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A Grand

Publications and source records attributed to A Grand.

At least 19 recordsLinked to original sources
PubMed2006

Molecular structure of a D-homoandrostanyl steroid derivative: single crystal and powder diffraction analyses.

The knowledge of the structure of a molecular crystal is frequently a prerequisite for the understanding of its solid state properties. Even though single-crystal diffractometry is the method of choice when it comes to crystal structure determination, methods using powder diffraction data become more and more competitive. There has been much recent interest in the development of a new generation of "direct-space" approaches that are particularly suited for molecular crystals. The crystallographic structure of a steroid derivative molecule (17,17-di-n-propyl-17a-aza-D-homo-5alpha-androstan-3beta-ol) was obtained in two independent ways: from a single crystal by laboratory X-rays and from a polycrystalline powder by high-resolution synchrotron powder diffraction. The molecule crystallizes in the orthorhombic space group P2(1)2(1)2(1) (a = 6.5346, b = 17.6006 and c = 19.6978 A). Hydrogen bonds form infinite chains of molecules parallel to the c axis.

Androstanols↗
PubMed2005

[Consensus statement on severe dementia].

Under the auspices of the French Society of Gerontology and Geriatrics, a multidisciplinary group of experts, including geriatricians, neurologists, epidemiologists, psychiatrists, pharmacologists, and public health specialists developed consensus recommendations about care for patients with severe dementia. They defined 21 recommendations for general practitioners, long-term care physicians, and specialists, based on the knowledge currently available (2005). The aim of care at all stages is to mitigate the quality-of-life of patient, caregiver, and family insofar as possible, combining care and future planning until the end of life. Management, to take into account problems including nutritional status, behavior disorders, and ability (or inability) to perform activities of daily living, must be global, multidisciplinary, and coordinated and must optimize use of local medical and social resources. The group also stressed the importance of clinical research to improve knowledge of disease course and assess management strategies and recommended specific area for research.

Aged↗
PubMed2005

[Consensus statement on severe dementia].

Under the auspices of the French Society of Gerontology and Geriatrics, a multidisciplinary team including geriatritians, neurologists, epidemiologists, psychiatrists, pharmacologists and public health specialists developed a consensus on care for patients with severe dementia. They defined 21 recommendations for general practitioners, long-term care physicians and specialists based on knowledge available in 2005. At all stages of the disease, the objective of care is to improve as much as possible quality-of-life for the patient and his/her family, including a life project until the end of life. It is always possible to do something for these patients and their family: nutritional status, behavior disorders, and incapacities to deal with basic activities of daily life have to be taken in consideration. Resource allocation and proximity care have to be targeted. Research areas necessary to improve the care of patients with severe dementia has been selected.

Aged↗
PubMed2005

Changes in informal care over one year for elderly persons with Alzheimer's disease.

BACKGROUND: Informal caregivers play a major role in all types of assistance for elderly persons with Alzheimer's disease but few longitudinal studies reports change in this role over time. OBJECTIVE: The aim of our research was to describe the objective and subjective burden of informal caregivers of elderly persons with dementia of Alzheimer type, and to follow its evolution during one year. METHODS: A multicentre prospective study of 333 principal caregivers of patients with Alzheimer's disease, followed for one year. RESULTS: At inclusion, the majority of caregivers were involved in most tasks of assistance (activities of daily living, handling money, supervision, organisation of support services) but only 13.4% were involved in basic activities of daily living. As expected, during follow-up, the involvement of caregivers increased and extended to all tasks: whereas at inclusion 11.0% regularly assisted in all tasks, after only 12 months follow-up this figure rose to 28.9% (P < 0.001). Whereas 45.9% of caregivers became involved in carrying out new tasks (mainly organisation of support services and help with basic activities of daily living), 8.9% no longer carried out certain tasks (essentially supervision and organisation of support services), 7.3% replaced one task by another, and for 37.8% there was no change. During the same time, the mean burden experienced by the caregiver showed a very slight change (increasing from a mean score of 21.08 +/- 14.65 to 22.68 +/- 16.45, P = 0.044) with great variation between caregivers. Those who increased their involvement also had a significant increase in caregiver burden. CONCLUSION: While home caregiving appeared to follow an even course, the needs of the care recipient changed rapidly over time and caregivers differed in their response to these changes, indicating that regular follow-up is required.

