15 research outputs found
Clinical and prognostic implications of phenomapping in patients with heart failure receiving cardiac resynchronization therapy
Despite having an indication for cardiac resynchronization therapy according to current guidelines, patients with heart failure with reduced ejection fraction who receive cardiac resynchronization therapy do not consistently derive benefit from it.; To determine whether unsupervised clustering analysis (phenomapping) can identify distinct phenogroups of patients with differential outcomes among cardiac resynchronization therapy recipients from routine clinical practice.; We used unsupervised hierarchical cluster analysis of phenotypic data after data reduction (55 clinical, biological and echocardiographic variables) to define new phenogroups among 328 patients with heart failure with reduced ejection fraction from routine clinical practice enrolled before cardiac resynchronization therapy. Clinical outcomes and cardiac resynchronization therapy response rate were studied according to phenogroups.; Although all patients met the recommended criteria for cardiac resynchronization therapy implantation, phenomapping analysis classified study participants into four phenogroups that differed distinctively in clinical, biological, electrocardiographic and echocardiographic characteristics and outcomes. Patients from phenogroups 1 and 2 had the most improved outcome in terms of mortality, associated with cardiac resynchronization therapy response rates of 81% and 78%, respectively. In contrast, patients from phenogroups 3 and 4 had cardiac resynchronization therapy response rates of 39% and 59%, respectively, and the worst outcome, with a considerably increased risk of mortality compared with patients from phenogroup 1 (hazard ratio 3.23, 95% confidence interval 1.9-5.5 and hazard ratio 2.49, 95% confidence interval 1.38-4.50, respectively).; Among patients with heart failure with reduced ejection fraction with an indication for cardiac resynchronization therapy from routine clinical practice, phenomapping identifies subgroups of patients with differential clinical, biological and echocardiographic features strongly linked to divergent outcomes and responses to cardiac resynchronization therapy. This approach may help to identify patients who will derive most benefit from cardiac resynchronization therapy in "individualized" clinical practice
Classification en référence à une matrice stochastique
International audienceEtant donnĂ© un tableau de donnĂ©es X portant sur un ensemble de n objets, et une matrice stochastique S qui peut ĂȘtre assimilĂ©e Ă une matrice de transition d'une chaĂźne de Markov, nous proposons une mĂ©thode de partitionnement consistant Ă appliquer la matrice S sur X de maniĂšre itĂ©rative jusqu'Ă convergence. Les classes formant la partition sont dĂ©terminĂ©es Ă partir des Ă©tats stationnaires de la matrice stochastique. Cette matrice stochastique peut ĂȘtre issue d'une matrice de similaritĂ© entre les objets, similaritĂ© qui peut ĂȘtre dĂ©terminĂ©e Ă partir du tableau X ou bien Ă partir de donnĂ©es externes. La matrice stochastique peut Ă©galement reflĂ©ter la densitĂ© de points autour des objets considĂ©rĂ©s. DiffĂ©rentes similaritĂ©s et fonctions de densitĂ© sont Ă©tudiĂ©es et comparĂ©es (plus proches voisins, noyaux de densitĂ©...). La dĂ©marche sera illustrĂ©e sur la base de donnĂ©es simulĂ©es et de donnĂ©es rĂ©elles
Discrimination et Classification supervisée en référence à des prototypes
