B Acad Nat Med Paris
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B Acad Nat Med Paris · Feb 2007
Comparative Study[Trends in stroke incidence and case-fatality rates over a 20-year period (1985-2004) in Dijon, France].
With progress in stroke prevention it is important to evaluate epidemiological trends over a long period and in an unselected population. We estimated changes in stroke incidence, the case-fatality rate, risk factors, and the use of primary prevention, based on a continuous registry of a well-defined population, from 1985 to 2004. We recorded 3142 ischemic strokes, 341 primary cerebral hemorrhages and 74 subarachnoid hemorrhages. ⋯ The frequency of pre-stroke antiplatelet and anticoagulant treatment increased significantly (p < 0.01). The age - and sex-adjusted incidence rates of stroke in Dijon, France, have thus been stable for the past 20 years. Age at stroke onset has increased, the case-fatality rate has fallen, antiplatelet treatment is more frequent, and the frequency of some pre-stroke risk factors has fallen.
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B Acad Nat Med Paris · Oct 2006
[Public health education in France: challenges and future perspectives].
Public health difers from other fields of health education by its vast scope and by the diversity of its target populations. University training in public health is currently ensured in France by more than 300 permanent lecturers with significant research activity. ⋯ Currently, university training is poorly organized and coordinated in France. The creation of the Ecole des Hautes Etudes en Santo Publique provides an opportunity to reorganize the training infrastructure and calls for a reassessment of the place of universities in public health education.
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In addition to aging, obesity is one of the most common underlying causes of osteoarthritis (OA). Mechanical loading, together with biochemical and systemic factors linked to altered lipid metabolism, are thought to contribute to the onset of OA. It has been suggested that OA is a systemic metabolic disease associated with lipid disorders affecting joint homeostasis. ⋯ Indeed, their relative levels in joints differ from that found in plasma. In particular, leptin levels are increased and adiponectin and resistin levels are reduced This hypothesis is supported by--leptin overexpression in OA cartilage and its correlation with the degree of cartilage destruction,--abundant leptin synthesis by osteophytes, and--the high leptin levels found in OA joints from female patients. This link between OA and adipokines provides new leads regarding the prevention of OA and the identification of new drug targets.
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B Acad Nat Med Paris · Mar 2006
Review Comparative Study[Medical treatment of critical leg ischemia: current status and future perspectives of gene and cell therapy].
Critical limb ischemia (CLI) is associated with a high risk of amputation and death. For patients who cannot be surgically revascularized, medical options include prostanoids, spinal cord stimulation and lumbar sympathectomy, but none of these treatments has a demonstrated impact on the amputation rate at six months. Gene and cell therapy, aimed at stimulating angiogenesis, have mainly been tested in phase I and II clinical trials. These approaches appear to be feasible and safe in the short-term, but large randomized studies are necessary to demonstrate their clinical benefits and long-term safety.
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B Acad Nat Med Paris · Mar 2006
Review[Role of interventional radiology in the management of critical limb ischemia].
Critical limb ischemia is a growing public health problem with major human and medical costs. Primary amputation is the rule in most countries and hospitals, but has major functional, psychological and financial consequences. By using a combination of endovascular and surgical techniques, it is now possible to save 9/10 limbs at risk. ⋯ Arteriography is currently the only technique that offers a robust workup and, in most cases, permits interventional radiology procedures under local anesthesia and during the same session. Various techniques can be used, depending on the type of lesions, from plain balloon angioplasty to stenting, subintimal recanalization, and use of a cutting balloon. We review the different interventional radiology approaches available in this setting, and their results relative to bypass surgery.