Activities of Daily Living↗
PubMed2004

[Aortitis after G-CSF injections].

INTRODUCTION: Aortitis consists in aortic wall inflammation from infectious or non infectious cause. It may lead to aortic aneurysm with a risk of rupture, which is life-threatening and may justify surgical procedures. The cause of the aortitis is sometimes obscure. CASE REPORT: We report the case of a 55 years old woman who developed acute aortitis of the descending aorta after G-CSF (granulocyte-colony stimulating factor) injections for blood stem cells graft. No cause was found to the aortitis, the evolution was favorable after corticosteroid treatment, without aneurysm at six months. CONCLUSION: The present case rises the question of G-CSF (Neupogen responsibility in aortic lesions. Neutrophilic mediated diseases (Sweet's syndrome, pyoderma gangrenosum) and leukocytoclastic vasculitis were reported after G-CSF therapy. Neutrophils induced by G-CSF injections present functional abnormalities which may play a role in the pathogenesis of these diseases.

Aortitis↗
PubMed2004

[Demography of oncologic practitioners working in France. Projection elements for the next 30 years].

In the early eighties, French medical regulatory authorities have decided to control the access to medical studies by restricting the number of admittances. From that date, the numerous clauses was unchanged, leading the physicians to observe a deep reduction in the number of young oncologists. The goal of this study was to define precisely the demography of French medical oncologists and the needs for new specialists. Our model used data from a wide range of sources was developed under the guidance of epidemiologists. We determined current and projected numbers and demographics of oncologists in France workforce from 2002 to 2032. The number of oncologists and physicians implicated in oncology (organ specialists, radiotherapists and paediatricians) entering the marked in the next few years will not be modified. Consequently, the number of physicians will dramatically decrease in the next 15 years resulting in a 25% global working-age population reduction. Our present analysis indicates that the number of oncologists will not be sufficient to meet future demand. Our data suggests that steps should be taken to stop the ongoing decline in the number of physicians involved in oncology and the decline of physicians in training. Consideration should be given to actions designed to increase the number of oncologists in practise in the years ahead.

Adult↗
PubMed2003

[Experience of an adherence support for HIV-1 seropositive patients with failure under treatment].

CONTEXT: To be successful highly active antiretroviral therapies need very high levels of adherence to be successful. In need to help patients in dealing with adverse effects, complexity and multiple constraints of these drugs, adherence support programs have been developed. Therefore, the efficacy on viral load of these interventions has not been established in the HIV-1 positive population. The aim of our study was to assess the virological efficacy of this type of program in our institution. METHODS: Non randomized intervention study with a control group. The intervention group was constituted of patients presenting with virological failure who where admitted in the adherence program. The control group (2:1) has been selected in our data base. Factors known to influence viral load have been analyzed by multiple logistic regression. RESULTS: The probability of obtaining a significant decrease of viral load was better at 6 months for patients using the adherence program (OR: 4,48 [2,72-11,8]). This benefit was not sustained at 12 months. The program efficacy varied with the kind of treatment (with or without protease inhibitors), the therapeutic history and the initial viral load. The absence of protease inhibitor, a high initial viral load, small number of previous drugs were linked to viral load decrease. CONCLUSION: The good virological results observed at 6 months in the intervention group are incentive. Long term virological gain and the profile of patients who could make the best of an adherence support program have to be determined.

Adult↗
PubMed2003

[Burden experienced by informal caregivers assisting Alzheimer's patients in the REAL.FR study].

