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Papers by Aurore Caumont-prim

Poster: "ECR 2014 / C-2224 / The value of a simplified contrast enhanced angio-MRI protocol ... more Poster: "ECR 2014 / C-2224 / The value of a simplified contrast enhanced angio-MRI protocol in the detection of head and neck parangangliomas in SDHx mutations carriers: A retrospective study from the PGL.EVA cohort" by: "G. GRAVEL, A. Caumont-Prim, A.-C. HERNIGOU, A.-P. Gimenez-Roqueplo, P. Halimi; Paris/FR"

Annals of Oncology, 2019

Background NACT is increasingly used as a model to explore new targeted therapy in combination wi... more Background NACT is increasingly used as a model to explore new targeted therapy in combination with CT in AOC. Whether an intermediate endpoint could be used as surrogate of PFS and/or OS in pts treated with NACT remains currently elusive and was explored retrospectively in the CHIVA trial. Methods Patients (pts) with FIGO stage IIIC-IV AOC considered as unresectable after laparoscopic (Lap) evaluation were treated with 3 to 4 cycles of platinum-taxane NACT + oral nintedanib before interval debulking surgery (IDS). CT (up to 6 cycles in total) and nintedanib were pursued post-operatively. Were measured response rates at the end of NACT according to RECIST (ORR) with CT-scan and to GCIG with CA125, initial Peritoneal Cancer Index (PCI) and its evolution at IDS, complete surgical resection rate (CC0), pathologic complete or near complete response rate (pCR). These covariates in univariate analysis were included together with other prognostic clinical covariates:age, FIGO stage, ECOG, ...

Journal of Pain Research, 2021

Purpose: Undertreatment of trauma-related pain is common in the pre-hospital and hospital setting... more Purpose: Undertreatment of trauma-related pain is common in the pre-hospital and hospital settings owing to barriers to the use of traditional standard of care analgesics. Low-dose methoxyflurane is an inhaled non-opioid analgesic with a rapid onset of pain relief that is approved for emergency relief of moderate-to-severe trauma-related pain in adults. This analysis was performed to compare the efficacy and safety of low-dose methoxyflurane with standard of care analgesics in adults with trauma-related pain. Methods: A meta-analysis was performed on pooled data from randomized controlled trials identified via a systematic review. The primary endpoint was the pain intensity difference between baseline and various time intervals (5, 10, 15, 20, and 30 minutes) after initiation of treatment. Results: The pain intensity difference was statistically superior with low-dose methoxyflurane compared with standard of care analgesics (overall estimated treatment effect=11.88, 95% CI=9.75-14.00; P<0.0001). The superiority of low-dose methoxyflurane was demonstrated at 5 minutes after treatment initiation and was maintained across all timepoints. Significantly more patients treated with methoxyflurane achieved response criteria of pain intensity ≤30 mm on a visual analog scale, and relative reductions in pain intensity of ≥30% and ≥50%, compared with patients who received standard of care analgesics. The median time to pain relief was shorter with methoxyflurane than with standard of care analgesics. The findings were consistent in a subgroup of elderly patients (aged ≥65 years). Conclusion: Methoxyflurane can be considered as an alternative to standard of care analgesics in pre-hospital and hospital settings for treatment of adult patients with acute trauma-related pain.

Respirology, 2016

Background and objective: Dyspnoea in pulmonary embolism (PE) remains poorly characterized. Littl... more Background and objective: Dyspnoea in pulmonary embolism (PE) remains poorly characterized. Little is known about how to measure intensity or about the underlying mechanisms that may be related to ventilatory abnormalities, alveolar dead space ventilation or modulating factors such as psychological modulate. We hypothesized that dyspnoea would mainly be associated with pulmonary vascular obstruction and its pathophysiological consequences, while the sensory-affective domain of dyspnoea would be influenced by other factors. Methods: We undertook a prospective study of 90 consecutive non-obese patients (mean AE SD age: 49 AE 16 years, 41 women) without cardiorespiratory disease. All patients were hospitalized with symptoms for <15 days and a confirmed PE (multi-detector computed tomography (MDCT) scan, n = 87 and high-probability ventilation/perfusion scan, n = 3). Patients underwent assessment of dyspnoea using the Borg score, modified Medical Research Council (mMRC) scale, assessment of psychological trait, state of anxiety and depression and chest pain via the Visual Analogical Scale at the time of maximum dyspnoea. Functional evaluations such as the quantitative ventilationperfusion lung scan, echocardiography, alveolar dead space fraction and tidal ventilation measurements were completed within 48 h of admission. Results: Multivariate analyses demonstrated that dyspnoea was mainly linked to pulmonary vascular obstruction and/or its consequences such as raised pulmonary arterial pressure and chest pain. The sensory-affective domain of dyspnoea showed additional determinants such as age, depression and breathing variability. Conclusion: Dyspnoea is mainly related to vascular consequences of PE such as increased pulmonary arterial pressure or chest pain. The sensory-affective domain of dyspnoea also correlates with age, depression and breathing variability.

