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Le Touquet – Paris-Plage, France

Deuschl G.,University of Kiel | Schupbach M.,University Pierre and Marie Curie | Knudsen K.,University of Kiel | Pinsker M.O.,University of Kiel | And 4 more authors.
Parkinsonism and Related Disorders

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for advanced Parkinson's disease (PD) with disabling motor complications. However, stimulation may be beneficial at an earlier stage of PD when motor fluctuations and dyskinesia are only mild and psychosocial competence is still maintained. The EARLYSTIM trial was conducted in patients with recent onset of levodopa-induced motor complications (≤3 years) whose social and occupational functioning remained preserved. This is called 'early' here. The study was a randomized, multicenter, bi-national pivotal trial with a 2 year observation period. Quality of life was the main outcome measure, and a video-based motor score was a blinded secondary outcome of the study. Motor, neuropsychological, psychiatric and psychosocial aspects were captured by established scales and questionnaires. The patient group randomized here is the earliest in the disease course and the youngest recruited in controlled DBS trials so far. The methodological innovation for DBS-studies of this study lies in novel procedures developed and used for monitoring best medical treatment, neurosurgical consistency, best management of stimulation programming, blinded video assessment of motor disability, and prevention of suicidal behaviors. © 2012 Elsevier Ltd. Source

Jacqueminet S.,CHU Pitie Salpetriere
Diabetes & metabolism

Maternal and perinatal complications linked to gestational diabetes mellitus could be decreased with an intensive management approach. To assess the effect of various treatments, glycaemic targets and procedures for self-monitoring of blood glucose on the foetal and maternal prognosis. Systematic review of literature studying the efficacy of the treatment of gestational diabetes in order to decrease maternal-foetal morbidity-mortality. Analysis based on bibliographic search in PubMed using the following keywords: " therapeutic" , " treatment" and " gestational diabetes" . Specific treatment of gestational diabetes (dietary, adapted physical activity, self-monitoring of blood glucose, insulin-therapy if appropriate) reduces severe perinatal complications (composite criterion), foetal macrosomia and preeclampsia compared to the absence of therapy, with however an increase in the number of labour inductions, and without any increase in the number of caesarean sections. Regarding oral antidiabetic agents (glibenclamide or metformin), despite the absence of difference found on foetal or maternal prognosis compared to insulin, they should not be prescribed during pregnancy at this time. The treatment of " severe or moderate" gestational diabetes is recommended. Additional studies, in particular long-term studies in children, are warranted before oral antidiabetic agents can be used. Source

Le Sache F.,CHU Pitie Salpetriere | Samama C.-M.,University of Paris Descartes
Praticien en Anesthesie Reanimation

Taking care of a patient on NOA during an emergency surgery procedure with a high bleeding risk proves to be challenging for physicians. Knowledge of NOA's plasma concentration and its half-life allows an estimation of its anticoagulation level. Concentration below or equal to 30ng/mL should allow a high-bleeding risk surgery procedure. Even though there are no specific antidotes, suggested guidelines published by the GIHP allow an increased control on the bleeding risk in such procedures. Activated prothrombin concentrate and non-Activated 4-factors prothrombin concentrates are thus suggested during an eventual NOA-induced bleeding, associated to a non-specific resuscitation. Specific antidotes are under development. © 2015 Elsevier Masson SAS. Source

Lucon A.,Service de cardiologie | Oger E.,Service de cardiologie | Oger E.,University of Monastir | Oger E.,French Institute of Health and Medical Research | And 14 more authors.
Circulation: Cardiovascular Interventions

Background-Pulmonary hypertension (PH) is associated with poor prognosis in patients with severe aortic stenosis. The aim of this multicenter study was to describe clinical outcome after transcatheter aortic valve implantation. Methods and Results-The FRANCE 2 Registry included all patients undergoing transcatheter aortic valve implantation in France in 2010 and 2011. Patients were divided into 3 groups depending on systolic pulmonary artery pressure (sPAP) estimated in transthoracic echocardiography: group I, sPAP <40 mm Hg (no PH); group II, sPAP 40 to 59 mm Hg (mildto- moderate PH); and group III, sPAP =60 mm Hg (severe PH). Patients were followed up for 1 year. A total of 2435 patients whose pre-transcatheter aortic valve implantation sPAP was reported were included. A total of 845 were in group I (34.7%), 1112 in group II (45.7%), and 478 in group III (19.6%). Procedural success, early complications, and 30-day mortality were statistically similar across sPAP groups. One-year mortality was higher in groups II and III (group I, 22%; group II, 28%; and group III, 28%; P=0.032). Mild-to-moderate and severe PH were identified as an independent factor of all-cause mortality. The major adverse cardiovascular event rates did not differ according to sPAP. New York Health Association functional class improved significantly in all groups. Conclusions-PH (sPAP =40 mm Hg) in patients with aortic stenosis undergoing transcatheter aortic valve implantation was associated with increased 1-year mortality especially when severe (sPAP =60 mm Hg) but not with increased 30-day mortality, and functional status was significantly improved regardless of PAP level. © 2014 American Heart Association, Inc. Source

Rey J.B.,University of Reims Champagne Ardenne | Launay-Vacher V.,CHU Pitie Salpetriere
Cancer Chemotherapy and Pharmacology

A significant proportion of post-menopausal, patients treated with AI reports side-effects, especially bone pain. In such patients, the difficulties to treat pain and to clearly identify its causes may lead to treatment discontinuation. Ageing is associated with physiological modifications that may impair drug pharmacokinetics (PKs). The elimination can be altered, with decreased drug clearance (CL), resulting in an increased exposure to the drug, reflected by increased AUCs. The reported increases in AI exposure being around 50 %, an intermittent dosing schedule of 1 administration every other day could result in a similar drug exposure as compared to the usual daily schedule. © 2015 Springer-Verlag Berlin Heidelberg. Source

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