1: Antimicrob Agents Chemother. 2005 Nov;49(11):4628-34.
Inhibitory Activities of Epidermal Growth Factor Receptor Tyrosine
Kinase-Targeted Dihydroxyisoflavone and Trihydroxydeoxybenzoin Derivatives on
Sarcocystis neurona, Neospora caninum, and Cryptosporidium parvum Development.
Gargala G, Baishanbo A, Favennec L, Francois A, Ballet JJ, Rossignol JF.
Laboratoire d'Immunologie et Immunopathologie, CHU Avenue Georges Clemenceau,
14033 Caen Cedex, France. ballet-jj@chu-caen.fr.
Several gene sequences of parasitic protozoa belonging to protein kinase gene
families and epidermal growth factor (EGF)-like peptides, which act via binding
to receptor tyrosine kinases of the EGF receptor (EGFR) family, appear to
mediate host-protozoan interactions. As a clue to EGFR protein tyrosine kinase
(PTK) mediation and a novel approach for identifying anticoccidial agents,
activities against Sarcocystis neurona, Neospora caninum, and Cryptosporidium
parvum grown in BM and HCT-8 cell cultures of 52 EGFR PTK inhibitor isoflavone
analogs (dihydroxyisoflavone and trihydroxydeoxybenzoine derivatives) were
investigated. Their cytotoxicities against host cells were either absent, mild,
or moderate by a nitroblue tetrazolium test. At concentrations ranging from 5 to
10 mug/ml, 20 and 5 analogs, including RM-6427 and RM-6428, exhibited an in
vitro inhibitory effect of >/=95% against at least one parasite or against all
three, respectively. In immunosuppressed Cryptosporidium parvum-infected
Mongolian gerbils orally treated with either 200 or 400 mg of agent RM-6427/kg
of body weight/day for 8 days, fecal microscopic oocyst shedding was abolished
in 6/10 animals (P of <0.001 versus untreated controls) and mean shedding was
reduced by 90.5% (P of <0.0001) and 92.0% (P of <0.0001), respectively, higher
levels of inhibition than after nitazoxanide (200 mg/kg/day for 8 days) or
paromomycin (100 mg/kg/day for 8 days) treatment (55.0%, P of <0.001, and 17.5%,
P of >0.05, respectively). After RM-6427 therapy (200 mg/kg/day for 8 days), the
reduction in the ratio of animals with intracellular parasites was nearly
significant in ileum (P = 0.067) and more marked in the biliary tract (P <
0.0013) than after nitazoxanide or paromomycin treatment (0.05 < P < 0.004).
RM-6428 treatment at a regimen of 400 mg/kg/day for 12 days inhibited oocyst
shedding, measured using flow cytometry from day 4 (P < 0.05) to day 12 (P <
0.02) of therapy, when 2/15 animals had no shedding (P < 0.0001) and 11/15 were
free of gut and/or biliary tract parasites (P < 0.01). No mucosal alteration was
microscopically observed for treated or untreated infected gerbils. To our
knowledge, this report is the first to suggest that the isoflavone class of
agents has the potential for anticoccidial therapy.
PMID: 16251305 [PubMed - in process]
2: Am J Hematol. 2005 Nov;80(3):243-5.
Intense paraneoplastic neutrophilic leukemoid reaction related to a
G-CSF-Secreting lung sarcoma.
Jardin F, Vasse M, Debled M, Dominique S, Courville P, Callonnec F, Buchonnet G,
Thiberville L, Tilly H.
Department of Haematology and EMI 9906, IFRMP 23, Centre Henri Becquerel, Rouen,
France.
A white blood cell count more than 50 x 10(9)/l, not related to bone marrow
involvement, is termed leukemoid reaction. We report on the first case of an
undifferentiated sarcoma of the lung associated with an intense paraneoplastic
neutrophilic leukemoid reaction related to the production of granulocyte
colony-stimulating factor (G-CSF). A radiography and a computed tomography scan
of the chest revealed a well-limited voluminous and heterogeneous low-density
mass of the left lung. The patient died of multiorgan failure related to
uncontrolled progressive tumor growth after admission and two cycles of
chemotherapy. The patient's G-CSF serum concentration was dramatically elevated
(6,538 pg/ml) compared to serum levels observed in normal controls and patients
with elevated leukocytosis (31 and 387 pg/ml, respectively). The G-CSF
concentration dramatically increased after the first cycle of chemotherapy and
during the subsequent neutropenia, as a result of the tumor lyses as well as of
disruption of the physiological negative feedback mechanism. Adjunction of the
patient's serum to CD34+ cell cultures induced a 12.3-fold increase in CD15+
cells, demonstrating the serum's capacity to induce myeloid differentiation. Am.
J. Hematol. 80:243-245, 2005. (c) 2005 Wiley-Liss, Inc.
PMID: 16247754 [PubMed - in process]
3: Gastrointest Endosc. 2005 Nov;62(5):785-90.
Factors that affect gastric passage of video capsule.
Ben-Soussan E, Savoye G, Antonietti M, Ramirez S, Lerebours E, Ducrotte P.
Current affiliations: Service d'hepatogastroenterologie, Centre Hospitalier
Universitaire Ch Nicolle, Rouen, France.
BACKGROUND: Gastric retention and delayed gastric emptying of the video capsule
are major limitations. We retrospectively studied gastric transit time, gastric
retention, and completeness of capsule endoscopy (CE) in relation to the
conditions in which it was performed. METHODS: From May 2002 to September 2004,
CE was performed in 190 patients (92 men; mean age, 58.4 years, range 16-91
years). Patients were stratified according to the way CE was performed (hospital
day setting, outpatient, or ongoing hospitalization), and the recordings were
analyzed to measure gastric retention, gastric transit time, and the
completeness of the examinations. RESULTS: CE examination was performed in a
hospital day setting in 100 patients, in an outpatient setting in 61, and during
hospitalization in 29. Gastric retention of the capsule occurred in 8 of 190
patients (4.2%) (5 women, 3 men; mean age, 37.9 years). Gastric retention
occurred during hospitalization in 7/29 (24.1%) and in hospital day setting in
one of 100. Ongoing hospitalization was statistically associated with an
increased risk of gastric capsule retention (p < 0.0001). The cecum was reached
in 165/190 (87%), and ongoing hospitalization was associated with a lower rate
of complete examinations (p < 0.001). Small-bowel transit time was similar,
regardless of the circumstances of CE performance. CONCLUSIONS: Ongoing
hospitalization is a major cause of gastric retention and incomplete examination
by CE. Therefore, CE performance during ongoing hospitalization may require the
use of a prokinetic agent.
PMID: 16246700 [PubMed - in process]
4: Ann Surg. 2005 Nov;242(5):662-669.
Efficacy of Sacral Nerve Stimulation for Fecal Incontinence: Results of a
Multicenter Double-Blind Crossover Study.
Leroi AM, Parc Y, Lehur PA, Mion F, Barth X, Rullier E, Bresler L, Portier G,
Michot F; the Study Group.
From the *Digestive Tract Research Group EA3234/IFRMP23, CHU Rouen, France;
daggerService de Chirurgie Digestive, Hopital Saint-Antoine, Paris, France;
double daggerPole digestif, Hotel Dieu, Nantes, France; section signService de
Physiologie Digestive, Hopital Edouard Herriot, Lyon, France; parallelService
de Chirurgie Digestive, Hopital Saint Andre, Bordeaux, France; paragraph
signService de Chirurgie Digestive, Hopital Brabois, Vandoeuvre les Nancy,
France; and **Service de Chirurgie Digestive, Hopital Purpan, Toulouse, France.
daggerdaggerThe study group: G. Gourcerol (Department of Physiology, CHU Rouen,
Hopital Charles Nicolle, Rouen, France), R. Parc, P. Lamy (Department of
Surgery, AP-HP, Hopital Saint-Antoine, Paris, France), S. Bruley des Varannes,
S. Pimont, G. Meurette (Department of Gastroenterology, CHU Nantes, Hotel Dieu,
Nantes, France), H. Damon (Department of Gastroenterology, CHU Lyon, Hopital
Edouard Herriot, Lyon, France), F. Zerbib (Department of Gastroenterology, CHU
Bordeaux, Hopital Saint-Andre, Bordeaux, France), F. Lazorthes (Department of
Surgery, CHU Toulouse, Hopital Purpan, Toulouse, France), J. L. Faucheron
(Department of Surgery, Hopital Michallon, Grenoble, France), I. Sielezneff
(Department of Surgery, Hopital St. Marguerite, Marseille, France), K. Slim
(Department of Surgery, Hotel Dieu, Clermont-Ferrand, France), A. L. Tarrerias
(Centre Beaulieu, Chamalieres, France), and P. Valleur (Department of Surgery,
Hopital Lariboisiere, Paris, France).
BACKGROUND AND AIMS:: This is the first double-blind multicenter study examining
the effectiveness of sacral nerve stimulation in a significant number of fecally
incontinent patients. METHODS:: A total of 34 consecutive patients (31 women),
median age 57 years (range, 33-73 years), underwent sacral nerve stimulation for
fecal incontinence. After implantation, 27 of 34 patients were randomized in a
double-blind crossover design to stimulation ON or OFF for 1-month periods.