European Respiratory Journal, Sep 1, 2011

European Radiology, 2016

Objectives To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced... more Objectives To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced magnetic resonance (MR) imaging in the detection of liver metastases. Methods A comprehensive search (EMBASE, PubMed, Cochrane) was performed to identify relevant articles up to June 2015. Inclusion criteria were: liver metastases, DW-MR imaging and/or gadoxetic acid-enhanced MR imaging, and per-lesion statistics. The reference standard was histopathology, intraoperative observation and/or follow-up. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effect regression model was used to obtain sensitivity estimates. Results Thirty-nine articles were included (1,989 patients, 3,854 metastases). Sensitivity estimates for DW-MR imaging, gadoxetic acid-enhanced MR imaging and the combined sequence for detecting liver metastases on a per-lesion basis was 87.1 %, 90.6 % and 95.5 %, respectively. Sensitivity estimates by gadoxetic acidenhanced MR imaging and the combined sequence were significantly better than DW-MR imaging (p = 0.0001 and p < 0.0001, respectively), and the combined MR sequence was significantly more sensitive than gadoxetic acid-enhanced MR imaging (p < 0.0001). Similar results were observed in articles that compared the three techniques simultaneously, with only colorectal liver metastases and in liver metastases smaller than 1 cm. Conclusions In patients with liver metastases, combined DW-MR and gadoxetic acid-enhanced MR imaging has the highest sensitivity for detecting liver metastases on a per-lesion basis. Key Points • DW-MRI is less sensitive than gadoxetic acid-enhanced MRI for detecting liver metastases • DW-MRI and gadoxetic acid-enhanced MRI is the best combination • Same results are observed in colorectal liver metastases • Same results are observed in liver metastases smaller than 1 cm • Same results are observed when histopathology alone is the reference standard

PURPOSE When radiological hallmarks of hepatocellular carcinoma (HCC) as defined by EASL–EORTC Cl... more PURPOSE When radiological hallmarks of hepatocellular carcinoma (HCC) as defined by EASL–EORTC Clinical Practice Guidelines are not seen on imaging, biopsy of nodule larger than 1cm is recommended. The goal of our study was to determine the usefulness of a second biopsy when the first one is inconclusive. METHOD AND MATERIALS In a multicenter prospective study of 430 cirrhotic patients with nodules < 3 cm detected during surveillance, 152 patients (mean age = 61.95 +/- 8.86 years) with 165 nodules had a percutaneous biopsy of a nodule and adjacent liver using 18G-cutting needles. When the first biopsy was inconclusive (no pathologic diagnosis of nodules), a second biopsy was proposed. RESULTS The mean diameter of the nodules was 19.4 +/- 5.7 mm. At first biopsy, the diagnosis was HCC, dysplastic nodule and regenerative nodule in 105 (63.6%), 6 (3.6%) and 10 (6.1%), respectively. No lesion was found at pathology in 43 (26.1%) nodules. 17 (39.5%) of the nodules underwent a second b...

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2014

There is no consensus on optimal screening procedures for multidrug-resistant Enterobacteriaceae ... more There is no consensus on optimal screening procedures for multidrug-resistant Enterobacteriaceae (MDRE) in intensive care units (ICUs). Therefore, we assessed five strategies for the detection of extended-spectrum beta-lactamase (ESBL) and high-level expressed AmpC cephalosporinase (HL-CASE) producers. During a 3-month period, a rectal screening swab sample was collected daily from every ICU patient, from the first 24 h to the last day of ICU stay. Samples were plated on MDRE-selective media. Bacteria were identified using MALDI-TOF mass spectrometry and antibiograms were performed using disk diffusion. MDREs were isolated from 682/2348 (29.0%) screening samples collected from 93/269 (34.6%) patients. Incidences of patients with ESBL and HL-CASE producers were 17.8 and 19.3 per 100 admissions, respectively. In 48/93 patients, MDRE carriage was intermittent. Compared with systematic screening at admission, systematic screening at discharge did not significantly increase the rate of M...

Journal of Clinical Microbiology, 2013

Overall, 2,337 rectal screening samples (RSSs) were seeded by using the Wasp instrument for autom... more Overall, 2,337 rectal screening samples (RSSs) were seeded by using the Wasp instrument for automated microbiological processing with five media for detection of extended-spectrum β-lactamase (ESBL): CHROMagar, ChromID, Brilliance, BD Drigalski, and HEGP media. Of 354 RSSs harboring ESBL-producing isolates, 89.3% were found to be positive on all media. Sensitivity and specificity ranged from 95.5 to 98.3% and from 57.9 to 72.3%, respectively. No medium was perfectly ESBL selective, and non-ESBL-producing strains were mainly Enterobacteriaceae overproducing AmpC β-lactamase and nonfermenting Gram-negative bacilli, mostly Pseudomonas aeruginosa .

Endurance-training in healthy men is associated with lesser exertional breathlessness that correl... more Endurance-training in healthy men is associated with lesser exertional breathlessness that correlates with circulatory-muscular conditioning markers in a cross-sectional design.

