CHU de Bicetre

Le Kremlin-Bicêtre, France

CHU de Bicetre

Le Kremlin-Bicêtre, France

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Bourgeois-Marcotte J.,Laval University | Flamand-Roze C.,CHU de Bicetre | Monetta L.,Laval University
Revue neurologique | Year: 2015

The goal of the present study was to adapt and to establish normative data for the recently developed Language Screening Test (LAST; Flamand-Roze et al., 2011) in the French-Canadian population according to age and level of education. After an adaptation process, 100 French-Canadian speakers were evaluated with the LAST-Q. As expected, a perfect score of 15/15 was obtained for all high level education participants, and a score of 14/15 was obtained for all participants with a lowest level of education or aged 80 years or more. Thanks to this adaptation, LAST-Q can be used in acute patients in stroke unit in Quebec. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Lambotte O.,CHU de Bicetre | Lambotte O.,University Paris - Sud | Lambotte O.,French Institute of Health and Medical Research
Medecine/Sciences | Year: 2012

Some patients infected by the HIV are called HIV controllers because viral replication remains undectectable during a prolonged period of time in the absence of any antirétroviral treatment. This state could be considered as a « functional cure » in these virally infected patients. Understanding mechanisms underlying this prolonged control of viral replication is key to the development of future vaccinal strategies. French ANRS is exploiting a cohort of HIV controllers since several years, and immunological analysis of these patients has yielded some mechanistic clues that this review will discuss. A striking feature is the very efficient and polyfunctional CD8 T cell response of these patients, which exhibits a high avidity against the gag protein of the virus. Other parameters and questions are studied : the role of HLA B57, overrepresented in this cohort ; how HIV controllers who do not express a very robust CD8 response control the viral replication ? The long term follow up of these patients will also give important informations on their immunological, viral and clinical evolution.

Coelho T.,Hospital Of Santo Antonio | Maia L.F.,Hertie Institute for Clinical Brain Research | Da Silva A.M.,Hospital Of Santo Antonio | Cruz M.W.,Hospital Universitario Clementino Fraga Filho | And 13 more authors.
Neurology | Year: 2012

Objectives: To evaluate the efficacy and safety of 18 months of tafamidis treatment in patients with early-stage V30M transthyretin familial amyloid polyneuropathy (TTR-FAP). Methods: In this randomized, double-blind trial, patients received tafamidis 20 mg QD or placebo. Coprimary endpoints were the Neuropathy Impairment Score-Lower Limbs (NIS-LL) responder analysis (<2-point worsening) and treatment-group difference in the mean change from baseline in Norfolk Quality of Life-Diabetic Neuropathy total score (TQOL) in the intent-to-treat (ITT) popuation (n = 125). These endpoints were also evaluated in the efficacy-evaluable (EE; n = 87) population. Secondary endpoints, including changes in neurologic function, nutritional status, and TTR stabilization, were analyzed in the ITT population. Results: There was a higher-than-anticipated liver transplantation dropout rate. No differences were observed between the tafamidis and placebo groups for the coprimary endpoints, NIS-LL responder analysis (45.3% vs 29.5% responders; p = 0.068) and change in TQOL (2.0 vs 7.2; p = 0.116) in the ITT population. In the EE population, significantly more tafamidis patients than placebo patients were NIS-LL responders (60.0% vs 38.1%; p = 0.041), and tafamidis patients had better-preserved TQOL (0.1 vs 8.9; p = 0.045). Significant differences in most secondary endpoints favored tafamidis. TTR was stabilized in 98% of tafamidis and 0% of placebo patients (p < 0.0001). Adverse events were similar between groups. Conclusions: Although the coprimary endpoints were not met in the ITT population, tafamidis was associated with no trend toward more NIS-LL responders and a significant reduction in worsening of most neurologic variables, supporting the hypothesis that preventing TTR dissociation can delay peripheral neurologic impairment. Classification of evidence: This study provides Class II evidence that 20 mg tafamidis QD was associated with no difference in clinical progression in patients with TTR-FAP, as measured by the NIS-LL and the Norfolk QOL-DN score. Secondary outcomes demonstrated a significant delay in peripheral neurologic impairment with tafamidis, which was well tolerated over 18 months. Copyright © 2012 by AAN Enterprises, Inc.

