of study (including environmental epidemiological studies) and reflect about the added value, limitations, and methodological principles related to the introduction of growing participation as part of such studies. An analysis matrix was co-created and filled by participants. RESULTS:For different types of studies (studies for assessment of environmental exposures, identification of their determinants, interventions on these exposures, development of sensors, quantitative risk assessment, environmental epidemiological studies, experimental research, studies on the health of ecosystems…), the matrix lists expected benefits for several categories of stakeholders, fundamental methodological principles and practical constraints, advantages and limitations related to the use of participatory approaches (such as the living lab one) or more “classical” approaches. CONCLUSIONS:LILAS has allowed, through a cross-acculturation process, to develop consolidated grounds for the co-construction of future participatory research projects on multiple environmental exposures

Living Labs and other participatory approaches applied to research on multiple environnemental exposures and chronic risks

International audienceBACKGROUND AND AIM: Participatory research in environmental health is still rare in France. The objectives of environmental health research, in general, can be very diverse (e.g.: identifying situations associated with risks estimating exposures and effects, testing the effectiveness of preventive actions) and related methods are diverse as well. Opportunities for greater implication of the civil society and related challenges differ at each step of research activities. These aspects need to be better known and shared collectively. The LILAS project aimed to 1) co-construct, among institutional researchers, academics and civil society representatives, a mutual understanding of the main problematics and research methods in environmental health, their stakes for different actors, but also the requirements, strengths and limitations of these methods 2) identify expected benefits and points of vigilance related to stronger degrees of participation as part of such environmental health research projects. METHODS: LILAS gathered institutional researchers, academics and civil society representatives interested in multiple exposures (chemical, radiological). Several meetings allowed to collectively identify different types of study (including environmental epidemiological studies) and reflect about the added value, limitations, and methodological principles related to the introduction of growing participation as part of such studies. An analysis matrix was co-created and filled by participants. RESULTS:For different types of studies (studies for assessment of environmental exposures, identification of their determinants, interventions on these exposures, development of sensors, quantitative risk assessment, environmental epidemiological studies, experimental research, studies on the health of ecosystems…), the matrix lists expected benefits for several categories of stakeholders, fundamental methodological principles and practical constraints, advantages and limitations related to the use of participatory approaches (such as the living lab one) or more “classical” approaches. CONCLUSIONS:LILAS has allowed, through a cross-acculturation process, to develop consolidated grounds for the co-construction of future participatory research projects on multiple environmental exposures

Living Labs and other participatory approaches applied to research on multiple environnemental exposures and chronic risks

International audienceBACKGROUND AND AIM: Participatory research in environmental health is still rare in France. The objectives of environmental health research, in general, can be very diverse (e.g.: identifying situations associated with risks estimating exposures and effects, testing the effectiveness of preventive actions) and related methods are diverse as well. Opportunities for greater implication of the civil society and related challenges differ at each step of research activities. These aspects need to be better known and shared collectively. The LILAS project aimed to 1) co-construct, among institutional researchers, academics and civil society representatives, a mutual understanding of the main problematics and research methods in environmental health, their stakes for different actors, but also the requirements, strengths and limitations of these methods 2) identify expected benefits and points of vigilance related to stronger degrees of participation as part of such environmental health research projects. METHODS: LILAS gathered institutional researchers, academics and civil society representatives interested in multiple exposures (chemical, radiological). Several meetings allowed to collectively identify different types of study (including environmental epidemiological studies) and reflect about the added value, limitations, and methodological principles related to the introduction of growing participation as part of such studies. An analysis matrix was co-created and filled by participants. RESULTS:For different types of studies (studies for assessment of environmental exposures, identification of their determinants, interventions on these exposures, development of sensors, quantitative risk assessment, environmental epidemiological studies, experimental research, studies on the health of ecosystems…), the matrix lists expected benefits for several categories of stakeholders, fundamental methodological principles and practical constraints, advantages and limitations related to the use of participatory approaches (such as the living lab one) or more “classical” approaches. CONCLUSIONS:LILAS has allowed, through a cross-acculturation process, to develop consolidated grounds for the co-construction of future participatory research projects on multiple environmental exposures

Living Labs et autres approches participatives appliquées à la recherche sur les multi-expositions environnementales et les risques chroniques.

Contexte Les recherches participatives en santé-environnement restent peu développées en France. Les objectifs poursuivis de manière générale par les recherches en santé-environnement (ex : identifier des situations potentiellement à risque, estimer des expositions, évaluer des effets, tester des actions préventives) et les méthodes employées à ces fins sont variés. Les opportunités d’une plus grande implication de la société civile et défis associés diffèrent à chaque étape de ces recherches. Ces aspects demandent à être mieux appréhendés collectivement. Le projet LILAS vise, en amont du développement de futurs projets de recherches participatives sur les multi-expositions environnementales, à 1) co-construire, entre chercheurs institutionnels, académiques et représentants de la société civile, une bonne compréhension commune des principales problématiques et méthodes de recherche en santé-environnement, de leurs enjeux, prérequis, forces et limites 2) identifier les bénéfices et points de vigilance liés à l’introduction de plus fortes dimensions participatives dans ces recherches. Méthode adoptéeLe projet LILAS a rassemblé des chercheurs institutionnels, académiques et représentants de la société civile intéressés par les multi-expositions (chimiques, radiologiques). Une recherche bibliographique a été initiée pour tirer le retour d’expérience de projets de recherches participatives en santé-environnement. Plusieurs réunions ont permis d’identifier collectivement différents types d’études et de réfléchir sur les apports, limites et principes méthodologiques relatifs à l’introduction de différents degrés de participation dans celles-ci. Une matrice d’analyse a été co-construite puis alimentée par les participants, en s’inspirant des approches « Living Lab ».Résultats Pour différents types d’études (études d’évaluations d’expositions, d’identification de leurs déterminants, tests d’interventions sur ceux-ci, développement de capteurs, évaluations de risques sanitaires, études épidémiologiques, recherches expérimentales, études sur la santé des écosystèmes…), la matrice liste les bénéfices attendus pour plusieurs catégories de parties prenantes, les principes méthodologiques fondamentaux et contraintes pratiques, les avantages et limites relatifs à l’emploi d’approches participatives (comme l’approche Living Lab) ou plus “classiques”, mais également les besoins d’accompagnements institutionnels et les effets structurants nécessaires à leur déploiement et leur amélioration qualitative.Conclusion LILAS a permis, par acculturation croisée, de poser des bases consolidées pour la co-construction de futurs projets de recherches participatives sur les multi-expositions environnementales