Journal of Pain Research, 2021

Purpose: Undertreatment of trauma-related pain is common in the pre-hospital and hospital setting... more Purpose: Undertreatment of trauma-related pain is common in the pre-hospital and hospital settings owing to barriers to the use of traditional standard of care analgesics. Low-dose methoxyflurane is an inhaled non-opioid analgesic with a rapid onset of pain relief that is approved for emergency relief of moderate-to-severe trauma-related pain in adults. This analysis was performed to compare the efficacy and safety of low-dose methoxyflurane with standard of care analgesics in adults with trauma-related pain. Methods: A meta-analysis was performed on pooled data from randomized controlled trials identified via a systematic review. The primary endpoint was the pain intensity difference between baseline and various time intervals (5, 10, 15, 20, and 30 minutes) after initiation of treatment. Results: The pain intensity difference was statistically superior with low-dose methoxyflurane compared with standard of care analgesics (overall estimated treatment effect=11.88, 95% CI=9.75-14.00; P<0.0001). The superiority of low-dose methoxyflurane was demonstrated at 5 minutes after treatment initiation and was maintained across all timepoints. Significantly more patients treated with methoxyflurane achieved response criteria of pain intensity ≤30 mm on a visual analog scale, and relative reductions in pain intensity of ≥30% and ≥50%, compared with patients who received standard of care analgesics. The median time to pain relief was shorter with methoxyflurane than with standard of care analgesics. The findings were consistent in a subgroup of elderly patients (aged ≥65 years). Conclusion: Methoxyflurane can be considered as an alternative to standard of care analgesics in pre-hospital and hospital settings for treatment of adult patients with acute trauma-related pain.

Intensive Care Medicine, 2013

Respirology, 2016

Background and objective: Dyspnoea in pulmonary embolism (PE) remains poorly characterized. Littl... more Background and objective: Dyspnoea in pulmonary embolism (PE) remains poorly characterized. Little is known about how to measure intensity or about the underlying mechanisms that may be related to ventilatory abnormalities, alveolar dead space ventilation or modulating factors such as psychological modulate. We hypothesized that dyspnoea would mainly be associated with pulmonary vascular obstruction and its pathophysiological consequences, while the sensory-affective domain of dyspnoea would be influenced by other factors. Methods: We undertook a prospective study of 90 consecutive non-obese patients (mean AE SD age: 49 AE 16 years, 41 women) without cardiorespiratory disease. All patients were hospitalized with symptoms for <15 days and a confirmed PE (multi-detector computed tomography (MDCT) scan, n = 87 and high-probability ventilation/perfusion scan, n = 3). Patients underwent assessment of dyspnoea using the Borg score, modified Medical Research Council (mMRC) scale, assessment of psychological trait, state of anxiety and depression and chest pain via the Visual Analogical Scale at the time of maximum dyspnoea. Functional evaluations such as the quantitative ventilationperfusion lung scan, echocardiography, alveolar dead space fraction and tidal ventilation measurements were completed within 48 h of admission. Results: Multivariate analyses demonstrated that dyspnoea was mainly linked to pulmonary vascular obstruction and/or its consequences such as raised pulmonary arterial pressure and chest pain. The sensory-affective domain of dyspnoea showed additional determinants such as age, depression and breathing variability. Conclusion: Dyspnoea is mainly related to vascular consequences of PE such as increased pulmonary arterial pressure or chest pain. The sensory-affective domain of dyspnoea also correlates with age, depression and breathing variability.

European Respiratory Journal, Sep 1, 2011

The ATS consensus stated that spirometry and lung volume measurements may be useful in the assess... more The ATS consensus stated that spirometry and lung volume measurements may be useful in the assessment of dyspnea, together with the evaluation of psychologic status. Our objectives were to assess these statements in non overlapping groups of patients with an abnormal impedance (obesity, COPD and interstitial lung disease [ILD]), and to provide cut-off values for defects that explain moderate/severe dyspnea. Patients with severe obesity (BMI≥35) or COPD (GOLD definition) or ILD underwent spirometry, lung volume and psychologic status (Hospital Anxiety-Depression [HAD], Fatigue Impact Scale [FIS], SGRQ and SF-36 scores) assessments. Patients with mild dyspnea (MRC score 1-2) were compared with those with moderate/severe dyspnea (MRC score ≥ 3). Three hundred and twenty-height patients were prospectively enrolled, of whom 107 (33%) exhibited moderate/severe dyspnea (45/128 COPD, 28/78 ILD, 34/122 obeses). Severe dyspnea was related to airflow limitation and lung hyperinflation in COPD, to the restrictive defect in ILD and to the only increase in resistance in obese patients. Principal component analysis demonstrated that anxiety and depression fatigue exhibited no effect on dyspnea because they were related to the mental component of SF-36, while dyspnea was related to its physical component only. In non obese patients, a FEV1 < 31% predicted exhibited a 92% positive predictive value for severe dyspnea (99% specificity). In conclusion, only very severe impairment of FEV1 can predict moderate to severe dyspnea in patients with either COPD or ILD. Exertional dyspnea is not affected by psychologic status in these patients.