BACKGROUND: Most AD patients are cared for at home by informal caregivers. The effect of different kind of stressors on caregivers has been referred to as caregiver burden. OBJECTIVE: To determine (1) the level of burden of informal caregivers of Alzheimer's patients in a French national sample; (2) the factors associated with a high level of burden. METHODS: Cross-sectional study of informal caregivers of the demented elderly referred to a psychogeriatric, geriatric or neurological service. The principal caregivers of 531 patients with mild to moderate dementia attending an outpatient cognitive assessment clinic were interviewed via a structured questionnaire that focused upon caregiver-related characteristics such as whether they were living with the patients, their feelings of burden assessed by the Zarit Burden Interview and patients were examined at baseline to evaluate their cognitive, behavioral and functional limitation. RESULTS: Logistic regression analysis showed that patients' characteristics (MMSE, behavioral problems, nutritional problems), caregiver's characteristics (female gender, number of tasks involved in caregiving, cohabitation) and the provision of medical services were independently associated with a high level of burden. In this study increased caregiver burden was related independently to increased levels of patient behaviour disturbance and cognitive impairment. However, neither the illness duration nor the functional disabilities in activities of daily living affected the level of burden. This may have relevance to appropriate interventions for informal caregivers.

Aged↗
PubMed2001

Bond energies and attachments sites of sodium and potassium cations to DNA and RNA nucleic acid bases in the gas phase.

Gas-phase metal affinities of DNA and RNA bases for the Na(+) and K(+) ions were determined at density functional level employing the hybrid B3LYP exchange correlation potential in connection with the 6-311+G(2df,2p) basis set. All the molecular complexes, obtained by the interaction between several low-lying tautomers of nucleic acid bases and the alkali ions on the different binding sites, were considered. Structural features of the sodium and potassium complexes were found to be similar except in some uracil and thymine compounds in which the tendency of potassium ion toward monocoordination appeared evident. B3LYP bond energies for both metal ions were in agreement with the available experimental results in the cases of uracil and thymine for which the most stable complex was obtained starting from the most stable tautomer of the free nucleic acid base. For adenine, although the interaction of the ions with the most stable free tautomer generated the least stable molecular complex, the best agreement with experiment was found in just this case. For the remaining cytosine and guanine bases, our calculations indicated that the metal ion affinity value closest to experiment should be determined taking into account the role played by the different tautomers of the free bases with similar energy and all the possible complexes obtained by them.

Adenine↗
PubMed2001

Interplay of intrinsic and environmental effects on the magnetic properties of free radicals issuing from H-atom addition to cytosine.

Possible radical reaction products issuing from H-atom addition to cytosine have been characterized and analyzed by means of a comprehensive quantum mechanical approach including density functional computations (B3LYP), together with simulation of the solvent by the polarizable continuum model (PCM), and averaging of spectroscopic properties over the most important vibrational motions. The hyperfine couplings of the semirigid 5,6-dihydrocytos-6yl radical computed at the optimized geometry are in good agreement with their experimental counterparts. On the other hand, vibrational averaging is mandatory for obtaining an effectively planar structure for the 5,6-dihydrocytos-5yl radical with the consequent equivalence of beta-hydrogens. Finally, only proper consideration of environmental effects restores the agreement between computed and experimental couplings for the base anion protonated at N3.

Cytosine↗
PubMed2001

A population-based study on radical prostatectomy in France.