While still blinded, the patients chose the period of stimulation (ON or OFF)
that they had preferred. The mode of stimulation corresponding to the selected
period was continued for 3 months (final period). Outcome measures were
frequency of fecal incontinence and urgency episodes, delay in postponing
defecation, score severity, feeling of improvement, preference for ON or OFF,
quality of life, and manometric measurements. RESULTS:: In the crossover portion
of the study, the self-reported frequency of fecal incontinence episodes was
significantly reduced during the ON versus the OFF period (P = 0.03), and this
symptomatic improvement was consistent: 1) with the patients feeling of greater
improvement during the ON versus OFF period (P = 0.02); 2) with the significant
preference of patients (P = 0.02) for the ON versus OFF period. In the final
period of the study, the frequency of fecal incontinence episodes decreased
significantly (P = 0.005) in patients with the stimulator ON. The ability to
postpone defecation (P = 0.01), the score for symptom severity (P = 0.0004), and
the quality of life (P < 0.05) as well as anal sphincter function significantly
improved. CONCLUSIONS:: The significant improvement in FI during the ON versus
OFF period indicated that the clinical benefit of sacral nerve stimulation was
not due to placebo.
PMID: 16244539 [PubMed - as supplied by publisher]
5: Gynecol Obstet Fertil. 2005 Oct 20; [Epub ahead of print]
[Decreased fetal movements in the third trimester: what to do?]
[Article in French]
Sergent F, Lefevre A, Verspyck E, Marpeau L.
Clinique gynecologique et obstetricale, pavillon Mere-Enfant, hopital
Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
Objective. - To appreciate at the end of pregnancy, in a low-risk pregnant
population, the interest of a screening for fetal well-being in case of
decreased fetal movements. To define the most adapted screening. Patients and
methods. - Retrospective study over a complete year of the patients having
consulted in the same center for decreased fetal movements and subjected to the
same screening for fetal activity in hospitalization during 48 hours. This
screening included a study of fetal heart rate repeated three times a day, a
fetal biophysical profile scoring, an umbilical artery Doppler, a
Kleihauer-Betke testing, and an amnioscopy. Results. - One hundred and sixty
patients were identified, representing 6.1% of pregnancies followed in the
center. There was no relation between the age, the parity of the patients and
the probability to consult for a decrease of fetal movements. Nevertheless the
antecedents of pathological pregnancy or fetal malformation were frequent.
Twenty-one percent of the deliveries were induced for a global rate of 18% in
the center. Twenty-eight percent of the patients had a cesarean section for a
global rate of 22.8%. Five percent of fetuses were at risk for prenatal asphyxia
on the data of the screening. Fetal heart rate was abnormal in 3.75% of cases,
fetal biophysical profile score pathological in 3.1% of cases. Just one
umbilical Doppler was highly pathological. No meconium amniotic fluid was found.
Two Kleihauer-Betke tests were disturbing. At the time of delivery, 28% of
fetuses presented a funicular abnormality, 4.3% a severe growth restriction,
4.3% a malformation. One child only had an anemia. There was no perinatal
mortality. Discussion and conclusion. - Screening for fetal vitality remains
necessary in case of decreased fetal movements. It has to associate the study of
fetal heart rate and the fetal biophysical profile with a Kleihauer-Betke
testing. In a low-risk pregnant population, the study of fetal Doppler
velocimetry is not profitable. Amnioscopy presents not enough interest. It is
necessary to insist with the patients on the necessity of consulting in case of
decreased fetal movements even in the approach of the term.
PMID: 16243568 [PubMed - as supplied by publisher]
6: Curr Med Res Opin. 2005 Oct;21(10):1659-68.
A randomized, double-blind, 24-week study of escitalopram (10 mg/day) versus
citalopram (20 mg/day) in primary care patients with major depressive disorder.
Colonna L, Andersen HF, Reines EH.
University Hospital, Rouen Cedex, France.
OBJECTIVE: A randomized, double-blind, 24-week-fixed-dose study comparing the
efficacy and safety of escitalopram to that of citalopram was safety was
conducted in primary care patients with moderate to severe major depressive
disorder (MDD). RESEARCH DESIGN AND METHODS: This was a randomized,
double-blind, 24-week fixeddose study. Patients were randomly assigned to
treatment with escitalopram 10 mg/day (n = 175) or citalopram 20 mg/day (n =
182). Clinical response was evaluated using the Montgomery-Asberg Depression
Rating Scale (MADRS) and Clinical Global Impression-Severity (CGI-S) scale. The
prospectively defined primary parameter of antidepressant efficacy was the
change from baseline in the mean MADRS total score during the 24 weeks of
double-blind treatment, using a repeated measures analysis of variance to
compare the treatment groups over all assessment points simultaneously. RESULTS:
Based on the primary parameter, escitalopram was at least as efficacious as
citalopram. Based on the prospectively defined secondary parameter, mean change
from baseline in the CGI-S score, escitalopram was statistically significantly
superior to citalopram at Week 24. The importance of long-term treatment could
be demonstrated, in that more than half (55% and 51%) of the patients who had
not responded by Week 8 achieved remission by Week 24. Both escitalopram and
citalopram were safe and well tolerated in acute and long-term treatment, and
the overall adverse event profiles for the two drugs were similar. For the
intent-to-treat population, there were statistically significantly fewer
withdrawals in the escitalopram group than in the citalopram group, particularly
after Week 8. CONCLUSION: Patients with MDD responded well to long-term
treatment with either escitalopram or citalopram. This study demonstrated the
importance of extending treatment of depression beyond 8 weeks.
PMID: 16238906 [PubMed - in process]
7: Chest. 2005 Oct;128(4):3086; author reply 3086-7.
A new tracheostomy procedure.
Cuvelier A, Molano LC, Muir JF.
Publication Types:
Comment
Letter
PMID: 16236993 [PubMed - in process]
8: Arch Pediatr. 2005 Oct 14; [Epub ahead of print]
[Calcium and D vitamin status in toddlers: original study performed in the area
of Rouen.]
[Article in French]
Mallet E, Claude V, Basuyau JP, Tourancheau E.
Departement de pediatrie medicale, CHU Charles-Nicolle, 1, rue de Germont, 76031
Rouen cedex, France.
Few data are available regarding calcium and vitamin D intake in toddlers,
despite a remaining high growth velocity. Therefore, a study was carried out in
the Rouen geographical area where the sunshine is limited. It appears that a
great majority of the children studied (9/10) received plain milk, and
subsequently only small quantities of vitamin D or calcium enriched milk.
Nevertheless, 12% of primarily 4 to 6 year-old children do not received daily
minimum requirements, and 6% of them had vitamin D insufficiency, which was
demonstrated by 25OHD plasma concentrations. These concentrations declined from
18 months to 6 years old were related to discontinuation in vitamin D
supplements. A great variability was observed in vitamin D supplementation as no
official recommendations were followed. Modalities of this supplementation
should be reconsidered.
PMID: 16236489 [PubMed - as supplied by publisher]
9: Anaesth Intensive Care. 2005 Oct;33(5):578-84.
Serum erythropoietin levels in septic shock.
Tamion F, Le Cam-Duchez V, Menard JF, Girault C, Coquerel A, Bonmarchand G.
Medical Intensive Care Unit, Radioanalysis Laboratory, Hematology Laboratory and
Department of Biostatistics, Rouen University Hospital, France.
Erythropoietin is a glycoprotein hormone mainly released by the kidney, which
stimulates red blood cell production. However, in sepsis, the mechanisms
responsible for the final increase in circulating erythropoietin remain unclear
Seventeen critically ill patients with Simplified Acute Physiologic Score
average 66 (range 43 to 103) were included in this study. Ten patients survived
and seven died within 28 days. Blood samples obtained at different times were
assayed for erythropoietin, cytokine levels and lactate measurements. PCO2 gap
was assessed to detect the presence of gastric mucosal acidosis. Erythropoietin
decreased in the patients who survived while it remained high or increased in
non-survivors (37+/-6.5 vs 147+/-6. 7 UI/l respectively, P<0.05). Erythropoietin
plasma levels were correlated with IL-6 levels (r=0.84, P<0.05) and TNFalpha
levels (r=0.84, P<0.05). We observed a significant positive relationship between
erythropoietin plasma levels and lactate concentrations (r= 0.89, P< 0. 05) and
with PCO2 gap (r=0.9, P < 0.05). No correlation was found between erythropoietin
concentration and the other parameters. High serum erythropoietin levels in
non-survivors were observed with septic shock despite an increase in the levels
of proinflammatory cytokines. We found a relationship between erythropoietin
concentration and biological markers of tissue hypoperfusion i.e. lactate levels
or PCO2 gap. This relationship could suggest tissue hypoperfusion as the
stimulating factor for erythropoietin production in septic shock.
PMID: 16235474 [PubMed - in process]
10: Ann Dermatol Venereol. 2005 Aug-Sep;132(8-9 Pt 1):659-62.
[Methotrexate for the treatment of patients with chronic cutaneous sarcoidosis:
4 cases]
[Article in French]
Gary A, Modeste AB, Richard C, Jubert C, Majour F, Nouvet G, Remond B, Joly P.
Clinique Dermatologique, CHU de Rouen.
INTRODUCTION: Pathogenesis of sarcoidosis remains partially unknown. Cutaneous
lesions are frequent (20 to 35% of cases). Their clinical features and follow-up
data are highly variable. Numerous treatments have been proposed. The clinical
features and follow up data of four patients with chronic cutaneous sarcoidosis
treated with methotrexate are reported. CASE REPORT: Mean age of patients (3
female, 1 male) was 40 years old (34-49 years). One patient presented with a
lupus pernio, two patients with papules and nodules, and the last with an
annular lesion of the face. All patients had been previously treated with
topical corticosteroids and/or hydroxychloroquine without any success. Patients
were treated with methotrexate at doses ranging from 12.5 mg to 30 mg per week
for at least 6 months. Complete remission of cutaneous lesions was observed in 3
of 4 patients after a mean treatment duration of 29 months (16 to 36).