PURPOSE When radiological hallmarks of hepatocellular carcinoma (HCC) as defined by EASL–EORTC Cl... more PURPOSE When radiological hallmarks of hepatocellular carcinoma (HCC) as defined by EASL–EORTC Clinical Practice Guidelines are not seen on imaging, biopsy of nodule larger than 1cm is recommended. The goal of our study was to determine the usefulness of a second biopsy when the first one is inconclusive. METHOD AND MATERIALS In a multicenter prospective study of 430 cirrhotic patients with nodules < 3 cm detected during surveillance, 152 patients (mean age = 61.95 +/- 8.86 years) with 165 nodules had a percutaneous biopsy of a nodule and adjacent liver using 18G-cutting needles. When the first biopsy was inconclusive (no pathologic diagnosis of nodules), a second biopsy was proposed. RESULTS The mean diameter of the nodules was 19.4 +/- 5.7 mm. At first biopsy, the diagnosis was HCC, dysplastic nodule and regenerative nodule in 105 (63.6%), 6 (3.6%) and 10 (6.1%), respectively. No lesion was found at pathology in 43 (26.1%) nodules. 17 (39.5%) of the nodules underwent a second b...

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2014

There is no consensus on optimal screening procedures for multidrug-resistant Enterobacteriaceae ... more There is no consensus on optimal screening procedures for multidrug-resistant Enterobacteriaceae (MDRE) in intensive care units (ICUs). Therefore, we assessed five strategies for the detection of extended-spectrum beta-lactamase (ESBL) and high-level expressed AmpC cephalosporinase (HL-CASE) producers. During a 3-month period, a rectal screening swab sample was collected daily from every ICU patient, from the first 24 h to the last day of ICU stay. Samples were plated on MDRE-selective media. Bacteria were identified using MALDI-TOF mass spectrometry and antibiograms were performed using disk diffusion. MDREs were isolated from 682/2348 (29.0%) screening samples collected from 93/269 (34.6%) patients. Incidences of patients with ESBL and HL-CASE producers were 17.8 and 19.3 per 100 admissions, respectively. In 48/93 patients, MDRE carriage was intermittent. Compared with systematic screening at admission, systematic screening at discharge did not significantly increase the rate of M...

Trials, 2013

Background: Dental caries is a common disease and affects many adults worldwide. Inlay or onlay r... more Background: Dental caries is a common disease and affects many adults worldwide. Inlay or onlay restoration is widely used to treat the resulting tooth substance loss. Two esthetic materials can be used to manufacture an inlay/onlay restoration of the tooth: ceramic or composite. Here, we present the protocol of a multicenter randomized controlled trial (RCT) comparing the clinical efficacy of both materials for tooth restoration. Other objectives are analysis of overall quality, wear, restoration survival and prognosis. Methods: The CEramic and COmposite Inlays Assessment (CECOIA) trial is an open-label, parallel-group, multicenter RCT involving two hospitals and five private practices. In all, 400 patients will be included. Inclusion criteria are adults who need an inlay/onlay restoration for one tooth (that can be isolated with use of a dental dam and has at least one intact cusp), can tolerate restorative procedures and do not have severe bruxism, periodontal or carious disease or poor oral hygiene. The decayed tissue will be evicted, the cavity will be prepared for receiving an inlay/onlay and the patient will be randomized by use of a centralized web-based interface to receive: 1) a ceramic or 2) composite inlay or onlay. Treatment allocation will be balanced (1:1). The inlay/onlay will be adhesively luted. Follow-up will be for 2 years and may be extended; two independent examiners will perform the evaluations. The primary outcome measure will be the score obtained with use of the consensus instrument of the Fédération Dentaire Internationale (FDI) World Dental Federation. Secondary outcomes include this instrument's items, inlay/onlay wear, overall quality and survival of the inlay/onlay. Data will be analyzed by a statistician blinded to treatments and an adjusted ordinal logistic regression model will be used to compare the efficacy of both materials. Discussion: For clinicians, the CECOIA trial results may help with evidence-based recommendations concerning the choice of materials for inlay/onlay restoration. For patients, the results may lead to improvement in long-term restoration. For researchers, the results may provide ideas for further research concerning inlay/onlay materials and prognosis. This trial is funded by a grant from the French Ministry of Health. Trial registration: ClinicalTrials.gov Identifier: NCT01724827

Journal of Clinical Microbiology, 2013

Overall, 2,337 rectal screening samples (RSSs) were seeded by using the Wasp instrument for autom... more Overall, 2,337 rectal screening samples (RSSs) were seeded by using the Wasp instrument for automated microbiological processing with five media for detection of extended-spectrum β-lactamase (ESBL): CHROMagar, ChromID, Brilliance, BD Drigalski, and HEGP media. Of 354 RSSs harboring ESBL-producing isolates, 89.3% were found to be positive on all media. Sensitivity and specificity ranged from 95.5 to 98.3% and from 57.9 to 72.3%, respectively. No medium was perfectly ESBL selective, and non-ESBL-producing strains were mainly Enterobacteriaceae overproducing AmpC β-lactamase and nonfermenting Gram-negative bacilli, mostly Pseudomonas aeruginosa .