Brugieres L.,Institute Gustave Roussy | Branchereau S.,CHU de Bicetre | Laithier V.,Besancon University Hospital Center
Bulletin du Cancer | Year: 2012

Tumours and pseudotumours of the liver are a heterogeneous group of neoplasm including 60% of malignant tumours. Malignant liver tumours account for less than 2% of the lesions in children and vary considerably in incidence throughout the paediatric age range, with hepatoblastoma, rhabdoid tumour of the liver, hemangioendothelioma, biliary tract rhabdomysosarcoma and mesenchymal hamartoma in the first two years of life and hepatocellular carcinoma, focal nodular hyperplasia, and undifferentiated sarcoma in older children and adolescents. Treatment of malignant epithelial tumours is based on the surgical resection of the tumour associated with preand postoperative chemotherapy including cisplatinum. Modalities of the treatment are adapted to risk factors. Survival rates at three years are over 80% for localised hepatoblastoma whereas they are less than 30% in hepatocellular carcinomas. The role of targeted therapies still has to be defined.

PubMed | Johns Hopkins University, Justus Liebig University, CHU de Bicetre, CRIUCPQ and 3 more.
Type: | Journal: American journal of respiratory and critical care medicine | Year: 2016

Despite important advances in its therapeutic management, pulmonary arterial hypertension (PAH) remains an incurable disease. Although numerous drugs exhibited beneficial effects in preclinical settings, only few have reached clinical trial phases, highlighting the challenges of translating preclinical investigations into clinical trials. Potential reasons for delayed PAH drug development may include the inherent limitations of the currently available animal and in vitro models, potential lack of appropriate standardization of the experimental design, regulatory agencies requirements, competing clinical trials and insufficient funding. Although this is not unique to PAH, there is urgency for reducing the number of false positive signals in preclinical studies and optimizing the development of innovative therapeutic targets through performance of clinical trials based on more robust experimental data. The current review discusses the challenges and opportunities in preclinical research to foster drug development in PAH.

Liacu D.,CHU de Bicetre | Idy-Peretti I.,University Paris Diderot | Ducreux D.,CHU de Bicetre | Bouilleret V.,CHU de Bicetre | De Marco G.,Paris West University Nanterre La Défense
Journal of Magnetic Resonance Imaging | Year: 2012

Purpose: To investigate changes in diffusion tensor imaging (DTI) measures in limbic system white matter of patients with temporal lobe epilepsy (TLE) using diffusion tensor tractography. Materials and Methods: DTI metrics including fractional anisotropy (FA), λ1, λ2, λ3, and trace (Tr) coefficients were obtained from tractography for bilateral fornix, superior and inferior cingulum fibers in 18 patients and 10 healthy controls. Hippocampal signal-to-noise ratio (SNR) quantitative analysis was performed in order to confirm the magnetic resonance imaging (MRI) hippocampal lesion presence or absence in TLE patients. Results: Nine patients presented unilateral hippocampal sclerosis (TLE+HS) and nine patients had no signal abnormalities on conventional MRI (TLE-HS). On the ipsilateral seizure side, all three investigated tracts showed significant DTI indices abnormalities in both patient groups when compared with controls, most marked on the inferior cingulum. Contralateral to the seizure side, the three tracts presented significant DTI parameters in only the TLE+HS group when compared with controls. Conclusion: The DTI abnormalities found in the TLE-HS group may suggest that in the inferior cingulum the structural integrity is more affected than in the fornix or superior cingulum white matter bundles. The eigenvalues taken separately add complementary information to the FA and Tr metrics and may be useful indices in better understanding the architectural reorganization of limbic system tracts in TLE patients without HS. J. Magn. Reson. Imaging 2012;36:561-568. © 2012 Wiley Periodicals, Inc.

