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Stammet P.,Center Hospitalier Of Luxembourg
Seminars in Neurology | Year: 2017

Biomarkers are part of the recommended outcome predictors after cardiac arrest. In general, blood biomarkers can easily be performed as routine laboratory tests, and they are unaffected by sedation, but bear the potential risk of laboratory errors. Nonetheless, if used properly, with the potential limitations in mind, they certainly help predict outcome after cardiac arrest. Among the routinely used and available blood biomarkers, neuron-specific enolase (NSE) has the best predictive value for poor outcome if measured serially from 24 to 72 hours. Cutoff values per se should be taken with caution because there is no 100% specificity (0% false-positive rate) in clinical practice. Rather, the increase over time of high NSE values is predictive of poor outcome. Other biomarkers like protein S100 and inflammatory markers also bear a potential to predict outcome, but they are outperformed by NSE. New blood biomarkers are currently under investigation and might improve the accuracy of outcome prediction. The family of noncoding RNAs, including microRNAs, is probably the most promising as microRNAs are not only associated with outcome, but also have the potential for therapeutic implications through their mechanism of action. Copyright © 2017 by Thieme Medical Publishers, Inc.


Beyenburg S.,Center Hospitalier Of Luxembourg | Stavem K.,Akershus University Hospital | Stavem K.,University of Oslo | Schmidt D.,Epilepsy Research Group
Epilepsia | Year: 2010

Although adjunctive treatment with modern antiepileptic drugs (AEDs) is standard care in refractory epilepsy, it is unclear how much of the effect can be attributed directly to the AEDs and how much to the beneficial changes seen with placebo. Therefore, we performed a systematic review and meta-analysis of the evidence to determine the placebo-corrected net efficacy of adjunctive treatment with modern AEDs on the market for refractory epilepsy. Of 317 potentially eligible articles reviewed in full text, 124 (39%) fulfilled eligibility criteria. After excluding 69 publications, 55 publications of 54 studies in 11,106 adults and children with refractory epilepsy form the basis of evidence. The overall weighted pooled-risk difference in favor of AEDs over placebo for seizure-freedom in the total sample of adults and children was 6% [95% confidence interval (CI) 4-8, z = 6.47, p < 0.001] and 21% (95% CI 19-24, z = 17.13, p < 0.001) for 50% seizure reduction. Although the presence of moderate heterogeneity may reduce the validity of the results and limit generalizations from the findings, we conclude that the placebo-corrected efficacy of adjunctive treatment with modern AEDs is disappointingly small and suggest that better strategies of finding drugs are needed for refractory epilepsy, which is a major public health problem. © 2009 International League Against Epilepsy.


Grant
Agency: European Commission | Branch: FP7 | Program: CP-FP | Phase: HEALTH.2012.2.4.3-1 | Award Amount: 6.38M | Year: 2012

Existing therapeutic devices for diabetic patients suffer from bulky size, inaccurate measurements and the difficulties of handling two body interfaces. Suboptimal control of blood glucose levels in type 1 or type 2 diabetes mellitus patients results in periods of hypo- and hyperglycaemia leading to severe and life-threatening complications. Exploiting a novel glucose sensor technology, SPIDIMAN aims to improve glycaemic management for better quality of life and healthier aging. The consortium will develop a new coating technology to apply a glucose-sensitive fluorescent dye onto a standard insulin catheter and incorporate this integrated glucose sensor into a single-port artificial pancreas system. Advanced optical continuous glucose monitoring technology (smart tattoos) with improved sensor accuracy, faster response times, wider dynamic range and higher signal stability will advance diabetes management by reducing hypo- and hyperglycaemic episodes. Within SPIDIMAN, research-intensive European SMEs will develop an innovative artificial pancreas approach, and experienced participants will perform clinical validation in a European network of specialised diabetes centres. SPIDIMAN will thus pave the way for a single-port device that integrates improved glucose measurement and more accurate insulin delivery to provide better glycaemic management in patients with insulin-dependent diabetes. The new device is expected to be particularly suitable for patients in childhood and adolescence, who will form a special focus of the project.