International audienceL'objectif de la classification supervisĂ©e est d'affecter des individus Ă des groupes dĂ©finis a priori Ă partir des mesures effectuĂ©es sur des variables. Dans ce contexte, les analyses discriminantes linĂ©aire et quadratique sont parmi les mĂ©thodes les plus populaires. Elles sont fondĂ©es sur des hypothĂšses de multinormalitĂ©. Dans certaines situations, cette rĂšgle s'avĂšre inappropriĂ©e en particulier dans le cas d'un groupe multimodal ou en prĂ©sence d'Ă©lĂ©ments atypiques. Pour pallier ce problĂšme, la mĂ©thode proposĂ©e consiste Ă pondĂ©rer les individus de maniĂšre Ă dĂ©terminer des statistiques robustes. Dans une communication prĂ©cĂ©dente, nous avons introduit une mĂ©thode de classification (non supervisĂ©e) basĂ©e sur la dĂ©termination d'une matrice stochastique. Un des intĂ©rĂȘts de cette approche est d'exhiber des barycentres pondĂ©rĂ©s (appelĂ©s prototypes) au sein des diffĂ©rents groupes. Cette dĂ©marche est Ă©tendue au cadre de la classification supervisĂ©e et au cadre de la discrimination. Pour la classification supervisĂ©e, nous adoptons une dĂ©marche similaire Ă celle prĂ©conisĂ©e dans le cadre des rĂ©seaux de neurones probabilistes. Pour l'analyse factorielle discriminante, nous utilisons le systĂšme de pondĂ©ration pour l'estimation des paramĂštres de localisation des matrices de variance covariance Ă l'intĂ©rieur de chaque groupe, ainsi que de la matrice de variance covariance totale
Mise en Ćuvre dâun programme dâactivitĂ© physique adaptĂ©e chez les patients atteints de cancer : amĂ©lioration de leur qualitĂ© de vie, de leur fatigue et de leur capacitĂ© physique
Introduction : Les bĂ©nĂ©fices de lâactivitĂ© physique dans la prise en charge globale en cancĂ©rologie sont maintenant reconnus. Malheureusement, lâoffre de soin reste encore trop limitĂ©e et peu standardisĂ©e. Objectif : Cette Ă©tude vise Ă Ă©valuer le programme dâactivitĂ© physique adaptĂ©e (APA) dĂ©veloppĂ© au sein de notre institut en comparant les niveaux de qualitĂ© de vie, de fatigue, dâactivitĂ© physique et de sĂ©dentaritĂ© ainsi que des capacitĂ©s physiques Ă lâentrĂ©e et Ă la sortie du sĂ©jour de rĂ©adaptation. MĂ©thode : Ătude rĂ©trospective sur les patients (nâ=â72) ayant suivi le programme dâAPA entre aoĂ»tâ2019 et avrilâ2021. La fatigue ressentie Ă©tait dĂ©terminĂ©e par lâĂ©chelle FSS (Fatigue Severity Scale), la qualitĂ© de vie par le questionnaire MOS-SF36 (santĂ© physique et mentale), et les capacitĂ©s physiques par le TM6 (test de marche des 6âminutes). Lâanalyse statistique de lâĂ©volution des paramĂštres Ă©tudiĂ©s a Ă©tĂ© rĂ©alisĂ©e par un test de Student appariĂ© en cas de normalitĂ© des donnĂ©es ou par un test de Wilcoxon dans le cas contraire. RĂ©sultats : Ă la suite des 24âdemi-journĂ©es du programme de rĂ©adaptation, on observait une diminution significative de la fatigue ressentie (4,3â±â1,6 vs. 3,3â±â1,4 ; pâ<â0,0001***), une amĂ©lioration de la qualitĂ© de vie Ă©valuĂ©e par le questionnaire MOS-SF36 (score physique, mentale et santĂ© perçue) ainsi que des capacitĂ©s physiques (432â±â115,3 vs. 490,8â±â100,5âm ; pâ<â0,0001***) des patients. Conclusion : Cette expĂ©rience pilote permet de valider les bĂ©nĂ©fices globaux de notre programme dâAPA chez les patients atteints de diffĂ©rent type de tumeur maligne
Comparison of three hypothesis testing approaches for the selection of the appropriate number of clusters of variables
Clustering of variables, Number of clusters, Hypothesis testing approach, Gap statistic, CLV, 62H15, 62H30, 62P99,
Yoga in the Rehabilitation of Post-Stroke Sequelae: A Non-Inferiority Randomized Controlled Trial.