Methotrexate side effects were observed in one patient (elevated liver enzymes)
leading to methotrexate discontinuation. DISCUSSION: Methotrexate seems to be an
effective treatment of cutaneous sarcoidosis. It should be used namely in
patients who failed to respond to previous treatments with topical
corticosteroids or antimalarial drugs.
PMID: 16230915 [PubMed - in process]
11: Ann Biol Clin (Paris). 2005 Sep-Oct;63(5):543-6.
[Macromolecular complex of cardiac troponin I: differences of reactivity with
DPC and Dade-Behring assays.]
[Article in French]
Lavoinne A, Cauliez B, Duflo-Leroy A, Tron C, Eltchaninoff H.
Laboratoire de biochimie medicale.
We have recently identified a macromolecular 440-kDa cardiac troponin I (cTnI)
complex after successful percutaneous transluminal coronary angioplasty (PTCA)
(Clin Chem 2003; 49: 505-7). The aim of the work was to confirm the existence of
such a complex by using another cTnI assay (Dimension RXL, Dade-Behring). We
have first studied the correlation between the two assays by using heparinized
samples [cTnI(Immulite) = 2.00 cTnI(Dimension) - 0.01 (n = 176; r = 0,987)].
Then, cTnI taken 120 minutes after PTCA for two patients was measured with the
two assays after fractionation by FPLC. The obtained results confirmed the
existence of the 440-kDa cTnI complex and showed that the reactivity between the
assays (DPC/Dade-Behring ratio) depended on the nature of the complex: the ratio
increased from 0.7 (440-kDa cTnI complex) to 3 (80-kDa cTnI complex) therefore
suggesting caution in the comparison between the different cTnI assays in the
context of reperfusion therapy.
PMID: 16230294 [PubMed - in process]
12: Br J Haematol. 2005 Nov;131(3):356-65.
Long-term incubation with IL-4 and IL-10 oppositely modifies procoagulant
activity of monocytes and modulates the surface expression of tissue factor and
tissue factor pathway inhibitor.
Paysant J, Soria C, Cornillet-Lefebvre P, Nguyen P, Lenormand B, Mishal Z,
Vannier JP, Vasse M.
Laboratoire DIFEMA, UFR de Medecine et Pharmacie de Rouen, Rouen, France.
Monocytes can be induced to express both tissue factor (TF) and its inhibitor,
TF pathway inhibitor-1 (TFPI-1). A short incubation (<6 h) with interleukin
(IL)-4 and IL-10, two potent deactivators of monocyte functions, has been shown
to modulate the synthesis and expression of TF by monocytes activated by
lipopolysaccharide, but the consequences of longer incubations (up to 96 h) on
both TF and TFPI-1 are unknown. The results of this study showed that adherent
monocytes in culture spontaneously expressed TF and TFPI and that prolonged
incubation with IL-10 induced a time- and dose-dependent decrease of monocyte TF
synthesis, and an accumulation of TF/TFPI-1 complexes at the moncyte surface,
suggesting a decreased clearance of these complexes. In contrast, IL-4 induced a
time- and dose-dependent increase in TF synthesis, which remained
intracytoplasmic, as shown by confocal microscopy. Surprisingly, TF:antigen (Ag)
was decreased at the monocyte surface, but the procoagulant activity (PCA) of
IL-4-treated monocytes was increased, as a result of more pronounced decrease of
TFPI-1:Ag expression than that of TF. In conclusion, prolonged incubation with
IL-4 and IL-10 oppositely modified PCA of cultured monocytes, and altered TF and
TFPI trafficking and clearance. These data explain the respective deleterious or
benefit effects of IL-4 or IL-10 in atherothrombosis.
PMID: 16225656 [PubMed - in process]
13: Arch Mal Coeur Vaiss. 2005 Jul-Aug;98(7-8):832-5.
[Role of vascular calcium-activated potassium channels in the regulation of
human peripheral conduit artery diameter]
[Article in French]
Bellien J, Joannides R, Lacob M, Arnaud P, Thuillez C.
Service de pharmacologie, INSERM U644, CHU de Rouen.
The role of an endothelium-derived hyperpolarizing factor (EDHF), acting through
the opening of vascular calcium-activated potassium (K(Ca)) channels, in the
regulation of the basal diameter of human peripheral conduit arteries has never
been investigated in vivo. We measured in 7 healthy subjects the effect of the
local infusion of an inhibitor of K(Ca) channels, tetraethylammonium chloride
(TEA, 9 micromol/min, 8 min), on radial artery diameter (echotracking) and flow
(Doppler). Endothelium-independent dilatation was assessed before and after TEA
using sodium nitroprusside (SNP: 5, 10 and 15 nmol/min, 3 min each). TEA induced
a decrease in radial artery diameter (2.65 +/- 0.09 to 2.52 +/- 0.09 mm: p <
0.05) and flow (9.4 +/- 1.2 to 7.4 +/- 1.1 ml/min; p < 0.01) without
modification in the radial artery dilatation in response to SNP (NS). The
decrease in radial artery diameter was still significant even when the decrease
in flow was taken as covariate into analysis (p < 0.05). These results
demonstrate the role of vascular K(Ca) channels in the regulation of basal
peripheral conduit artery diameter and arteriolar tone in human strongly
suggesting the involvement of an EDHF a these two levels.
PMID: 16220756 [PubMed - in process]
14: Rev Hist Pharm (Paris). 2005;53(346):247-56.
[The Book of the Eparch, by Leo VI: interest for the history of pharmacy]
[Article in French]
Lafont O.
Faculte de medecine et de pharmacie de Rouen.
In 1893, Jules Nicole discovered a greek manuscript, named Genevensis 23, which
proved to bee the Book of the Eparch. This document contained the regulations
for trade guilds in Constantinople, at the end of the IXth century and the
beginning of the Xth century. It had been published by Emperor Leo VI, who
reigned upon the Byzantine Empire from 886 to 911. Three professions mentioned
in this book have some interest for history of pharmacy: wax chandlers, spicers
and perfumers. The differences between spicers and perfumers consisted in the
kind of products they sold and in the way they weighed these products. Spicers
were, at the time, for from pharmacy, because they sold mainly food and no
spices, while the perfumers dealt with spices and perfumes. Anyway, none of
these professions was involved in preparing medicines. No mention was made of
pigmentarioi in the Book of the Eparch and that raised the question of the part
really played by these so-called <<pigment maker>> in the preparation and the
dispensation of medicines. The role of physicians remained preeminent in
supplying patients with drugs.
PMID: 16217898 [PubMed - in process]
15: Eur J Cancer. 2005 Oct;41(15):2237-2240. Epub 2005 Apr 14.
Disclosure of competing financial interests and role of sponsors in phase III
cancer trials.
Tuech JJ, Moutel G, Pessaux P, Thoma V, Schraub S, Herve C.
Laboratoire d'Ethique Medicale et Medecine Legale, Faculte de Medecine de Paris
5, 45 rue des Saints-Peres, 75006 Paris, France; Department of Digestive
Surgery, CHU Rouen, 1 rue de Germont, 76031 Rouen Cedex, France.
Financial relationships between industry, researchers and academic institutions
are becoming increasingly complex, raising concern about sponsors' involvement
in the conduct of biomedical research. A review of published randomised trials
(RCTs) in cancer research was performed to assess adherence to the 1997
disclosure requirements and to document the nature of the disclosed interests.
Source(s) of study support, author-sponsor relationships and the role of the
study sponsor were assessed for all RCTs published between 1999 and 2003 in 12
international journals. A total of 655 cancer RCTs were identified. Of these,
516 (78.8%) disclosed the source of sponsorship. The nature of the relationship
between the authors and the study sponsor was included in 219 of the 227
industry-sponsored studies. The most commonly cited relationships were (131
studies had multiple relations): grants (93.6%); employment (39.2%);
consultant/honorarium (12.7%) and stock ownership and participation in a
speaker's bureau (12, 5.5% each). Only 41 (18%) of the 227 industry-sponsored
RCTs reported the role of the sponsor. Of these, 20 explicitly stated that the
sponsor had no role in the study. Twenty-one papers described the sponsor's
role, the degree of sponsor involvement was variable and usually described
vaguely. Among these papers, four stated that researchers had full access to all
data, one that the researchers had no limits on publication and one that 'the
decision to submit the paper for publication was determined by the study
sponsor'. In conclusion, no researcher should be expected to produce 'findings'
without full access to the data, freedom from interference in analysis and
interpretation and liberty to publish all results, however disappointing to the
stakeholder they may be. In the meantime, researchers do well to arm themselves
with the rules for research partnerships and editors to take on the role of
watchdog.
PMID: 16214044 [PubMed - as supplied by publisher]
16: Presse Med. 2005 Sep 24;34(16 Pt 2):1191-2.
[Prevention in nephrology]
[Article in French]
Godin M, Laville M.
PMID: 16208271 [PubMed - in process]
17: J Fr Ophtalmol. 2005 Sep;28(7):733-6.
[Macular hole evaluation with 10-MHz and 20-MHz ultrasonography and optical
coherence tomography.]
[Article in French]
Siahmed K, Berges O, Brasseur G.
Service d'Ophtalmologie, Hopital Charles Nicolle, Rouen.