Guinhouya B.C.,University Lille Northern France | Samouda H.,CRP Sante | De Beaufort C.,Center Hospitalier Of Luxembourg
Public Health | Year: 2013

This study explored the proportion of European youth who are sufficiently active according to physical activity (PA) recommendations, based exclusively on objective assessment through accelerometers. A systematic electronic search of studies published up to March 2012 was conducted. PubMed was used to identify accelerometry-assessed PA studies that involved European youth. Within the 131 European studies, only 35 clearly reported the proportion of youth meeting the PA recommendations. Different thresholds lying between 1000 and 4000 counts/min (cpm) were used to define moderate-to-vigorous PA (MVPA). Overall, up to 100% of youth may be sufficiently active when using a threshold of approximately >1000-1500 cpm. With the most cited cut-off point (i.e. >2000 cpm), up to 87% of European youth might be considered physically active with reference to the current recommendations. Alternatively, with a cut-off point >3000 cpm, no more than 3-5% of them appeared to achieve these recommendations. The large discrepancy in outcomes released by accelerometer data is mainly due to the variety of cut-off points for MVPA among youth, hindering the definition of a clear goal towards PA promotion in Europe. Standardization of methods is urgently required. © 2013 The Royal Society for Public Health.


Grant
Agency: European Commission | Branch: H2020 | Program: RIA | Phase: SC1-PM-09-2016 | Award Amount: 4.95M | Year: 2017

TYPE 1 DIABETES is one of the most COMMON CHRONIC diseases in children with a RAPID increase in number of cases particularly in young children. Type 1 diabetes is associated with LIFE-LONG dependency on insulin administration. POOR glucose control leads to diabetes COMPLICATIONS, e.g. eye, heart, kidney disease, including BRAIN changes in young children. Episodes of VERY LOW glucose levels may be life threatening and are a major complication. The ARTIFICIAL PANCREAS addresses the problem of LOW and HIGH glucose levels by delivering insulin BELOW and ABOVE pre-set amounts according to real-time sensor GLUCOSE levels, combining glucose SENSOR, insulin PUMP, and CONTROL ALGORITHM. The Artificial pancreas promises to TRANSFORM management of type 1 diabetes but EVIDENCE supporting its use during FREE LIVING in YOUNG CHILDREN is MISSING. The project evaluates the biomedical, psychosocial, and cost effectiveness of NOVEL INDIVIDUALISED artificial pancreas in young children aged 1 to 7 years with type 1 diabetes. Following a PILOT (n=24), in the MAIN study (n=94) half of the participants (n=47) will be treated over 12 MONTHS by the ARTIFICIAL PANCREAS and the other half (n=47) by STATE-OF-THE-ART PREDICTIVE LOW GLUCOSE MANAGEMENT insulin pump therapy. Each treatment will last ONE YEAR. QUALITY OF LIFE will be assessed and semi-structured INTERVIEWS conducted to understand the impact on daily life. HEALTH TECHNOLOGY ASSESSMENT will support reimbursement. The project will OPTIMISE artificial pancreas and SPEARHEAD SYSTEM-WIDE improvements in health care quality and health outcomes in YOUNG CHILDERN with TYPE 1 DIABETES who live with the disease LONGEST. By IMPROVING THERAPEUTIC OUTCOMES, the project will CHANGE clinical practice and INFLUENCE national and international treatment guidelines making the artificial pancreas WIDELY ACCEPTABLE as the state-of-art treatment modality in young children.


Pull C.B.,Center Hospitalier Of Luxembourg
Annales Medico-Psychologiques | Year: 2014

In 2014, two classifications of mental disorders are known and used on an international level: the Diagnostic and Statistical Manual of Mental Disorders or DSM, developed by the American Psychiatric Association and Chapter F, for Mental and Behavioural Disorders, of the International Classification of Diseases, developed by the World Health Organization. Whereas the 5th edition of the DSM has been approved by the APA and published in 2013, under the name DSM-5, the 11th revision of the ICD or ICD-11 is still a work in progress and all available information has still to be considered provisisonal at this time. The text presented here highlights the main commonalities and divergencies DSM-IV and ICD-10 and reports on those communalities and divergencies between DSM-5 and ICD-11 that seem to be final at this point in time. © 2014 Elsevier Masson SAS.