Poster: "ECR 2014 / C-2224 / The value of a simplified contrast enhanced angio-MRI protocol ... more Poster: "ECR 2014 / C-2224 / The value of a simplified contrast enhanced angio-MRI protocol in the detection of head and neck parangangliomas in SDHx mutations carriers: A retrospective study from the PGL.EVA cohort" by: "G. GRAVEL, A. Caumont-Prim, A.-C. HERNIGOU, A.-P. Gimenez-Roqueplo, P. Halimi; Paris/FR"

Annals of Oncology, 2019

Background NACT is increasingly used as a model to explore new targeted therapy in combination wi... more Background NACT is increasingly used as a model to explore new targeted therapy in combination with CT in AOC. Whether an intermediate endpoint could be used as surrogate of PFS and/or OS in pts treated with NACT remains currently elusive and was explored retrospectively in the CHIVA trial. Methods Patients (pts) with FIGO stage IIIC-IV AOC considered as unresectable after laparoscopic (Lap) evaluation were treated with 3 to 4 cycles of platinum-taxane NACT + oral nintedanib before interval debulking surgery (IDS). CT (up to 6 cycles in total) and nintedanib were pursued post-operatively. Were measured response rates at the end of NACT according to RECIST (ORR) with CT-scan and to GCIG with CA125, initial Peritoneal Cancer Index (PCI) and its evolution at IDS, complete surgical resection rate (CC0), pathologic complete or near complete response rate (pCR). These covariates in univariate analysis were included together with other prognostic clinical covariates:age, FIGO stage, ECOG, ...

Journal of Pain Research, 2021

Purpose: Undertreatment of trauma-related pain is common in the pre-hospital and hospital setting... more Purpose: Undertreatment of trauma-related pain is common in the pre-hospital and hospital settings owing to barriers to the use of traditional standard of care analgesics. Low-dose methoxyflurane is an inhaled non-opioid analgesic with a rapid onset of pain relief that is approved for emergency relief of moderate-to-severe trauma-related pain in adults. This analysis was performed to compare the efficacy and safety of low-dose methoxyflurane with standard of care analgesics in adults with trauma-related pain. Methods: A meta-analysis was performed on pooled data from randomized controlled trials identified via a systematic review. The primary endpoint was the pain intensity difference between baseline and various time intervals (5, 10, 15, 20, and 30 minutes) after initiation of treatment. Results: The pain intensity difference was statistically superior with low-dose methoxyflurane compared with standard of care analgesics (overall estimated treatment effect=11.88, 95% CI=9.75-14.00; P<0.0001). The superiority of low-dose methoxyflurane was demonstrated at 5 minutes after treatment initiation and was maintained across all timepoints. Significantly more patients treated with methoxyflurane achieved response criteria of pain intensity ≤30 mm on a visual analog scale, and relative reductions in pain intensity of ≥30% and ≥50%, compared with patients who received standard of care analgesics. The median time to pain relief was shorter with methoxyflurane than with standard of care analgesics. The findings were consistent in a subgroup of elderly patients (aged ≥65 years). Conclusion: Methoxyflurane can be considered as an alternative to standard of care analgesics in pre-hospital and hospital settings for treatment of adult patients with acute trauma-related pain.

Respirology, 2016

Background and objective: Dyspnoea in pulmonary embolism (PE) remains poorly characterized. Littl... more Background and objective: Dyspnoea in pulmonary embolism (PE) remains poorly characterized. Little is known about how to measure intensity or about the underlying mechanisms that may be related to ventilatory abnormalities, alveolar dead space ventilation or modulating factors such as psychological modulate. We hypothesized that dyspnoea would mainly be associated with pulmonary vascular obstruction and its pathophysiological consequences, while the sensory-affective domain of dyspnoea would be influenced by other factors. Methods: We undertook a prospective study of 90 consecutive non-obese patients (mean AE SD age: 49 AE 16 years, 41 women) without cardiorespiratory disease. All patients were hospitalized with symptoms for <15 days and a confirmed PE (multi-detector computed tomography (MDCT) scan, n = 87 and high-probability ventilation/perfusion scan, n = 3). Patients underwent assessment of dyspnoea using the Borg score, modified Medical Research Council (mMRC) scale, assessment of psychological trait, state of anxiety and depression and chest pain via the Visual Analogical Scale at the time of maximum dyspnoea. Functional evaluations such as the quantitative ventilationperfusion lung scan, echocardiography, alveolar dead space fraction and tidal ventilation measurements were completed within 48 h of admission. Results: Multivariate analyses demonstrated that dyspnoea was mainly linked to pulmonary vascular obstruction and/or its consequences such as raised pulmonary arterial pressure and chest pain. The sensory-affective domain of dyspnoea showed additional determinants such as age, depression and breathing variability. Conclusion: Dyspnoea is mainly related to vascular consequences of PE such as increased pulmonary arterial pressure or chest pain. The sensory-affective domain of dyspnoea also correlates with age, depression and breathing variability.

