Papers by Delphine Maucort-boulch
Cancer Medicine
BackgroundCytotoxic chemotherapy (CC) is currently used in metastatic melanoma after patients hav... more BackgroundCytotoxic chemotherapy (CC) is currently used in metastatic melanoma after patients have developed resistance to immune checkpoint inhibitors (ICI) and/or Mitogen‐Activated Protein Kinase inhibitors (MAPKi). We sought to evaluate if a previous treatment by ICI or MAPKi influences clinical outcomes in patients treated by CC in metastatic melanoma.MethodsEighty‐eight patients with a metastatic melanoma, treated by CC after a previous treatment by ICI or MAPKi between January 2009 and October 2019, were retrospectively analyzed. Progression‐Free‐Survival (PFS), Overall Survival (OS), Overall Response Rate (ORR), and Disease Control Rate (DCR) were evaluated in patients treated by CC according to their prior treatment by ICI or MAPKi.ResultsPatients treated by CC after ICI tended to have a better median PFS (2.81 months (2.39–5.30) versus 2.40 months (0.91–2.75), p = 0.023), median OS (6.03 months (3.54–11.54) versus 4.44 months (1.54–8.59), p = 0.27), DCR (26.0% vs. 10.5%, p ...
Journal of Clinical Medicine
Background: Sarcoidosis is one of the leading causes of uveitis. To date, no studies have assesse... more Background: Sarcoidosis is one of the leading causes of uveitis. To date, no studies have assessed the factors specifically related with recovery in ocular sarcoidosis. In this study, we aimed to determine factors associated with ocular and extraocular recovery in patients with sarcoid uveitis. Methods: A retrospective study of sarcoid uveitis, with a three-year minimum follow-up in Lyon University Hospital between December 2003 and December 2019. Patients presented biopsy-proven sarcoidosis or presumed sarcoid. Recovery was defined by a disease-free status, spontaneously or despite being off all treatments for three years or more. Results: 143 patients were included: 110 with biopsy-proven and 33 with presumed sarcoid uveitis. Seventy-one percent were women, the median age at presentation was 53 years, and 71% were Caucasian. Chronic uveitis was the main clinical presentation (75%), mostly panuveitis (48%) with bilateral involvement (82%). After a median follow-up of 83.5 months, r...
Additional file 2. Patient-declared behavior change questionnaire.
Clinical Neuroradiology, 2021
Several studies reported gadolinium deposition in the dentate nuclei (DN) and the globus pallidus... more Several studies reported gadolinium deposition in the dentate nuclei (DN) and the globus pallidus (GP) that was associated to linear GBCA administrations rather than macrocyclic. It is therefore imperative to evaluate and assess the safety of cumulative administration of gadoterate meglumine (macrocyclic). Thus, T1-weighted images (T1WI) of multiple sclerosis (MS) patients longitudinally followed for 4 years were retrospectively analyzed. In this study 44 patients, 10 with clinically isolated syndrome (CIS), 24 relapsing-remitting MS (RRMS) and 10 primary-progressive MS (PPMS) were examined every 6 months (first four scans) and then with a 1-year interval (last two scans). Image processing consisted in reorienting unenhanced T1WI to standard space, followed by B1 inhomogeneity correction. A patient-specific template was then generated to normalize T1WI signal intensity (SI) and segment the DN and subcortical GM structures. All structures were then transformed to each patient space in order to measure the SI in each region. The cerebellar peduncles (CP) and semi-oval (SO) white matter were then manually delineated and used as reference to calculate SI ratios in the DN and subcortical GM structures. A linear mixed-effect model was finally applied to longitudinally analyze SI variations. The SI measurements performed in all structures showed no significant increases with the cumulative GBCA administration. This study showed no significant SI increases within the DN and subcortical GM structures of longitudinally followed MS patients even with the cumulative administration of the macrocyclic GBCA gadoterate meglumine.
Cancers, 2022
Background In previous studies, patient-reported outcomes (PROs) have been shown to improve survi... more Background In previous studies, patient-reported outcomes (PROs) have been shown to improve survival in cancer patients. The aim of the present study was to assess symptoms potentially related to adverse events experienced by cancer outpatients treated by oral anticancer agents (OAAs) using PROs. Methods Between September 2018 and May 2019, outpatients starting OAAs were included in a 12-week follow-up to assess 15 symptoms listed in the National Cancer Institute PRO Common Terminology Criteria for Adverse Events, using a 5-point scale of severity or frequency. Patients were requested to alert a referral nurse or pharmacist when they self-assessed high-level (level 3 or 4) symptoms. Results 407 questionnaires were completed by 63 patients in which 2333 symptoms were reported. Almost three-quarters (74.6%) reported at least one high-level symptom. The symptoms that were most commonly experienced were fatigue (>9 in 10 patients; 13.2% of symptoms declared), various psychological di...