PURPOSE: To evaluate and compare the data provided by 10-MHz and 20-MHz
ultrasonography and optical coherence tomography (OCT) in macular hole
exploration. MATERIAL: and methods: Sixty patients with macular hole at
different stages were included in the study from January 2002 to April 2003. All
patients received three successive examinations: an echographic examination with
a 10- and 20-MHz probe (Quantel Medical Cinescan) and an examination with
optical coherence tomography (OCT) (Humphrey Zeiss). RESULTS: In stages I and
II, the 10-MHz examination was not a useful tool; in certain cases the 20-MHz
examination highlighted stage II macular holes. OCT was better than
ultrasonography in all these cases: it clearly defined the outline of the hole
and perifovea posterior vitreous detachment (PVD). In stage III, the 10-MHz
examination only allowed the visualization of the high reflectivity of the
prefoveal operculum; the 20-MHz examination could also measure the thickness of
the macular neuroepithelium. OCT very precisely visualized the hole as well as
the opercula and the detachment of the posterior hyaloid located in the macular
area but still attached to the papilla. In stage IV, the 10-MHz examination
confirmed total PVD. High-frequency ultrasound examination and OCT provided
somewhat similar information. OCT provided the advantage of measuring the hole.
DISCUSSION: It is possible now to use probes of frequencies higher than 10 MHz
for the study of the posterior pole and the vitreomacular junction at the cost
of a more reduced exploration area than that usually obtained with a 10-MHz
probe and a lower reflectivity of the interfaces encountered. One is indeed very
quickly limited by noise if the gain is increased. Usually, the standard gain
with 20 MHz is close to 90 dB and beyond 100 dB, the images are uninterpretable
because of noise. CONCLUSION: The 10-MHz ultrasonography is very useful for an
overall assessment of the vitreous body, its mobility, and in searching for PVD.
The 20-MHz examination gives very valuable information on the analysis of the
vitreomacular junction, approaching the precision level provided by OCT. It
demands a very rigorous examination protocol. OCT, however, remains better for
the fine morphological study of this zone, unless opaque media studies are
necessary to determine the maximum frequency usable to increase the space
resolution of the lesions of the posterior pole. In this case, the combined
ultrasonographic study using 10 and 20 MHz provides a valid diagnosis and a
therapeutic approach to the posterior pole.
PMID: 16208223 [PubMed - in process]
18: Microbiology. 2005 Oct;151(Pt 10):3171-80.
Multilocus sequence analysis and comparative evolution of virulence-associated
genes and housekeeping genes of Clostridium difficile.
Lemee L, Bourgeois I, Ruffin E, Collignon A, Lemeland JF, Pons JL.
Groupe de Recherche sur les Antimicrobiens et les Micro-organismes (GRAM EA
2656, IFR 23), Universite de Rouen, Faculte de Medecine-Pharmacie, F-76183 Rouen
Cedex, France. ludovic.lemee@chu-rouen.fr
A multilocus sequence analysis of ten virulence-associated genes was performed
to study the genetic relationships between 29 Clostridium difficile isolates of
various origins, hosts and clinical presentations, and selected from the main
lineages previously defined by multilocus sequence typing (MLST) of housekeeping
genes. Colonization-factor-encoding genes (cwp66, cwp84, fbp68, fliC, fliD,
groEL and slpA), toxin A and B genes (tcdA and tcdB), and the toxin A and B
positive regulator gene (tcdD) were investigated. Binary toxin genes (cdtA and
cdtB) were also detected, and internal fragments were sequenced for positive
isolates. Virulence-associated genes exhibited a moderate polymorphism,
comparable to the polymorphism of housekeeping genes, whereas cwp66 and slpA
genes appeared highly polymorphic. Isolates recovered from human
pseudomembranous colitis cases did not define a specific lineage. The presence
of binary toxin genes, detected in five of the 29 isolates (17 %), was also not
linked to clinical presentation. Conversely, toxigenic A-B+ isolates defined a
very homogeneous lineage, which is distantly related to other isolates. By
clustering analysis, animal isolates were intermixed with human isolates.
Multilocus sequence analysis of virulence-associated genes is consistent with a
clonal population structure for C. difficile and with the lack of host
specificity. The data suggest a co-evolution of several of the
virulence-associated genes studied (including toxins A and B and the binary
toxin genes) with housekeeping genes, reflecting the genetic background of C.
difficile, whereas flagellin, cwp66 and slpA genes may undergo recombination
events and/or environmental selective pressure.
PMID: 16207902 [PubMed - in process]
19: Sante. 2005 Jul-Sep;15(3):171-4.
[Children of HIV-positive mothers: 4 cases of contamination in 14 years of
follow-up at the Rouen University Hospital Center]
[Article in French]
Ye D, Brossard V, Mercier A, Marret S, Clavier B, Simon F, Sawadogo A.
Service de pediatrie, Centre hospitalier universitaire Yalgado Ouedraogo, 01 BP
5488, Ouagadougou 01, Burkina Faso. yediarra@hotmail.com
The prevention of mother-to-child transmission is important in the control of
HIV. Despite preventive measures, the objective of a zero transmission rate from
mother to child has not yet been reached even in Northern countries.
OBSERVATION: A retrospective study covering a 14-year period (January 1988
through December 2001) examined records of 80 children born to HIV-positive
mothers at Rouen University Hospital Center. Four children were contaminated. We
report several particularities of these four children, contaminated despite the
preventive measures taken. CONCLUSION: Prevention of mother-to-child
transmission involves not only administration of antiretrovirals during
pregnancy, but also better follow-up of pregnancy and delivery and more
effective management of risk factors such as drug addiction and poverty.
Multidisciplinary follow-up is needed for these children in view of our current
lack of knowledge of the long-range side effects of these antiretrovirals.
PMID: 16207579 [PubMed - in process]
20: Arthritis Res Ther. 2005;7(5):R1056-62. Epub 2005 Jun 29.
Association between the TNFRII 196R allele and diagnosis of rheumatoid
arthritis.
Goeb V, Dieude P, Vittecoq O, Mejjad O, Menard JF, Thomas M, Gilbert D, Boumier
P, Pouplin S, Daragon A, Fardellone P, Tron F, Cornelis F, Le Loet X.
Rheumatology Department, University Hospital of Rouen, Rouen, France.
goebvince@yahoo.fr
Tumour necrosis factor (TNF)-alpha plays a key role in the pathogenesis of
rheumatoid arthritis (RA). It binds to two receptors, namely TNF receptor
(TNFR)I and TNFRII. Several studies have suggested an association between TNFRII
196R/R genotype and RA. The objective of the present study was to evaluate the
predictive value of the TNFRII 196R allele for RA diagnosis and prognosis in a
cohort of patients with very early arthritis. We followed up a total of 278
patients recruited from the community, who had swelling of at least two joints
that had persisted for longer than 4 weeks but had been evolving for less than 6
months, and who had not received disease-modifying antirheumatic drugs or
steroid therapy. At 2 years, patients were classified according to the American
College of Rheumatology criteria. All patients were genotyped with respect to
TNFRII 196M/R polymorphism. Radiographs of hands and feet (read according to the
modified Sharp method) and the Health Assessment Questionnaire were used to
quantify structural and functional severity. The cohort of 278 patients was
found to include 156 and 122 RA and non-RA patients, respectively. The TNFRII
196R allele was found to be associated with RA (P = 0.002). However, progression
of radiographic severity and Health Assessment Questionnaire scores over 1 year
did not differ between carriers of the 196R allele and noncarriers. Our findings
suggest that the TNFRII 196R allele may be associated with RA diagnosis but that
it does not predict early radiographic progression or functional severity in
patients with very early, unclassified arthritis.
PMID: 16207322 [PubMed - in process]
21: Clin Ther. 2005;27 Suppl A:S25-37.
Treatment of cognitive dysfunction in schizophrenia.
Peuskens J, Demily C, Thibaut F.
Department of Psychiatry, University Center St. Jozef, Kortenberg, Belgium.
jozef.peuskens@uc-kortenberg.be
BACKGROUND: Cognitive impairment has always been regarded as an important
characteristic of schizophrenia. Many domains of cognition are disrupted with
varying degrees of deficit: attention, executive functions, verbal and
visuospatial working memory, learning, and memory. However, it is only recently
that cognitive dysfunction has been recognized as a primary and enduring core
deficit in schizophrenia (rather than the previous focus on positive and
negative symptoms). OBJECTIVE: This article discusses cognitive impairment and
the therapeutic effects of newer antipsychotic agents on cognitive functioning
in patients with schizophrenia. CONCLUSIONS: Cognitive dysfunction occurs before
the first psychotic episode and persists throughout the course of the illness.
It involves every aspect of cognitive functioning and has an important impact on
long-term social and occupational outcomes. Improvement of cognitive functioning
by antipsychotic treatment can be due indirectly to the improvement of
therapeutic profiles of the newer antipsychotic agents (eg, higher efficacy on
positive and negative symptoms, fewer side effects, less anticholinergic
effects) or directly to effects on cerebral functioning (eg, by restoring
dopamine prefrontal activity). However, further research is needed regarding the
therapeutic effects of the newer antipsychotic drugs on cognitive functioning
and their impact on psychosocial outcome. Although newer medications may improve
cognitive functioning, they do not normalize neurocognitive deficits in
schizophrenia. In addition, various nonpharmacologic, psychological
interventions have been used in the rehabilitation of patients with cognitive
deficits.
Publication Types:
Review
PMID: 16198199 [PubMed - indexed for MEDLINE]
1: Antimicrob Agents Chemother. 2005 Nov;49(11):4628-34.