There has as yet been no descriptive study of the practice of radical prostatectomy in the general population in France. The objective of this work was to investigate the use of radical prostatectomy (RP) in France and its determinants and geographic variations. A total of 175 radical prostatectomies was identified in a random sample of 798 cases of prostate cancer recorded in 1995 by four cancer registries, in the departments of Bas-Rhin, Calvados, Isère and Tarn. Tumour characteristics, diagnostic procedures and histopathological results were analysed. Multivariate analysis by logistic regression was used to take into account age, prostate specific antigen (PSA) levels and clinical stage in order to study variations between geographical departments and sectors of activity (private or public). The mean age of the patients at the time of diagnosis was 65.3 y (range 46-76). Median PSA level was 18.2 ng/ml (range 1-184). Diagnosis was made by randomised biopsies in 73.8% of cases or by transurethral resection (6.9%). Clinical stage was classified T(1) (22.3%), T(2) (64%), T(3) (8.6%), N(+) (0.6%) and unknown (4.5%). The histopathological result was pT(2)N0 in 46.3% of cases, pT(3)N0 in 40%, pT(4)N0 in 1.7%, pT(x)N(+) in 8.6% and unknown in 3.4%. Adjuvant therapy (radiotherapy 13.7%, hormonal treatment 13.7% or both 3%) was administered in 54 patients (31%). Logistic regression showed that the probability of undergoing RP was three times higher in one department than in the other departments, and was 2.6 times as high in the private sector. This study on the practice of RP is the first performed in the general population in France. It shows that practice differs according to geographical region and sector of activity, indicating that schools of thought and medical culture vary within the same country.Prostate Cnacer and Prostatic diseases (2001) 4, 118-123

Journal Article↗
PubMed2001

[Subacute infectious endocarditis due to the agent of cat scratch fever: Bartonella henselae].

The diagnosis of severe mitral stenosis with left atrial thrombus was rectified at valvular replacement in a 48-year old immuno-competent man who was a cat owner. The mass in the left atrium was, in fact, a large endocarditic vegetation. Pre- and postoperative blood cultures were negative as was culture of the excised mitral valve. The diagnosis of infectious endocarditis (IE) due to Bartonella Henselae was made from a positive serological test (1600) and identification of the germ by genetic amplification. Antibiotic therapy was continued for 6 months and the patient was cured with a follow-up of 4 years. Bartonella Henselae IE is very rare (14 reported cases) and affects mainly the aortic valve, often giving rise to very large vegetations which, in half the cases, are complicated by systemic emboli. Germs like Batonella are sensitive to most antibiotics, especially the aminosides and macrolides. In Bartonella Henselae IE, valve replacement is the rule (13 out of 14 cases) and the prognosis is usually good. Sero-diagnosis of Bartonellosis should be part of the systematic investigation of all blood culture negative IE.

Azithromycin↗
PubMed2001

[Variations of the practice of radical prostatectomy in France].

OBJECTIVE: A description of radical prostatectomy (PR) practice in the general population in France has never been reported. The objective of this study was to analyse RP practice in France, and its determinants and geographical variations based on the CCAFU-Francim survey on prostate cancer (PC) diagnosed in 1995. MATERIAL AND METHOD: 175 PR were performed on the sample of 798 patients selected at random from the cases of PC identified in 1995 by four cancer registries (Bas-Rhin, Calvados, Isère and Tarn). Analysis was based on tumour characteristics, diagnostic methods and histopathological results. Multivariate analysis by logistic regression taking into account age, PSA and clinical stage studied variations between departments and types of urology practice (private or public). RESULTS: The mean age of the patients at the time of the diagnosis was 65.3 years (46-76). The median PSA was 18.3 ng/ml (1-184). The diagnosis was made by biopsies (91%) which were systematized in 74% of cases or by transurethral resection (7%). The clinical stage was T1 (22.3%), T2 (64%), T3 (8.6%), N+ (0.611) and unknown (4.5%). The pathological stage was pT2N0 (46.3%), pT3N0 (40%), pT4N0 (1.7%), pTxN0 (8.6%) and unknown (3.4%). Adjuvant treatment (radiotherapy: 13.7%, endocrine therapy: 13.7% or both: 31%) was performed in 54 patients (31%). Multivariate analysis showed that the adjusted probability to be treated by RP was 3 times higher in one department compared to others and 2.6 times higher in the private sector. CONCLUSION: This study of RP practice in the general population shows a concordance with the 1995 recommendations, but it also shows practice variations according to the region and the type of practice, reflecting different schools of thought and medical education within the same country.