Facy O.,Center Hospitalier Of Luxembourg
Journal of visceral surgery | Year: 2013

The role of laparoscopy for right colectomy remains controversial - largely because of a lack of standardization of the operative procedure, including a diversity of techniques including laparoscopy-assisted cases with extra-corporeal anastomosis and totally laparoscopic procedures with intra-corporeal anastomosis. The charts of all patients who underwent right colectomy by a totally laparoscopic approach in our service since 2004 were reviewed and pre-, intra-, and postoperative data were collected. Eighty-two patients underwent totally laparoscopic right colectomy; of these, 32 had a BMI greater than 20 kg/m2 (39%). The mean operative duration was 113 minutes. In most cases, the operative specimen was extracted through a supra-pubic Pfannenstiel incision measuring 4-6 cm in length. Three cases were converted to a laparoscopy-assisted technique (in order to control the ileo-cecal vascular pedicle because of extensive nodal invasion in two cases, and to evaluate a hepatic flexure polyp in the third case). Overall morbidity was 29.3% and parietal morbidity was only 9.8%; there was no difference in morbidity between obese patients (BMI>30 kg/m2) and non-obese patients (BMI<30 kg/m2). The mean duration of hospitalization was 9 days and two patients developed ventral hernia in the extraction incision in long-term follow-up. These satisfactory results show that the totally laparoscopic approach to right colectomy is technically feasible and safe, even in obese patients. In addition, the very low rate of parietal complications is an argument in favor of this approach. Copyright © 2013 Elsevier Masson SAS. All rights reserved.


Dicato M.,Center Hospitalier Of Luxembourg | Plawny L.,Center Hospitalier Of Luxembourg | Diederich M.,Center Hospitalier Of Luxembourg
Annals of Oncology | Year: 2010

Inflammatory cytokines such as tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), among others, play a major role in the pathophysiology of anemia in the cancer patient not only through complex mechanisms of the purely inflammatory situation but also through genetic regulatory aspects of erythropoiesis via GATA-1 and GATA-2, and other factors. In terms of therapy, iron is used more and more; the late side effects of transfusions are not really understood and the recent controversy regarding erythropoietin usage has resulted in regulatory authorities and scientific societies providing several recommendations and guidelines. These various aspects are addressed herein. © The Author 2010. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


Plawny L.,Center Hospitalier Of Luxembourg | Ries F.,Center Hospitalier Of Luxembourg
Current Opinion in Oncology | Year: 2014

PURPOSE OF REVIEW: Although some haematologic diseases such as Hodgkin lymphoma and aggressive lymphoma yield high response rates and acceptable overall survival in first-line treatment, relapse is still a challenge particularly in those patients not eligible for transplant. In acute leukaemias, the prognosis remains poor in general with standard chemotherapy, thus stressing the need for efficient alternate therapies. RECENT FINDINGS: In recent years, biological anticancer agents comprising mAbs, small targeted molecules or more recently bispecific T-cell engaging molecules or chimeric antigen receptors have been developed in haematologic diseases. This review examines the recent advances in biotherapies in the fields of acute leukaemias, aggressive lymphoma, Hodgkin lymphoma and chronic lymphatic leukaemia. SUMMARY: Most biological anticancer agents are currently developed in the setting of relapsed or refractory disease. Some of them however are under development or are already used in first-line therapy wherein they have improved the prognosis of haematology patients. © 2014 Wolters Kluwer Health.


Gerich T.G.,Center Hospitalier Of Luxembourg
Bulletin de la Société des sciences médicales du Grand-Duché de Luxembourg | Year: 2011

A thrust plate prosthesis can be used as an alternative to a conventional stem prosthesis, preserving the diaphyseal bone stock. Recent findings however predict a higher rate of aseptic loosening than with intramedullary devices. The purpose of our investigation was to compare the clinical outcome and radiological findings with a finite element analysis of bone remodeling. The hypothesis was that aseptic loosening after thrust plate prosthesis of the hip is inherent to the design. From 1997 to 2001, 58 thrust plates were implanted in 52 patients. Average age at the time of surgery was 40.9 years. Ninety four percent returned for follow up at an average of 26 months. A finite element model of the thrust plate within the femur was developed and stress shielding as well as bone remodeling were analyzed. A total of 4 patients required revision surgery (6.9%). Data from the finite element analysis revealed an inherent failure mechanism to the implant, facilitating stress shielding and loosening. Lacking the ideal total hip prosthesis in young patients, the thrust plate can still be regarded as a feasible implant. However, surgeons and patients should be aware of possible mechanical problems regarding the design of the thrust plate. There is evidence that thrust plate prostheses are prone to early aseptic loosening. Clinical and radiological observations are in agreement with the results from the numerical simulations. Stress concentrations computed at the leash are interpreted as an explanation for leash pain. The authors regard computational methods as an aid to improve existing prosthesis design and future developments.

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