Inhibitory Activities of Epidermal Growth Factor Receptor Tyrosine
Kinase-Targeted Dihydroxyisoflavone and Trihydroxydeoxybenzoin Derivatives on
Sarcocystis neurona, Neospora caninum, and Cryptosporidium parvum Development.
Gargala G, Baishanbo A, Favennec L, Francois A, Ballet JJ, Rossignol JF.
Laboratoire d'Immunologie et Immunopathologie, CHU Avenue Georges Clemenceau,
14033 Caen Cedex, France. ballet-jj@chu-caen.fr.
Several gene sequences of parasitic protozoa belonging to protein kinase gene
families and epidermal growth factor (EGF)-like peptides, which act via binding
to receptor tyrosine kinases of the EGF receptor (EGFR) family, appear to
mediate host-protozoan interactions. As a clue to EGFR protein tyrosine kinase
(PTK) mediation and a novel approach for identifying anticoccidial agents,
activities against Sarcocystis neurona, Neospora caninum, and Cryptosporidium
parvum grown in BM and HCT-8 cell cultures of 52 EGFR PTK inhibitor isoflavone
analogs (dihydroxyisoflavone and trihydroxydeoxybenzoine derivatives) were
investigated. Their cytotoxicities against host cells were either absent, mild,
or moderate by a nitroblue tetrazolium test. At concentrations ranging from 5 to
10 mug/ml, 20 and 5 analogs, including RM-6427 and RM-6428, exhibited an in
vitro inhibitory effect of >/=95% against at least one parasite or against all
three, respectively. In immunosuppressed Cryptosporidium parvum-infected
Mongolian gerbils orally treated with either 200 or 400 mg of agent RM-6427/kg
of body weight/day for 8 days, fecal microscopic oocyst shedding was abolished
in 6/10 animals (P of <0.001 versus untreated controls) and mean shedding was
reduced by 90.5% (P of <0.0001) and 92.0% (P of <0.0001), respectively, higher
levels of inhibition than after nitazoxanide (200 mg/kg/day for 8 days) or
paromomycin (100 mg/kg/day for 8 days) treatment (55.0%, P of <0.001, and 17.5%,
P of >0.05, respectively). After RM-6427 therapy (200 mg/kg/day for 8 days), the
reduction in the ratio of animals with intracellular parasites was nearly
significant in ileum (P = 0.067) and more marked in the biliary tract (P <
0.0013) than after nitazoxanide or paromomycin treatment (0.05 < P < 0.004).
RM-6428 treatment at a regimen of 400 mg/kg/day for 12 days inhibited oocyst
shedding, measured using flow cytometry from day 4 (P < 0.05) to day 12 (P <
0.02) of therapy, when 2/15 animals had no shedding (P < 0.0001) and 11/15 were
free of gut and/or biliary tract parasites (P < 0.01). No mucosal alteration was
microscopically observed for treated or untreated infected gerbils. To our
knowledge, this report is the first to suggest that the isoflavone class of
agents has the potential for anticoccidial therapy.
PMID: 16251305 [PubMed - in process]
2: Am J Hematol. 2005 Nov;80(3):243-5.
Intense paraneoplastic neutrophilic leukemoid reaction related to a
G-CSF-Secreting lung sarcoma.
Jardin F, Vasse M, Debled M, Dominique S, Courville P, Callonnec F, Buchonnet G,
Thiberville L, Tilly H.
Department of Haematology and EMI 9906, IFRMP 23, Centre Henri Becquerel, Rouen,
France.
A white blood cell count more than 50 x 10(9)/l, not related to bone marrow
involvement, is termed leukemoid reaction. We report on the first case of an
undifferentiated sarcoma of the lung associated with an intense paraneoplastic
neutrophilic leukemoid reaction related to the production of granulocyte
colony-stimulating factor (G-CSF). A radiography and a computed tomography scan
of the chest revealed a well-limited voluminous and heterogeneous low-density
mass of the left lung. The patient died of multiorgan failure related to
uncontrolled progressive tumor growth after admission and two cycles of
chemotherapy. The patient's G-CSF serum concentration was dramatically elevated
(6,538 pg/ml) compared to serum levels observed in normal controls and patients
with elevated leukocytosis (31 and 387 pg/ml, respectively). The G-CSF
concentration dramatically increased after the first cycle of chemotherapy and
during the subsequent neutropenia, as a result of the tumor lyses as well as of
disruption of the physiological negative feedback mechanism. Adjunction of the
patient's serum to CD34+ cell cultures induced a 12.3-fold increase in CD15+
cells, demonstrating the serum's capacity to induce myeloid differentiation. Am.
J. Hematol. 80:243-245, 2005. (c) 2005 Wiley-Liss, Inc.
PMID: 16247754 [PubMed - in process]
3: Gastrointest Endosc. 2005 Nov;62(5):785-90.
Factors that affect gastric passage of video capsule.
Ben-Soussan E, Savoye G, Antonietti M, Ramirez S, Lerebours E, Ducrotte P.
Current affiliations: Service d'hepatogastroenterologie, Centre Hospitalier
Universitaire Ch Nicolle, Rouen, France.
BACKGROUND: Gastric retention and delayed gastric emptying of the video capsule
are major limitations. We retrospectively studied gastric transit time, gastric
retention, and completeness of capsule endoscopy (CE) in relation to the
conditions in which it was performed. METHODS: From May 2002 to September 2004,
CE was performed in 190 patients (92 men; mean age, 58.4 years, range 16-91
years). Patients were stratified according to the way CE was performed (hospital
day setting, outpatient, or ongoing hospitalization), and the recordings were
analyzed to measure gastric retention, gastric transit time, and the
completeness of the examinations. RESULTS: CE examination was performed in a
hospital day setting in 100 patients, in an outpatient setting in 61, and during
hospitalization in 29. Gastric retention of the capsule occurred in 8 of 190
patients (4.2%) (5 women, 3 men; mean age, 37.9 years). Gastric retention
occurred during hospitalization in 7/29 (24.1%) and in hospital day setting in
one of 100. Ongoing hospitalization was statistically associated with an
increased risk of gastric capsule retention (p < 0.0001). The cecum was reached
in 165/190 (87%), and ongoing hospitalization was associated with a lower rate
of complete examinations (p < 0.001). Small-bowel transit time was similar,
regardless of the circumstances of CE performance. CONCLUSIONS: Ongoing
hospitalization is a major cause of gastric retention and incomplete examination
by CE. Therefore, CE performance during ongoing hospitalization may require the
use of a prokinetic agent.
PMID: 16246700 [PubMed - in process]
4: Ann Surg. 2005 Nov;242(5):662-669.
Efficacy of Sacral Nerve Stimulation for Fecal Incontinence: Results of a
Multicenter Double-Blind Crossover Study.
Leroi AM, Parc Y, Lehur PA, Mion F, Barth X, Rullier E, Bresler L, Portier G,
Michot F; the Study Group.
From the *Digestive Tract Research Group EA3234/IFRMP23, CHU Rouen, France;
daggerService de Chirurgie Digestive, Hopital Saint-Antoine, Paris, France;
double daggerPole digestif, Hotel Dieu, Nantes, France; section signService de
Physiologie Digestive, Hopital Edouard Herriot, Lyon, France; parallelService
de Chirurgie Digestive, Hopital Saint Andre, Bordeaux, France; paragraph
signService de Chirurgie Digestive, Hopital Brabois, Vandoeuvre les Nancy,
France; and **Service de Chirurgie Digestive, Hopital Purpan, Toulouse, France.
daggerdaggerThe study group: G. Gourcerol (Department of Physiology, CHU Rouen,
Hopital Charles Nicolle, Rouen, France), R. Parc, P. Lamy (Department of
Surgery, AP-HP, Hopital Saint-Antoine, Paris, France), S. Bruley des Varannes,
S. Pimont, G. Meurette (Department of Gastroenterology, CHU Nantes, Hotel Dieu,
Nantes, France), H. Damon (Department of Gastroenterology, CHU Lyon, Hopital
Edouard Herriot, Lyon, France), F. Zerbib (Department of Gastroenterology, CHU
Bordeaux, Hopital Saint-Andre, Bordeaux, France), F. Lazorthes (Department of
Surgery, CHU Toulouse, Hopital Purpan, Toulouse, France), J. L. Faucheron
(Department of Surgery, Hopital Michallon, Grenoble, France), I. Sielezneff
(Department of Surgery, Hopital St. Marguerite, Marseille, France), K. Slim
(Department of Surgery, Hotel Dieu, Clermont-Ferrand, France), A. L. Tarrerias
(Centre Beaulieu, Chamalieres, France), and P. Valleur (Department of Surgery,
Hopital Lariboisiere, Paris, France).
BACKGROUND AND AIMS:: This is the first double-blind multicenter study examining
the effectiveness of sacral nerve stimulation in a significant number of fecally
incontinent patients. METHODS:: A total of 34 consecutive patients (31 women),
median age 57 years (range, 33-73 years), underwent sacral nerve stimulation for
fecal incontinence. After implantation, 27 of 34 patients were randomized in a
double-blind crossover design to stimulation ON or OFF for 1-month periods.