Vigue B.,CHU de Bicetre | Ract C.,CHU de Bicetre
Annales Francaises d'Anesthesie et de Reanimation | Year: 2014

When a severe traumatic brain-injured patient arrives to hospital, fear of failure and definite opinions about the outcome modify early care and provoke self-fulfilling prophecies. It is obvious that working on prognosis is not only useful to inform relatives but also permits to maintain a high level of care, key for a better outcome. Mortality is high (40-50%) if deaths in the first days are not excluded. Following guidelines in all cases will permit to decrease the number of preventable death and a decrease in morbidity. Well-defined networks of care leading to specialized centres with multimodal monitoring give best results. However, only 20% of living patients return to their previous life with mild handicap. These unsatisfactory results require intensifying research, notably in early rehabilitation in intensive care unit. Ethic issues should be discussed after few days of care and dialogue with relatives in a defined "window of opportunity". Ideally, we need to find strong and early indicators of outcome to limit fears on presumed handicap. A magnetic resonance imaging (MRI) sequence called diffusion tensor imaging (TDI) permits to visualise traumatic axonal injury. Studies with complex statistical methodology give a good estimated probability of bad outcome but must be confirmed by more validation studies. Progress will come from a better understanding of physiopathology. Focuses on processing chain, rapid multi-monitoring, biomarkers, and investigations in MRI and TDI will help to establish opportunities for treatments and to determine limits. © 2014.

Ract C.,CHU de Bicetre
Praticien en Anesthesie Reanimation | Year: 2014

Dexmedetomidine is a selective alpha-2 adrenergic agonist. Dexmedetomidine induces sedation in intensive care (ICU) patients without respiratory depression. The mean continuous intravenous dose is 0.5 and 0.8 μg/kg/h. Dexmedetomidine decreases the incidence of cognitive disorders and agitation in ICU patients. The main side effect is the occurrence of hypotension and bradycardia, especially after the administration of a loading dose. The use of dexmedetomidine is restricted, due to the side effects in patients in unstable haemodynamic condition. © 2014 Elsevier Masson SAS. All rights reserved.

Tran-Dinh A.,CHU de Bicetre | Depret F.,CHU de Bicetre | Vigue B.,CHU de Bicetre
Annales Francaises d'Anesthesie et de Reanimation | Year: 2012

The main purpose of neurointensive care is to fight against cerebral ischaemia. Ischaemia is the cell energy failure following inadequacy between supply of glucose and oxygen and demand. Ischemia monitoring starts with a global approach, especially with cerebral perfusion pressure (CPP) determined by mean arterial pressure and intracranial pressure (ICP). However, global monitoring is insufficient to detect " regional" ischaemia, leading to development of local monitoring such as brain oxygen partial pressure (PtiO 2). PtiO 2 is measured on a volume of a few mm 3 from a probe implanted in the cerebral tissue. The normal value is classically included between 25 and 35 mmHg and critical ischemic threshold is 10mmHg. Understanding what exactly is PtiO 2 is still a matter of debate. PtiO 2 is more an indicator of oxygen diffusion depending of oxygen arterial pressure (PaO 2) and local cerebral blood flow (CBF). Increase PaO 2 to treat PtiO 2 would hide information about local CBF. PtiO 2 is useful for the detection of low local CBF even when ICP is low as in hypocapnia-induced vasoconstriction. PtiO 2-guided management could lead to a continuous optimization of arterial oxygen transport for an optimal cerebral tissue oxygenation. Finally, PtiO 2 has probably a global prognostic value because studies showed that hypoxic values for a long period of time lead to an unfavourable neurologic outcome. In conclusion, PtiO 2 provides additional information for regional monitoring of cerebral ischaemia and deserves more intensive use to better understand it and probably improve neurointensive care management. © 2012.

Inhalation of foreign bodies may produce acute respiratory insufficiency in children especially under 3 years. The diagnosis is commonly easy to perform due to clinical symptoms of inhalation. Chest X-ray is poorly contributive but helicoidal CT-scan may allow to perform virtual bronchoscopy to localize the obstruction. Foreign body extraction is performed under general anaesthesia. The anaesthetic technique deals with the need of adequate ventilation and level of anaesthesia to avoid arterial oxygen desaturation, laryngospasm and bronchospasm. The choice between spontaneous and controlled ventilation depends on the site of obstruction and on the extraction technique. Intravenous anaesthesia is easier to handle for maintaining a stable level of anaesthesia but inhalation anaesthesia better provides adequate conditions for spontaneous ventilation. © 2012 Published by Elsevier Masson SAS.

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