European Respiratory Journal, Sep 1, 2011

European Radiology, 2016

Objectives To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced... more Objectives To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced magnetic resonance (MR) imaging in the detection of liver metastases. Methods A comprehensive search (EMBASE, PubMed, Cochrane) was performed to identify relevant articles up to June 2015. Inclusion criteria were: liver metastases, DW-MR imaging and/or gadoxetic acid-enhanced MR imaging, and per-lesion statistics. The reference standard was histopathology, intraoperative observation and/or follow-up. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effect regression model was used to obtain sensitivity estimates. Results Thirty-nine articles were included (1,989 patients, 3,854 metastases). Sensitivity estimates for DW-MR imaging, gadoxetic acid-enhanced MR imaging and the combined sequence for detecting liver metastases on a per-lesion basis was 87.1 %, 90.6 % and 95.5 %, respectively. Sensitivity estimates by gadoxetic acidenhanced MR imaging and the combined sequence were significantly better than DW-MR imaging (p = 0.0001 and p < 0.0001, respectively), and the combined MR sequence was significantly more sensitive than gadoxetic acid-enhanced MR imaging (p < 0.0001). Similar results were observed in articles that compared the three techniques simultaneously, with only colorectal liver metastases and in liver metastases smaller than 1 cm. Conclusions In patients with liver metastases, combined DW-MR and gadoxetic acid-enhanced MR imaging has the highest sensitivity for detecting liver metastases on a per-lesion basis. Key Points • DW-MRI is less sensitive than gadoxetic acid-enhanced MRI for detecting liver metastases • DW-MRI and gadoxetic acid-enhanced MRI is the best combination • Same results are observed in colorectal liver metastases • Same results are observed in liver metastases smaller than 1 cm • Same results are observed when histopathology alone is the reference standard

PURPOSE When radiological hallmarks of hepatocellular carcinoma (HCC) as defined by EASL–EORTC Cl... more PURPOSE When radiological hallmarks of hepatocellular carcinoma (HCC) as defined by EASL–EORTC Clinical Practice Guidelines are not seen on imaging, biopsy of nodule larger than 1cm is recommended. The goal of our study was to determine the usefulness of a second biopsy when the first one is inconclusive. METHOD AND MATERIALS In a multicenter prospective study of 430 cirrhotic patients with nodules < 3 cm detected during surveillance, 152 patients (mean age = 61.95 +/- 8.86 years) with 165 nodules had a percutaneous biopsy of a nodule and adjacent liver using 18G-cutting needles. When the first biopsy was inconclusive (no pathologic diagnosis of nodules), a second biopsy was proposed. RESULTS The mean diameter of the nodules was 19.4 +/- 5.7 mm. At first biopsy, the diagnosis was HCC, dysplastic nodule and regenerative nodule in 105 (63.6%), 6 (3.6%) and 10 (6.1%), respectively. No lesion was found at pathology in 43 (26.1%) nodules. 17 (39.5%) of the nodules underwent a second b...

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2014

There is no consensus on optimal screening procedures for multidrug-resistant Enterobacteriaceae ... more There is no consensus on optimal screening procedures for multidrug-resistant Enterobacteriaceae (MDRE) in intensive care units (ICUs). Therefore, we assessed five strategies for the detection of extended-spectrum beta-lactamase (ESBL) and high-level expressed AmpC cephalosporinase (HL-CASE) producers. During a 3-month period, a rectal screening swab sample was collected daily from every ICU patient, from the first 24 h to the last day of ICU stay. Samples were plated on MDRE-selective media. Bacteria were identified using MALDI-TOF mass spectrometry and antibiograms were performed using disk diffusion. MDREs were isolated from 682/2348 (29.0%) screening samples collected from 93/269 (34.6%) patients. Incidences of patients with ESBL and HL-CASE producers were 17.8 and 19.3 per 100 admissions, respectively. In 48/93 patients, MDRE carriage was intermittent. Compared with systematic screening at admission, systematic screening at discharge did not significantly increase the rate of M...

Journal of Clinical Microbiology, 2013

Overall, 2,337 rectal screening samples (RSSs) were seeded by using the Wasp instrument for autom... more Overall, 2,337 rectal screening samples (RSSs) were seeded by using the Wasp instrument for automated microbiological processing with five media for detection of extended-spectrum β-lactamase (ESBL): CHROMagar, ChromID, Brilliance, BD Drigalski, and HEGP media. Of 354 RSSs harboring ESBL-producing isolates, 89.3% were found to be positive on all media. Sensitivity and specificity ranged from 95.5 to 98.3% and from 57.9 to 72.3%, respectively. No medium was perfectly ESBL selective, and non-ESBL-producing strains were mainly Enterobacteriaceae overproducing AmpC β-lactamase and nonfermenting Gram-negative bacilli, mostly Pseudomonas aeruginosa .

Endurance-training in healthy men is associated with lesser exertional breathlessness that correl... more Endurance-training in healthy men is associated with lesser exertional breathlessness that correlates with circulatory-muscular conditioning markers in a cross-sectional design.