While still blinded, the patients chose the period of stimulation (ON or OFF)
that they had preferred. The mode of stimulation corresponding to the selected
period was continued for 3 months (final period). Outcome measures were
frequency of fecal incontinence and urgency episodes, delay in postponing
defecation, score severity, feeling of improvement, preference for ON or OFF,
quality of life, and manometric measurements. RESULTS:: In the crossover portion
of the study, the self-reported frequency of fecal incontinence episodes was
significantly reduced during the ON versus the OFF period (P = 0.03), and this
symptomatic improvement was consistent: 1) with the patients feeling of greater
improvement during the ON versus OFF period (P = 0.02); 2) with the significant
preference of patients (P = 0.02) for the ON versus OFF period. In the final
period of the study, the frequency of fecal incontinence episodes decreased
significantly (P = 0.005) in patients with the stimulator ON. The ability to
postpone defecation (P = 0.01), the score for symptom severity (P = 0.0004), and
the quality of life (P < 0.05) as well as anal sphincter function significantly
improved. CONCLUSIONS:: The significant improvement in FI during the ON versus
OFF period indicated that the clinical benefit of sacral nerve stimulation was
not due to placebo.
PMID: 16244539 [PubMed - as supplied by publisher]
5: Gynecol Obstet Fertil. 2005 Oct 20; [Epub ahead of print]
[Decreased fetal movements in the third trimester: what to do?]
[Article in French]
Sergent F, Lefevre A, Verspyck E, Marpeau L.
Clinique gynecologique et obstetricale, pavillon Mere-Enfant, hopital
Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76031 Rouen cedex, France.
Objective. - To appreciate at the end of pregnancy, in a low-risk pregnant
population, the interest of a screening for fetal well-being in case of
decreased fetal movements. To define the most adapted screening. Patients and
methods. - Retrospective study over a complete year of the patients having
consulted in the same center for decreased fetal movements and subjected to the
same screening for fetal activity in hospitalization during 48 hours. This
screening included a study of fetal heart rate repeated three times a day, a
fetal biophysical profile scoring, an umbilical artery Doppler, a
Kleihauer-Betke testing, and an amnioscopy. Results. - One hundred and sixty
patients were identified, representing 6.1% of pregnancies followed in the
center. There was no relation between the age, the parity of the patients and
the probability to consult for a decrease of fetal movements. Nevertheless the
antecedents of pathological pregnancy or fetal malformation were frequent.
Twenty-one percent of the deliveries were induced for a global rate of 18% in
the center. Twenty-eight percent of the patients had a cesarean section for a
global rate of 22.8%. Five percent of fetuses were at risk for prenatal asphyxia
on the data of the screening. Fetal heart rate was abnormal in 3.75% of cases,
fetal biophysical profile score pathological in 3.1% of cases. Just one
umbilical Doppler was highly pathological. No meconium amniotic fluid was found.
Two Kleihauer-Betke tests were disturbing. At the time of delivery, 28% of
fetuses presented a funicular abnormality, 4.3% a severe growth restriction,
4.3% a malformation. One child only had an anemia. There was no perinatal
mortality. Discussion and conclusion. - Screening for fetal vitality remains
necessary in case of decreased fetal movements. It has to associate the study of
fetal heart rate and the fetal biophysical profile with a Kleihauer-Betke
testing. In a low-risk pregnant population, the study of fetal Doppler
velocimetry is not profitable. Amnioscopy presents not enough interest. It is
necessary to insist with the patients on the necessity of consulting in case of
decreased fetal movements even in the approach of the term.
PMID: 16243568 [PubMed - as supplied by publisher]
6: Curr Med Res Opin. 2005 Oct;21(10):1659-68.
A randomized, double-blind, 24-week study of escitalopram (10 mg/day) versus
citalopram (20 mg/day) in primary care patients with major depressive disorder.
Colonna L, Andersen HF, Reines EH.
University Hospital, Rouen Cedex, France.
OBJECTIVE: A randomized, double-blind, 24-week-fixed-dose study comparing the
efficacy and safety of escitalopram to that of citalopram was safety was
conducted in primary care patients with moderate to severe major depressive
disorder (MDD). RESEARCH DESIGN AND METHODS: This was a randomized,
double-blind, 24-week fixeddose study. Patients were randomly assigned to
treatment with escitalopram 10 mg/day (n = 175) or citalopram 20 mg/day (n =
182). Clinical response was evaluated using the Montgomery-Asberg Depression
Rating Scale (MADRS) and Clinical Global Impression-Severity (CGI-S) scale. The
prospectively defined primary parameter of antidepressant efficacy was the
change from baseline in the mean MADRS total score during the 24 weeks of
double-blind treatment, using a repeated measures analysis of variance to
compare the treatment groups over all assessment points simultaneously. RESULTS:
Based on the primary parameter, escitalopram was at least as efficacious as
citalopram. Based on the prospectively defined secondary parameter, mean change
from baseline in the CGI-S score, escitalopram was statistically significantly
superior to citalopram at Week 24. The importance of long-term treatment could
be demonstrated, in that more than half (55% and 51%) of the patients who had
not responded by Week 8 achieved remission by Week 24. Both escitalopram and
citalopram were safe and well tolerated in acute and long-term treatment, and
the overall adverse event profiles for the two drugs were similar. For the
intent-to-treat population, there were statistically significantly fewer
withdrawals in the escitalopram group than in the citalopram group, particularly
after Week 8. CONCLUSION: Patients with MDD responded well to long-term
treatment with either escitalopram or citalopram. This study demonstrated the
importance of extending treatment of depression beyond 8 weeks.
PMID: 16238906 [PubMed - in process]
7: Chest. 2005 Oct;128(4):3086; author reply 3086-7.
A new tracheostomy procedure.
Cuvelier A, Molano LC, Muir JF.
Publication Types:
Comment
Letter
PMID: 16236993 [PubMed - in process]
8: Arch Pediatr. 2005 Oct 14; [Epub ahead of print]
[Calcium and D vitamin status in toddlers: original study performed in the area
of Rouen.]
[Article in French]
Mallet E, Claude V, Basuyau JP, Tourancheau E.
Departement de pediatrie medicale, CHU Charles-Nicolle, 1, rue de Germont, 76031
Rouen cedex, France.
Few data are available regarding calcium and vitamin D intake in toddlers,
despite a remaining high growth velocity. Therefore, a study was carried out in
the Rouen geographical area where the sunshine is limited. It appears that a
great majority of the children studied (9/10) received plain milk, and
subsequently only small quantities of vitamin D or calcium enriched milk.
Nevertheless, 12% of primarily 4 to 6 year-old children do not received daily
minimum requirements, and 6% of them had vitamin D insufficiency, which was
demonstrated by 25OHD plasma concentrations. These concentrations declined from
18 months to 6 years old were related to discontinuation in vitamin D
supplements. A great variability was observed in vitamin D supplementation as no
official recommendations were followed. Modalities of this supplementation
should be reconsidered.
PMID: 16236489 [PubMed - as supplied by publisher]
9: Anaesth Intensive Care. 2005 Oct;33(5):578-84.
Serum erythropoietin levels in septic shock.
Tamion F, Le Cam-Duchez V, Menard JF, Girault C, Coquerel A, Bonmarchand G.
Medical Intensive Care Unit, Radioanalysis Laboratory, Hematology Laboratory and
Department of Biostatistics, Rouen University Hospital, France.
Erythropoietin is a glycoprotein hormone mainly released by the kidney, which
stimulates red blood cell production. However, in sepsis, the mechanisms
responsible for the final increase in circulating erythropoietin remain unclear
Seventeen critically ill patients with Simplified Acute Physiologic Score
average 66 (range 43 to 103) were included in this study. Ten patients survived
and seven died within 28 days. Blood samples obtained at different times were
assayed for erythropoietin, cytokine levels and lactate measurements. PCO2 gap
was assessed to detect the presence of gastric mucosal acidosis. Erythropoietin
decreased in the patients who survived while it remained high or increased in
non-survivors (37+/-6.5 vs 147+/-6. 7 UI/l respectively, P<0.05). Erythropoietin
plasma levels were correlated with IL-6 levels (r=0.84, P<0.05) and TNFalpha
levels (r=0.84, P<0.05). We observed a significant positive relationship between
erythropoietin plasma levels and lactate concentrations (r= 0.89, P< 0. 05) and
with PCO2 gap (r=0.9, P < 0.05). No correlation was found between erythropoietin
concentration and the other parameters. High serum erythropoietin levels in
non-survivors were observed with septic shock despite an increase in the levels
of proinflammatory cytokines. We found a relationship between erythropoietin
concentration and biological markers of tissue hypoperfusion i.e. lactate levels
or PCO2 gap. This relationship could suggest tissue hypoperfusion as the
stimulating factor for erythropoietin production in septic shock.
PMID: 16235474 [PubMed - in process]
10: Ann Dermatol Venereol. 2005 Aug-Sep;132(8-9 Pt 1):659-62.
[Methotrexate for the treatment of patients with chronic cutaneous sarcoidosis:
4 cases]
[Article in French]
Gary A, Modeste AB, Richard C, Jubert C, Majour F, Nouvet G, Remond B, Joly P.
Clinique Dermatologique, CHU de Rouen.
INTRODUCTION: Pathogenesis of sarcoidosis remains partially unknown. Cutaneous
lesions are frequent (20 to 35% of cases). Their clinical features and follow-up
data are highly variable. Numerous treatments have been proposed. The clinical
features and follow up data of four patients with chronic cutaneous sarcoidosis
treated with methotrexate are reported. CASE REPORT: Mean age of patients (3
female, 1 male) was 40 years old (34-49 years). One patient presented with a
lupus pernio, two patients with papules and nodules, and the last with an
annular lesion of the face. All patients had been previously treated with
topical corticosteroids and/or hydroxychloroquine without any success. Patients
were treated with methotrexate at doses ranging from 12.5 mg to 30 mg per week
for at least 6 months. Complete remission of cutaneous lesions was observed in 3
of 4 patients after a mean treatment duration of 29 months (16 to 36).