Univariate and multivariate analyses of mortality according to CX3CR1 mRNA expression in critical... more Univariate and multivariate analyses of mortality according to CX3CR1 mRNA expression in critically ill patients. A- D7 mortality and CX3CR1 mRNA expression at D1. B- D28 mortality and CX3CR1 mRNA expression at D3. (DOC 53 kb)
Primer designs. (DOC 29 kb)
Survival curve of the total cohort of intensive care unit patients. (PPT 83 kb)
Scatter plot showing the parts of dilution variance, technical variance, and lack of fit with Mod... more Scatter plot showing the parts of dilution variance, technical variance, and lack of fit with Model 1S. (TIFF 1318Â kb)
Relationship between theoretical and NLP-quantified protein concentrations. (TIFF 2929Â kb)
Number of transitions and peptides per protein and the percent of missing and zero values among p... more Number of transitions and peptides per protein and the percent of missing and zero values among protein concentration measurements. (DOCX 18Â kb)
SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related docu... more SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents. (DOC 121 kb)
Intraocular sarcoidosis: association of clinical characteristics of uveitis with findings from 18... more Intraocular sarcoidosis: association of clinical characteristics of uveitis with findings from 18F-labelled fluorodeoxyglucose positron
Oral Radiology, 2021
Background During interventions for deep caries lesions without severe symptoms, preserving pulpa... more Background During interventions for deep caries lesions without severe symptoms, preserving pulpal vitality is important to ensure treatment success, improve organ prognosis, and decrease cost-effectiveness. Current pre-operative radiographs allow visual estimation but not accurate measurement of lesion depth. Purpose Investigate the ability of ratio ‘remaining/total dentin thickness’ (RDT/TDT, as determined on pre-operative radiographs) to predict pulp exposure during excavation. Methods This retrospective study (January 2018–June 2020) analyzed data on 360 patients. Four independent raters examined standard pre-operative radiographs and their contrasted versions. Lines put at the dentino-enamel junction, the floor of the carious lesion, and the pulp chamber wall allowed deriving RDT/TDT. Inter-rater agreements and concordance were assessed. A logistic regression accounting for measurement errors provided odds ratios that estimated the ability of the RDT/TDT to predict pulp exposure. Results The median RDT/TDT ratio ranges were 16.8–26.5% on standard and 16.2–24.6% on contrasted radiographs. Inter-rater agreements on RDT/TDT were rather poor and inter-rater reliability was low and similar in standard and contrasted radiographs: the concordance correlation coefficients (95% CIs) were estimated at 0.46 (0.40; 0.51) and 0.46 (0.40; 0.52), respectively. The risk of pulp exposure increased by 2.5 times [odds ratio (95% CI) 2.57 (2.06; 3.20)] per 10-point decrease of the ratio on standard radiographs vs. 4.15 (3.15; 5.46) on contrasted radiographs. Conclusion RDT/TDT ratio is potentially helpful in predicting pulp exposure. However, the measurement errors on RDT and TDT being non-negligible and the interrater agreements poor, there is still place for advances through development of an automated process that will improve reliability and reproducibility of pulp exposure risk assessment. Clinical trial Trial registration number. ClinicalTrials.gov NCT04607395, October 29, 2020
Sarcoidosis, Vasculitis, and Diffuse Lung Diseases, 2017
Backgroung: This study investigated the efficacy and safety of TNF antagonists in sarcoid uveitis... more Backgroung: This study investigated the efficacy and safety of TNF antagonists in sarcoid uveitis in unselected cases. Design: This is a multicentre study on patients with sarcoidosis who received TNF antagonists in pneumology and internal medicine departments in France. We present here the subgroup of patients with biopsy-proven sarcoid uveitis included in the nationwide registry STAT (Sarcoidosis treated with TNF AnTagonists). Results: Among the 132 patients included in this multicenter study, 18 patients with refractory uveitis were treated as a first-line TNF antagonist with infliximab (n=14), adalimumab (n=3) and certolizumab (n=1). Before anti-TNF initiation, the median duration of sarcoidosis was 42 months and 83% of the patients have been treated with at least one immunosuppressive drug. Six patients switched for a second-line TNF antagonist. After a mean time under treatment of 29 months, the treatment resulted in a significant decrease of the ophthalmic extrapulmonary Phys...
Intensive Care Medicine, 2021
Hyperglycaemia is an adaptive response to stress commonly observed in critical illness. Its manag... more Hyperglycaemia is an adaptive response to stress commonly observed in critical illness. Its management remains debated in the intensive care unit (ICU). Individualising hyperglycaemia management, by targeting the patient’s pre-admission usual glycaemia, could improve outcome. In a multicentre, randomized, double-blind, parallel-group study, critically-ill adults were considered for inclusion. Patients underwent until ICU discharge either individualised glucose control by targeting the pre-admission usual glycaemia using the glycated haemoglobin A1c level at ICU admission (IC group), or conventional glucose control by maintaining glycaemia below 180 mg/dL (CC group). A non-commercial web application of a dynamic sliding-scale insulin protocol gave to nurses all instructions for glucose control in both groups. The primary outcome was death within 90 days. Owing to a low likelihood of benefit and evidence of the possibility of harm related to hypoglycaemia, the study was stopped early....