International audienceIntroduction: Stroke survivors can experience various consequences that affect their physical and psychological balance. Yoga seems to be relevant for this population as it allows to work on both the body and the mind. The first objective of this study was to investigate the non-inferiority of yoga compared with conventional physical activity in improving physical function in patients with chronic post-stroke sequelae. The secondary objective was to investigate the superiority of yoga in improving the mental health of these patients.Methods: A randomized controlled trial was conducted. Thirty-six patients were randomized into two groups to practice a yoga program (YOG'AVC) or the Fitness and Mobility Exercise (FAME) program. Patients were assessed in a blinding mode pre- (T0) and post-program (T1) and 3â4 months after completion (T2). The physical assessments were the Berg Balance Scale, timed up and go test, 6-minute walk test, and quadriceps strength measured by hand-held dynamometer. Questionnaire assessments were: Activities-specific Balance Confidence ScaleâSimplified, State-Trait Anxiety Inventory, Beck's Depression Inventory, and the Reintegration to Normal Living Index.Results: The YOG'AVC program was not inferior to the FAME program in improving balance, functional mobility and muscle strength. Both groups showed significant improvement (pâ<â0.05) between T0 and T1 in their anxiety, depression, and reintegration to normal life scores, with no significant difference between groups.Discussion: Both programs seem to be valuable in improving the physical abilities and psychological well-being of chronic post-stroke patients. However, further studies are required to confirm the difference between these programs
Do high-dose progestins impair sexual function in women treated for endometriosis? A prospective observational longitudinal study
International audienceIntroduction: High-dose progestins are used as an effective therapy for painful symptoms of endometriosis but their impact on sexual function has been poorly studied. The study aims to assess the impact of high-dose progestin on sexual function among women treated for endometriosis. Material and methods: In this bicenter prospective observational study, women with endometriosis who received medical or surgical treatment for endometriosis and who were sexually active were included. They completed the Sexual Activity Questionnaire (SAQ, a validated tool) before (T0) and 12 months after (T1) endometriosis treatment. We classified patients into two groups according to whether they were using high-dose progestins at T1: a high-dose progestin group and a control group. The main outcome was sexual function measured by the SAQ score (from 0 to 30) at T1. The secondary outcomes were each individual SAQ item, the dyspareunia 100-mm visual analog scale (VAS) and the quality of life assessed with EuroQoL Group 5D Index (EQ-5D) at T1. We also assessed the change in dyspareunia VAS and quality of life between T0 and T1. The Ethics Committee of Ile-de-France (Act 2004-806, 9 August 2004) approved the study. Results: Among 214 women included, 25 (12%) were exposed to high-dose progestins at T1. The SAQ score of women exposed to high-dose progestins was significantly lower compared with the control group, with or without adjustment for covariates (15.5 ± 6.3 vs 18.3 ± 6.2, P =.03, adjusted effect size â0.44 [95% CI â0.86 to â0.02], P =.04). High-dose progestin intake at T1 was associated with a lower subscore on two SAQ items: pleasure (1.8 ± 0.8 vs 2.2 ± 0.9, P =.02), and satisfaction with frequency of intercourse (1.2 ± 1.2 vs 1.8 ± 1.1, P =.02). In the overall population, dyspareunia VAS and quality of life assessed by EQ-5D improved between T0 and T1 (45 ± 29 at T0 vs 28 ± 29 at T1, P <.001; 0.78 ± 0.14 at T0 vs 0.86 ± 0.14 at T1, P <.001, respectively). At T1, the groups did not differ significantly for dyspareunia VAS (effect size 0.36 [95% CI â0.06 to 0.78], P =.10) and quality of life (EQ-5D, effect size 0.02 [95% CI â0.40 to 0.44], P =.91). Conclusion: In this observational study, high-dose progestins impair the sexual function of women treated for endometriosis even though they improved dyspareunia
Projet de multi-instrumentation géophysique en région Pays de la Loire
International audienc
Does accelerometry reflect hand function in infants at risk of unilateral cerebral palsy? A secondary analysis of BB-Bim results
Background: Infants at high-risk of unilateral Cerebral Palsy (UCP) may have asymmetry in upper extremity movement and function, which should be identified as soon as possible for management.AimsTo explore the feasibility of using two AX3 Axivity monitors in wrist-worn bracelets to quantify movements, and to identify whether accelerometry parameters are consistent with hand function.Methods and procedures6 infants at high risk of UCP (aged 3 to ?12 months) were included in a Single-Case Experimental Design to explore the impact of an 8-week bimanual stimulation home program.OutcomesEach week of the baseline (randomized duration 4-7 weeks) and 8-week program, the Hand Assessment for Infants (HAI) was performed and accelerometry parameters were collected during HAI and also during spontaneous activity, several times a week.ResultsActimetry was analyzed during HAI and 238 spontaneous activity sessions (mean 42±21min). Actimetry ratios distribution and evolution show a high variability, especially for spontaneous activity. No strong correlation was found between HAI scores and accelerometry parameters, either collected during HAI, or during spontaneous activity times.Conclusion and implicationsDespite its feasibility, using accelerometry bracelets looks unreliable for detecting and monitoring hand function in infants under one year