Methotrexate side effects were observed in one patient (elevated liver enzymes)
leading to methotrexate discontinuation. DISCUSSION: Methotrexate seems to be an
effective treatment of cutaneous sarcoidosis. It should be used namely in
patients who failed to respond to previous treatments with topical
corticosteroids or antimalarial drugs.
PMID: 16230915 [PubMed - in process]
11: Ann Biol Clin (Paris). 2005 Sep-Oct;63(5):543-6.
[Macromolecular complex of cardiac troponin I: differences of reactivity with
DPC and Dade-Behring assays.]
[Article in French]
Lavoinne A, Cauliez B, Duflo-Leroy A, Tron C, Eltchaninoff H.
Laboratoire de biochimie medicale.
We have recently identified a macromolecular 440-kDa cardiac troponin I (cTnI)
complex after successful percutaneous transluminal coronary angioplasty (PTCA)
(Clin Chem 2003; 49: 505-7). The aim of the work was to confirm the existence of
such a complex by using another cTnI assay (Dimension RXL, Dade-Behring). We
have first studied the correlation between the two assays by using heparinized
samples [cTnI(Immulite) = 2.00 cTnI(Dimension) - 0.01 (n = 176; r = 0,987)].
Then, cTnI taken 120 minutes after PTCA for two patients was measured with the
two assays after fractionation by FPLC. The obtained results confirmed the
existence of the 440-kDa cTnI complex and showed that the reactivity between the
assays (DPC/Dade-Behring ratio) depended on the nature of the complex: the ratio
increased from 0.7 (440-kDa cTnI complex) to 3 (80-kDa cTnI complex) therefore
suggesting caution in the comparison between the different cTnI assays in the
context of reperfusion therapy.
PMID: 16230294 [PubMed - in process]
12: Br J Haematol. 2005 Nov;131(3):356-65.
Long-term incubation with IL-4 and IL-10 oppositely modifies procoagulant
activity of monocytes and modulates the surface expression of tissue factor and
tissue factor pathway inhibitor.
Paysant J, Soria C, Cornillet-Lefebvre P, Nguyen P, Lenormand B, Mishal Z,
Vannier JP, Vasse M.
Laboratoire DIFEMA, UFR de Medecine et Pharmacie de Rouen, Rouen, France.
Monocytes can be induced to express both tissue factor (TF) and its inhibitor,
TF pathway inhibitor-1 (TFPI-1). A short incubation (<6 h) with interleukin
(IL)-4 and IL-10, two potent deactivators of monocyte functions, has been shown
to modulate the synthesis and expression of TF by monocytes activated by
lipopolysaccharide, but the consequences of longer incubations (up to 96 h) on
both TF and TFPI-1 are unknown. The results of this study showed that adherent
monocytes in culture spontaneously expressed TF and TFPI and that prolonged
incubation with IL-10 induced a time- and dose-dependent decrease of monocyte TF
synthesis, and an accumulation of TF/TFPI-1 complexes at the moncyte surface,
suggesting a decreased clearance of these complexes. In contrast, IL-4 induced a
time- and dose-dependent increase in TF synthesis, which remained
intracytoplasmic, as shown by confocal microscopy. Surprisingly, TF:antigen (Ag)
was decreased at the monocyte surface, but the procoagulant activity (PCA) of
IL-4-treated monocytes was increased, as a result of more pronounced decrease of
TFPI-1:Ag expression than that of TF. In conclusion, prolonged incubation with
IL-4 and IL-10 oppositely modified PCA of cultured monocytes, and altered TF and
TFPI trafficking and clearance. These data explain the respective deleterious or
benefit effects of IL-4 or IL-10 in atherothrombosis.
PMID: 16225656 [PubMed - in process]
13: Arch Mal Coeur Vaiss. 2005 Jul-Aug;98(7-8):832-5.
[Role of vascular calcium-activated potassium channels in the regulation of
human peripheral conduit artery diameter]
[Article in French]
Bellien J, Joannides R, Lacob M, Arnaud P, Thuillez C.
Service de pharmacologie, INSERM U644, CHU de Rouen.
The role of an endothelium-derived hyperpolarizing factor (EDHF), acting through
the opening of vascular calcium-activated potassium (K(Ca)) channels, in the
regulation of the basal diameter of human peripheral conduit arteries has never
been investigated in vivo. We measured in 7 healthy subjects the effect of the
local infusion of an inhibitor of K(Ca) channels, tetraethylammonium chloride
(TEA, 9 micromol/min, 8 min), on radial artery diameter (echotracking) and flow
(Doppler). Endothelium-independent dilatation was assessed before and after TEA
using sodium nitroprusside (SNP: 5, 10 and 15 nmol/min, 3 min each). TEA induced
a decrease in radial artery diameter (2.65 +/- 0.09 to 2.52 +/- 0.09 mm: p <
0.05) and flow (9.4 +/- 1.2 to 7.4 +/- 1.1 ml/min; p < 0.01) without
modification in the radial artery dilatation in response to SNP (NS). The
decrease in radial artery diameter was still significant even when the decrease
in flow was taken as covariate into analysis (p < 0.05). These results
demonstrate the role of vascular K(Ca) channels in the regulation of basal
peripheral conduit artery diameter and arteriolar tone in human strongly
suggesting the involvement of an EDHF a these two levels.
PMID: 16220756 [PubMed - in process]
14: Rev Hist Pharm (Paris). 2005;53(346):247-56.
[The Book of the Eparch, by Leo VI: interest for the history of pharmacy]
[Article in French]
Lafont O.
Faculte de medecine et de pharmacie de Rouen.
In 1893, Jules Nicole discovered a greek manuscript, named Genevensis 23, which
proved to bee the Book of the Eparch. This document contained the regulations
for trade guilds in Constantinople, at the end of the IXth century and the
beginning of the Xth century. It had been published by Emperor Leo VI, who
reigned upon the Byzantine Empire from 886 to 911. Three professions mentioned
in this book have some interest for history of pharmacy: wax chandlers, spicers
and perfumers. The differences between spicers and perfumers consisted in the
kind of products they sold and in the way they weighed these products. Spicers
were, at the time, for from pharmacy, because they sold mainly food and no
spices, while the perfumers dealt with spices and perfumes. Anyway, none of
these professions was involved in preparing medicines. No mention was made of
pigmentarioi in the Book of the Eparch and that raised the question of the part
really played by these so-called <<pigment maker>> in the preparation and the
dispensation of medicines. The role of physicians remained preeminent in
supplying patients with drugs.
PMID: 16217898 [PubMed - in process]
15: Eur J Cancer. 2005 Oct;41(15):2237-2240. Epub 2005 Apr 14.
Disclosure of competing financial interests and role of sponsors in phase III
cancer trials.
Tuech JJ, Moutel G, Pessaux P, Thoma V, Schraub S, Herve C.
Laboratoire d'Ethique Medicale et Medecine Legale, Faculte de Medecine de Paris
5, 45 rue des Saints-Peres, 75006 Paris, France; Department of Digestive
Surgery, CHU Rouen, 1 rue de Germont, 76031 Rouen Cedex, France.
Financial relationships between industry, researchers and academic institutions
are becoming increasingly complex, raising concern about sponsors' involvement
in the conduct of biomedical research. A review of published randomised trials
(RCTs) in cancer research was performed to assess adherence to the 1997
disclosure requirements and to document the nature of the disclosed interests.
Source(s) of study support, author-sponsor relationships and the role of the
study sponsor were assessed for all RCTs published between 1999 and 2003 in 12
international journals. A total of 655 cancer RCTs were identified. Of these,
516 (78.8%) disclosed the source of sponsorship. The nature of the relationship
between the authors and the study sponsor was included in 219 of the 227
industry-sponsored studies. The most commonly cited relationships were (131
studies had multiple relations): grants (93.6%); employment (39.2%);
consultant/honorarium (12.7%) and stock ownership and participation in a
speaker's bureau (12, 5.5% each). Only 41 (18%) of the 227 industry-sponsored
RCTs reported the role of the sponsor. Of these, 20 explicitly stated that the
sponsor had no role in the study. Twenty-one papers described the sponsor's
role, the degree of sponsor involvement was variable and usually described
vaguely. Among these papers, four stated that researchers had full access to all
data, one that the researchers had no limits on publication and one that 'the
decision to submit the paper for publication was determined by the study
sponsor'. In conclusion, no researcher should be expected to produce 'findings'
without full access to the data, freedom from interference in analysis and
interpretation and liberty to publish all results, however disappointing to the
stakeholder they may be. In the meantime, researchers do well to arm themselves
with the rules for research partnerships and editors to take on the role of
watchdog.
PMID: 16214044 [PubMed - as supplied by publisher]
16: Presse Med. 2005 Sep 24;34(16 Pt 2):1191-2.
[Prevention in nephrology]
[Article in French]
Godin M, Laville M.
PMID: 16208271 [PubMed - in process]
17: J Fr Ophtalmol. 2005 Sep;28(7):733-6.
[Macular hole evaluation with 10-MHz and 20-MHz ultrasonography and optical
coherence tomography.]
[Article in French]
Siahmed K, Berges O, Brasseur G.
Service d'Ophtalmologie, Hopital Charles Nicolle, Rouen.