Adult↗
PubMed2001

Nutritional risk factors for institutional placement in Alzheimer's disease after one year follow-up.

Amongst factors associated with the institutional placement of elderly people with dementia, there has been little study of those related to malnutrition. We followed a cohort of 318 individuals with Alzheimer's disease (AD). Patients, who were all living at home at the start of the study were recruited from the outpatient service of a hospital unit specialising in AD. After one year, 20% of the patients had moved into institutional care. Multivariate analysis showed that a Mini nutritional Assessment score (MNA) of less than 25.5 (median score of the sample) and overeating behavioural problems (p=0.006) were risk factors for institutional placement. Nutritional problems are reversible and patients with a low MNA score could benefit from a thorough geriatric assessment, in order to slow or prevent institutional placement.

Activities of Daily Living↗
PubMed2001

[Cancer of the prostate in France: results of the survey CCAFU-FRANCIM].

OBJECTIVE: The management, diagnosis and treatment of prostate cancer (PC) in the general population are poorly defined in France. The objective of this survey was to analyse the diagnostic and therapeutic modalities of prostate cancer in 1995, on the basis of a population derived from 4 French cancer registries. MATERIAL AND METHOD: A sample of 803 PCs diagnosed in 1995 were selected at random from the cases listed in the 4 registries (Bas-Rhin, Calvados, Isère and Tarn). Analysis by questionnaire concerned the modalities of diagnosis, clinical tumour stage and the treatment performed. Clinical stage (TNM 1992) was submitted to centralized coding. Logistic regression was used to quantify the various practices, taking into account the patient's age, PSA level and clinical stage. The probability of receiving each treatment modality was studied by using the same clinical determinants. RESULTS: The mean age of the patients was 71.6 years (range: 46-94). The clinical stage was T1 or T2 in 60% of cases, T3 or T4 in 14% of cases and N+ or M+ in 17% of cases. PSA (median: 18.2 ng/ml) was assayed in 92.4% of cases. The diagnosis was established by biopsy in 63% of cases and by endoscopic resection (TURP) in 32% (5% unknown). The main treatments were: radical prostatectomy (RP): 21.9%, radiotherapy: 19.4%, endocrine therapy: 33%, isolated TURP: 16.3%, conservative management: 6% and unspecified treatment: 5.6% of cases. 31% of cases received combinations of various treatment modalities. RP was performed more frequently in patients over the age of 60 years, for T2 tumours (OR: 3.3) and for 4 < PSA < 20 ng/ml. Radiotherapy tended to be reserved for older patients with T3-T4 tumours and 20 < PSA < 50 ng/ml. The frequency of endocrine therapy increased with age and PSA (> 50 ng/ml). The frequency of TURP and surveillance also increased with age, decreased with high PSA and essentially concerned T1 tumours. CONCLUSION: PC was diagnosed relatively early in France in 1995 with clinically localized tumours in 60% of cases. In this survey, 94% of patients received treatment during the year following diagnosis, with 40% of curative treatments and 31% of combined treatments.

Aged↗
PubMed2000

Alzheimer disease: protective factors.

Approximately 6-8% of all persons aged >65 y have Alzheimer disease and the prevalence of the disease is increasing. Any intervention strategy aimed at decreasing risks or delaying the onset of the disease will therefore have a substantial effect on health care costs. Nutrition seems to be one of the factors that may play a protective role in Alzheimer disease. Many studies suggest that oxidative stress and the accumulation of free radicals are involved in the pathophysiology of the disease. Several studies have shown the existence of a correlation between cognitive skills and the serum concentrations of folate, vitamin B-12, vitamin B-6, and, more recently, homocysteine. However, nutritional factors have to be studied not alone but with the other factors related to Alzheimer disease: genetics, estrogen, antiinflammatory drug use, and socioeconomic variables. The objective of this article was to review recent studies in this field.

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