Revue de Médecine Interne, 2019
Introduction L’atteinte ophtalmologique est rapportee chez 25 a 50 % des patients atteints de sar... more Introduction L’atteinte ophtalmologique est rapportee chez 25 a 50 % des patients atteints de sarcoidose. Les facteurs pronostiques de deficience visuelle sont : l’âge > 40 ans a la presentation initiale, une origine afro-americaine, un delai de prise en charge par un specialiste des uveites > 1 an et l’existence d’un glaucome et d’une uveite intermediaire ou posterieure [1] . L’objectif de l’etude est d’identifier des marqueurs pronostiques associes a la guerison et a l’utilisation d’un traitement immunosuppresseur chez des patients atteints d’uveite sarcoidosique. Patients et methodes Etude retrospective observationnelle realisee dans deux services de medecine interne d’un CHU entre 2003 et 2019. Etaient inclus les patients suivis plus de 3 ans presentant une uveite sarcoidosique avec preuve histologique ou repondant aux criteres ABAD modifies : imagerie thoracique compatible associee au minimum a une elevation de l’enzyme de conversion de l’angiotensine et/ou une alveolite ...
JACC: Cardiovascular Imaging, 2021
OBJECTIVES This study aimed to identify a subset of patients based on echocardiographic parameter... more OBJECTIVES This study aimed to identify a subset of patients based on echocardiographic parameters who might have benefited from transcatheter correction using the Mitraclip system in the MITRA-FR (Percutaneous Repair with the MitraClip Device for Severe Functional/Secondary Mitral Regurgitation) trial. BACKGROUND It has been suggested that differences in the degree of mitral regurgitation (MR) and left ventricular (LV) remodeling may explain the conflicting results between the MITRA-FR and the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trials. METHODS In a post hoc analysis, we evaluated the interaction between the intervention and subsets of patients defined based on MR severity (effective regurgitant orifice [ERO], regurgitant volume [RVOL] and regurgitant fraction [RF]), LV remodeling (end-diastolic and end-systolic diameters and volumes) and combination of these parameters with respect to the composite of death from any cause or unplanned hospitalization for heart failure at 24 months. RESULTS We observed a neutral impact of the intervention in subsets with the highest MR degree (ERO $30 mm 2 , RVOL $45 ml or RF $50%) as in patients with milder MR degree. The same was seen in subsets with the milder LV remodeling using either diastolic or systolic diameters or volumes. When parameters of MR severity and LV remodeling were combined, there was still no benefit of the intervention including in the subset of patients with an ERO/enddiastolic volume ratio $ 0.15 despite similar ERO and LV end-diastolic volume compared with COAPT patients. CONCLUSIONS In the MITRA-FR trial, we could not identify a subset of patients defined based on the degree of the regurgitation, LV remodeling or on their combination, including those deemed as having disproportionate MR, that might have benefited from transcatheter correction using the Mitraclip system. (Multicentre Study of Percutaneous Mitral Valve Repair MitraClip Device in Patients With Severe Secondary Mitral Regurgitation [MITRA-FR]; NCT01920698).
Biometrical Journal, 2021
Generalized pairwise comparisons (GPCs) are a statistical method used in randomized clinical tria... more Generalized pairwise comparisons (GPCs) are a statistical method used in randomized clinical trials to simultaneously analyze several prioritized outcomes. This procedure estimates the net benefit (Δ). Δ may be interpreted as the probability for a random patient in the treatment group to have a better overall outcome than a random patient in the control group, minus the probability of the opposite situation. However, the presence of right censoring introduces uninformative pairs that will typically bias the estimate of Δ toward 0. We propose a correction to GPCs that estimates the contribution of each uninformative pair based on the average contribution of the informative pairs. The correction can be applied to the analysis of several prioritized outcomes. We perform a simulation study to evaluate the bias associated with this correction. When only one time‐to‐event outcome was generated, the corrected estimates were unbiased except in the presence of very heavy censoring. The correction had no effect on the power or type‐1 error of the tests based on the Δ. Finally, we illustrate the impact of the correction using data from two randomized trials. The illustrative datasets showed that the correction had limited impact when the proportion of censored observations was around 20% and was most useful when this proportion was close to 70%. Overall, we propose an estimator for the net benefit that is minimally affected by censoring under the assumption that uninformative pairs are exchangeable with informative pairs.
Intensive Care Medicine, 2021
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Papers by Delphine Maucort-boulch