PURPOSE: To evaluate and compare the data provided by 10-MHz and 20-MHz
ultrasonography and optical coherence tomography (OCT) in macular hole
exploration. MATERIAL: and methods: Sixty patients with macular hole at
different stages were included in the study from January 2002 to April 2003. All
patients received three successive examinations: an echographic examination with
a 10- and 20-MHz probe (Quantel Medical Cinescan) and an examination with
optical coherence tomography (OCT) (Humphrey Zeiss). RESULTS: In stages I and
II, the 10-MHz examination was not a useful tool; in certain cases the 20-MHz
examination highlighted stage II macular holes. OCT was better than
ultrasonography in all these cases: it clearly defined the outline of the hole
and perifovea posterior vitreous detachment (PVD). In stage III, the 10-MHz
examination only allowed the visualization of the high reflectivity of the
prefoveal operculum; the 20-MHz examination could also measure the thickness of
the macular neuroepithelium. OCT very precisely visualized the hole as well as
the opercula and the detachment of the posterior hyaloid located in the macular
area but still attached to the papilla. In stage IV, the 10-MHz examination
confirmed total PVD. High-frequency ultrasound examination and OCT provided
somewhat similar information. OCT provided the advantage of measuring the hole.
DISCUSSION: It is possible now to use probes of frequencies higher than 10 MHz
for the study of the posterior pole and the vitreomacular junction at the cost
of a more reduced exploration area than that usually obtained with a 10-MHz
probe and a lower reflectivity of the interfaces encountered. One is indeed very
quickly limited by noise if the gain is increased. Usually, the standard gain
with 20 MHz is close to 90 dB and beyond 100 dB, the images are uninterpretable
because of noise. CONCLUSION: The 10-MHz ultrasonography is very useful for an
overall assessment of the vitreous body, its mobility, and in searching for PVD.
The 20-MHz examination gives very valuable information on the analysis of the
vitreomacular junction, approaching the precision level provided by OCT. It
demands a very rigorous examination protocol. OCT, however, remains better for
the fine morphological study of this zone, unless opaque media studies are
necessary to determine the maximum frequency usable to increase the space
resolution of the lesions of the posterior pole. In this case, the combined
ultrasonographic study using 10 and 20 MHz provides a valid diagnosis and a
therapeutic approach to the posterior pole.
PMID: 16208223 [PubMed - in process]
18: Microbiology. 2005 Oct;151(Pt 10):3171-80.
Multilocus sequence analysis and comparative evolution of virulence-associated
genes and housekeeping genes of Clostridium difficile.
Lemee L, Bourgeois I, Ruffin E, Collignon A, Lemeland JF, Pons JL.
Groupe de Recherche sur les Antimicrobiens et les Micro-organismes (GRAM EA
2656, IFR 23), Universite de Rouen, Faculte de Medecine-Pharmacie, F-76183 Rouen
Cedex, France. ludovic.lemee@chu-rouen.fr
A multilocus sequence analysis of ten virulence-associated genes was performed
to study the genetic relationships between 29 Clostridium difficile isolates of
various origins, hosts and clinical presentations, and selected from the main
lineages previously defined by multilocus sequence typing (MLST) of housekeeping
genes. Colonization-factor-encoding genes (cwp66, cwp84, fbp68, fliC, fliD,
groEL and slpA), toxin A and B genes (tcdA and tcdB), and the toxin A and B
positive regulator gene (tcdD) were investigated. Binary toxin genes (cdtA and
cdtB) were also detected, and internal fragments were sequenced for positive
isolates. Virulence-associated genes exhibited a moderate polymorphism,
comparable to the polymorphism of housekeeping genes, whereas cwp66 and slpA
genes appeared highly polymorphic. Isolates recovered from human
pseudomembranous colitis cases did not define a specific lineage. The presence
of binary toxin genes, detected in five of the 29 isolates (17 %), was also not
linked to clinical presentation. Conversely, toxigenic A-B+ isolates defined a
very homogeneous lineage, which is distantly related to other isolates. By
clustering analysis, animal isolates were intermixed with human isolates.
Multilocus sequence analysis of virulence-associated genes is consistent with a
clonal population structure for C. difficile and with the lack of host
specificity. The data suggest a co-evolution of several of the
virulence-associated genes studied (including toxins A and B and the binary
toxin genes) with housekeeping genes, reflecting the genetic background of C.
difficile, whereas flagellin, cwp66 and slpA genes may undergo recombination
events and/or environmental selective pressure.
PMID: 16207902 [PubMed - in process]
19: Sante. 2005 Jul-Sep;15(3):171-4.
[Children of HIV-positive mothers: 4 cases of contamination in 14 years of
follow-up at the Rouen University Hospital Center]
[Article in French]
Ye D, Brossard V, Mercier A, Marret S, Clavier B, Simon F, Sawadogo A.
Service de pediatrie, Centre hospitalier universitaire Yalgado Ouedraogo, 01 BP
5488, Ouagadougou 01, Burkina Faso. yediarra@hotmail.com
The prevention of mother-to-child transmission is important in the control of
HIV. Despite preventive measures, the objective of a zero transmission rate from
mother to child has not yet been reached even in Northern countries.
OBSERVATION: A retrospective study covering a 14-year period (January 1988
through December 2001) examined records of 80 children born to HIV-positive
mothers at Rouen University Hospital Center. Four children were contaminated. We
report several particularities of these four children, contaminated despite the
preventive measures taken. CONCLUSION: Prevention of mother-to-child
transmission involves not only administration of antiretrovirals during
pregnancy, but also better follow-up of pregnancy and delivery and more
effective management of risk factors such as drug addiction and poverty.
Multidisciplinary follow-up is needed for these children in view of our current
lack of knowledge of the long-range side effects of these antiretrovirals.
PMID: 16207579 [PubMed - in process]
20: Arthritis Res Ther. 2005;7(5):R1056-62. Epub 2005 Jun 29.
Association between the TNFRII 196R allele and diagnosis of rheumatoid
arthritis.
Goeb V, Dieude P, Vittecoq O, Mejjad O, Menard JF, Thomas M, Gilbert D, Boumier
P, Pouplin S, Daragon A, Fardellone P, Tron F, Cornelis F, Le Loet X.
Rheumatology Department, University Hospital of Rouen, Rouen, France.
goebvince@yahoo.fr
Tumour necrosis factor (TNF)-alpha plays a key role in the pathogenesis of
rheumatoid arthritis (RA). It binds to two receptors, namely TNF receptor
(TNFR)I and TNFRII. Several studies have suggested an association between TNFRII
196R/R genotype and RA. The objective of the present study was to evaluate the
predictive value of the TNFRII 196R allele for RA diagnosis and prognosis in a
cohort of patients with very early arthritis. We followed up a total of 278
patients recruited from the community, who had swelling of at least two joints
that had persisted for longer than 4 weeks but had been evolving for less than 6
months, and who had not received disease-modifying antirheumatic drugs or
steroid therapy. At 2 years, patients were classified according to the American
College of Rheumatology criteria. All patients were genotyped with respect to
TNFRII 196M/R polymorphism. Radiographs of hands and feet (read according to the
modified Sharp method) and the Health Assessment Questionnaire were used to
quantify structural and functional severity. The cohort of 278 patients was
found to include 156 and 122 RA and non-RA patients, respectively. The TNFRII
196R allele was found to be associated with RA (P = 0.002). However, progression
of radiographic severity and Health Assessment Questionnaire scores over 1 year
did not differ between carriers of the 196R allele and noncarriers. Our findings
suggest that the TNFRII 196R allele may be associated with RA diagnosis but that
it does not predict early radiographic progression or functional severity in
patients with very early, unclassified arthritis.
PMID: 16207322 [PubMed - in process]
21: Clin Ther. 2005;27 Suppl A:S25-37.
Treatment of cognitive dysfunction in schizophrenia.
Peuskens J, Demily C, Thibaut F.
Department of Psychiatry, University Center St. Jozef, Kortenberg, Belgium.
jozef.peuskens@uc-kortenberg.be
BACKGROUND: Cognitive impairment has always been regarded as an important
characteristic of schizophrenia. Many domains of cognition are disrupted with
varying degrees of deficit: attention, executive functions, verbal and
visuospatial working memory, learning, and memory. However, it is only recently
that cognitive dysfunction has been recognized as a primary and enduring core
deficit in schizophrenia (rather than the previous focus on positive and
negative symptoms). OBJECTIVE: This article discusses cognitive impairment and
the therapeutic effects of newer antipsychotic agents on cognitive functioning
in patients with schizophrenia. CONCLUSIONS: Cognitive dysfunction occurs before
the first psychotic episode and persists throughout the course of the illness.
It involves every aspect of cognitive functioning and has an important impact on
long-term social and occupational outcomes. Improvement of cognitive functioning
by antipsychotic treatment can be due indirectly to the improvement of
therapeutic profiles of the newer antipsychotic agents (eg, higher efficacy on
positive and negative symptoms, fewer side effects, less anticholinergic
effects) or directly to effects on cerebral functioning (eg, by restoring
dopamine prefrontal activity). However, further research is needed regarding the
therapeutic effects of the newer antipsychotic drugs on cognitive functioning
and their impact on psychosocial outcome. Although newer medications may improve
cognitive functioning, they do not normalize neurocognitive deficits in
schizophrenia. In addition, various nonpharmacologic, psychological
interventions have been used in the rehabilitation of patients with cognitive
deficits.
Publication Types:
Review
PMID: 16198199 [PubMed - indexed for MEDLINE]