Journal of Pain Research, 2021

Purpose: Undertreatment of trauma-related pain is common in the pre-hospital and hospital setting... more Purpose: Undertreatment of trauma-related pain is common in the pre-hospital and hospital settings owing to barriers to the use of traditional standard of care analgesics. Low-dose methoxyflurane is an inhaled non-opioid analgesic with a rapid onset of pain relief that is approved for emergency relief of moderate-to-severe trauma-related pain in adults. This analysis was performed to compare the efficacy and safety of low-dose methoxyflurane with standard of care analgesics in adults with trauma-related pain. Methods: A meta-analysis was performed on pooled data from randomized controlled trials identified via a systematic review. The primary endpoint was the pain intensity difference between baseline and various time intervals (5, 10, 15, 20, and 30 minutes) after initiation of treatment. Results: The pain intensity difference was statistically superior with low-dose methoxyflurane compared with standard of care analgesics (overall estimated treatment effect=11.88, 95% CI=9.75-14.00; P<0.0001). The superiority of low-dose methoxyflurane was demonstrated at 5 minutes after treatment initiation and was maintained across all timepoints. Significantly more patients treated with methoxyflurane achieved response criteria of pain intensity ≤30 mm on a visual analog scale, and relative reductions in pain intensity of ≥30% and ≥50%, compared with patients who received standard of care analgesics. The median time to pain relief was shorter with methoxyflurane than with standard of care analgesics. The findings were consistent in a subgroup of elderly patients (aged ≥65 years). Conclusion: Methoxyflurane can be considered as an alternative to standard of care analgesics in pre-hospital and hospital settings for treatment of adult patients with acute trauma-related pain.

Intensive Care Medicine, 2013

Respirology, 2016

Background and objective: Dyspnoea in pulmonary embolism (PE) remains poorly characterized. Littl... more Background and objective: Dyspnoea in pulmonary embolism (PE) remains poorly characterized. Little is known about how to measure intensity or about the underlying mechanisms that may be related to ventilatory abnormalities, alveolar dead space ventilation or modulating factors such as psychological modulate. We hypothesized that dyspnoea would mainly be associated with pulmonary vascular obstruction and its pathophysiological consequences, while the sensory-affective domain of dyspnoea would be influenced by other factors. Methods: We undertook a prospective study of 90 consecutive non-obese patients (mean AE SD age: 49 AE 16 years, 41 women) without cardiorespiratory disease. All patients were hospitalized with symptoms for <15 days and a confirmed PE (multi-detector computed tomography (MDCT) scan, n = 87 and high-probability ventilation/perfusion scan, n = 3). Patients underwent assessment of dyspnoea using the Borg score, modified Medical Research Council (mMRC) scale, assessment of psychological trait, state of anxiety and depression and chest pain via the Visual Analogical Scale at the time of maximum dyspnoea. Functional evaluations such as the quantitative ventilationperfusion lung scan, echocardiography, alveolar dead space fraction and tidal ventilation measurements were completed within 48 h of admission. Results: Multivariate analyses demonstrated that dyspnoea was mainly linked to pulmonary vascular obstruction and/or its consequences such as raised pulmonary arterial pressure and chest pain. The sensory-affective domain of dyspnoea showed additional determinants such as age, depression and breathing variability. Conclusion: Dyspnoea is mainly related to vascular consequences of PE such as increased pulmonary arterial pressure or chest pain. The sensory-affective domain of dyspnoea also correlates with age, depression and breathing variability.

European Respiratory Journal, Sep 1, 2011

The ATS consensus stated that spirometry and lung volume measurements may be useful in the assess... more The ATS consensus stated that spirometry and lung volume measurements may be useful in the assessment of dyspnea, together with the evaluation of psychologic status. Our objectives were to assess these statements in non overlapping groups of patients with an abnormal impedance (obesity, COPD and interstitial lung disease [ILD]), and to provide cut-off values for defects that explain moderate/severe dyspnea. Patients with severe obesity (BMI≥35) or COPD (GOLD definition) or ILD underwent spirometry, lung volume and psychologic status (Hospital Anxiety-Depression [HAD], Fatigue Impact Scale [FIS], SGRQ and SF-36 scores) assessments. Patients with mild dyspnea (MRC score 1-2) were compared with those with moderate/severe dyspnea (MRC score ≥ 3). Three hundred and twenty-height patients were prospectively enrolled, of whom 107 (33%) exhibited moderate/severe dyspnea (45/128 COPD, 28/78 ILD, 34/122 obeses). Severe dyspnea was related to airflow limitation and lung hyperinflation in COPD, to the restrictive defect in ILD and to the only increase in resistance in obese patients. Principal component analysis demonstrated that anxiety and depression fatigue exhibited no effect on dyspnea because they were related to the mental component of SF-36, while dyspnea was related to its physical component only. In non obese patients, a FEV1 < 31% predicted exhibited a 92% positive predictive value for severe dyspnea (99% specificity). In conclusion, only very severe impairment of FEV1 can predict moderate to severe dyspnea in patients with either COPD or ILD. Exertional dyspnea is not affected by psychologic status in these patients.

PURPOSE When radiological hallmarks of hepatocellular carcinoma (HCC) as defined by EASL–EORTC Cl... more PURPOSE When radiological hallmarks of hepatocellular carcinoma (HCC) as defined by EASL–EORTC Clinical Practice Guidelines are not seen on imaging, biopsy of nodule larger than 1cm is recommended. The goal of our study was to determine the usefulness of a second biopsy when the first one is inconclusive. METHOD AND MATERIALS In a multicenter prospective study of 430 cirrhotic patients with nodules < 3 cm detected during surveillance, 152 patients (mean age = 61.95 +/- 8.86 years) with 165 nodules had a percutaneous biopsy of a nodule and adjacent liver using 18G-cutting needles. When the first biopsy was inconclusive (no pathologic diagnosis of nodules), a second biopsy was proposed. RESULTS The mean diameter of the nodules was 19.4 +/- 5.7 mm. At first biopsy, the diagnosis was HCC, dysplastic nodule and regenerative nodule in 105 (63.6%), 6 (3.6%) and 10 (6.1%), respectively. No lesion was found at pathology in 43 (26.1%) nodules. 17 (39.5%) of the nodules underwent a second b...

Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2014

There is no consensus on optimal screening procedures for multidrug-resistant Enterobacteriaceae ... more There is no consensus on optimal screening procedures for multidrug-resistant Enterobacteriaceae (MDRE) in intensive care units (ICUs). Therefore, we assessed five strategies for the detection of extended-spectrum beta-lactamase (ESBL) and high-level expressed AmpC cephalosporinase (HL-CASE) producers. During a 3-month period, a rectal screening swab sample was collected daily from every ICU patient, from the first 24 h to the last day of ICU stay. Samples were plated on MDRE-selective media. Bacteria were identified using MALDI-TOF mass spectrometry and antibiograms were performed using disk diffusion. MDREs were isolated from 682/2348 (29.0%) screening samples collected from 93/269 (34.6%) patients. Incidences of patients with ESBL and HL-CASE producers were 17.8 and 19.3 per 100 admissions, respectively. In 48/93 patients, MDRE carriage was intermittent. Compared with systematic screening at admission, systematic screening at discharge did not significantly increase the rate of M...

Trials, 2013

Background: Dental caries is a common disease and affects many adults worldwide. Inlay or onlay r... more Background: Dental caries is a common disease and affects many adults worldwide. Inlay or onlay restoration is widely used to treat the resulting tooth substance loss. Two esthetic materials can be used to manufacture an inlay/onlay restoration of the tooth: ceramic or composite. Here, we present the protocol of a multicenter randomized controlled trial (RCT) comparing the clinical efficacy of both materials for tooth restoration. Other objectives are analysis of overall quality, wear, restoration survival and prognosis. Methods: The CEramic and COmposite Inlays Assessment (CECOIA) trial is an open-label, parallel-group, multicenter RCT involving two hospitals and five private practices. In all, 400 patients will be included. Inclusion criteria are adults who need an inlay/onlay restoration for one tooth (that can be isolated with use of a dental dam and has at least one intact cusp), can tolerate restorative procedures and do not have severe bruxism, periodontal or carious disease or poor oral hygiene. The decayed tissue will be evicted, the cavity will be prepared for receiving an inlay/onlay and the patient will be randomized by use of a centralized web-based interface to receive: 1) a ceramic or 2) composite inlay or onlay. Treatment allocation will be balanced (1:1). The inlay/onlay will be adhesively luted. Follow-up will be for 2 years and may be extended; two independent examiners will perform the evaluations. The primary outcome measure will be the score obtained with use of the consensus instrument of the Fédération Dentaire Internationale (FDI) World Dental Federation. Secondary outcomes include this instrument's items, inlay/onlay wear, overall quality and survival of the inlay/onlay. Data will be analyzed by a statistician blinded to treatments and an adjusted ordinal logistic regression model will be used to compare the efficacy of both materials. Discussion: For clinicians, the CECOIA trial results may help with evidence-based recommendations concerning the choice of materials for inlay/onlay restoration. For patients, the results may lead to improvement in long-term restoration. For researchers, the results may provide ideas for further research concerning inlay/onlay materials and prognosis. This trial is funded by a grant from the French Ministry of Health. Trial registration: ClinicalTrials.gov Identifier: NCT01724827

Journal of Clinical Microbiology, 2013

Overall, 2,337 rectal screening samples (RSSs) were seeded by using the Wasp instrument for autom... more Overall, 2,337 rectal screening samples (RSSs) were seeded by using the Wasp instrument for automated microbiological processing with five media for detection of extended-spectrum β-lactamase (ESBL): CHROMagar, ChromID, Brilliance, BD Drigalski, and HEGP media. Of 354 RSSs harboring ESBL-producing isolates, 89.3% were found to be positive on all media. Sensitivity and specificity ranged from 95.5 to 98.3% and from 57.9 to 72.3%, respectively. No medium was perfectly ESBL selective, and non-ESBL-producing strains were mainly Enterobacteriaceae overproducing AmpC β-lactamase and nonfermenting Gram-negative bacilli, mostly Pseudomonas aeruginosa .