News Article | May 21, 2017
ATS 2017, WASHINGTON, DC -- In a new study that analyzed data from the large French CUB-REA database, high volume intensive care units (ICUs) were found to have lower death rates from acute respiratory distress syndrome (ARDS) than low and moderate volume ICUs. The researchers also found that, overall, among the 35 ICUs in the CUB-REA registry, ICU mortality decreased despite an increase in ARDS severity. The study was presented at the 2017 American Thoracic Society International Conference. ARDS is a common disease affecting 10 percent of patients admitted to ICUs. ARDS occurs when fluid builds up in the tiny, elastic air sacs in the lungs. This buildup reduces oxygen levels in the bloodstream, depriving organs of the oxygen they need to function. "Our study is the first to look at a large and regional database that suggests patients with ARDS admitted to centers caring for large numbers of people with ARDS may have better prognoses than in centers with a lower case volume," said lead author Martin Dres, MD, of the AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumonologie et Réanimation Médicale, Paris, France. "We hope our research fuels further discussion regarding global quality of care and global management in the setting of ARDS." Dr. Dres and colleagues looked at CUB-REA data for 316,000 ICU stays taking place between 2000 and 2014. They assessed the difference in ARDS severity using the SAPS2 scoring method, which measures the severity of disease for patients admitted to the ICU. They also looked at ARDS-related mortality for low, moderate and high patient volume ICUs. They statistically adjusted their analyses to account for severity of illness and other confounding factors. The researchers found that 18,022 ICU stays between 2000 and 2014 were related to ARDS. Overall ICU prevalence of ARDS was 8.3 percent, while its prevalence progressively increased from 6.5 percent in 2000 to 10.5 percent in 2008. Prevalence then decreased to 7.2 percent in 2014. During this time, SAPS2 severity scores increased from an average of 52 to 58 (with 52 representing a predicted 50 percent mortality rate). ICU mortality gradually decreased over these years, from 57.9 percent to 45.5 percent, and hospital mortality decreased from 59.1 percent to 48.4 percent. SAPS2 scores were highest in high-volume ICUs, while high volume ICUs had 51.5 percent mortality; moderate volume ICUs had 54 percent mortality; and low volume ICUs had 55.2 percent mortality rates. Length of stay was also lowest in high volume ICUs. "Further studies are warranted to confirm and delineate our results and determine whether regionalization of patients with ARDS should be recommended," said Dr. Dres. He added: "Since submitting our research abstract, we have confirmed our findings with several methods of case volume calculation for a shorter duration of time (2000-2012). This allowed us to confirm our preliminary results with a more homogeneous population." Effect of High Volume ICUs on Mortality in ARDS Over 15 Years Introduction: Acute Respiratory Distress Syndrome (ARDS) is a common disease affecting 10% of patients admitted in the Intensive Care Unit (ICU) and associated with a crude ICU mortality ranging from 30 to 40% (1). As the management of ARDS patients requires a complex, well organized, and technically sophisticated level of care, we aimed at investigating whether there is or there is not a relationship between patient's outcomes and case-volume ICUs. A secondary objective was to assess trends in patients' characteristics, outcomes, and management between 2000 and 2014. Material and Methods: The French CUB-REA database includes 35 ICUs, which collected 316,000 individual ICUs stays between 2000 and 2014. ARDS were identified from the hospital coding system. We assessed the difference in severity (SAPS2) and ICU mortality between tertiles of case volume. To reach this goal, multivariate analysis using mixed models was performed to adjust for severity of illness and other confounding factors. Results: Between 2000 and 2014, 18,022 stays were related to ARDS. Overall, ICU prevalence of ARDS was 8.3%. ICU prevalence of ARDS progressively increased from 6.5% in 2000 to 10.5% in 2008 and then decreased to 7.2% in 2014 (p During this period, SAPS II increased from 52 [37-71] to 58 [41-75] (p The three ARDS case volume tertiles were: low volume (?37 admissions per year), moderate volume (38-67), and high volume (>68). SAPS2 was significantly higher in high volume ICUs as compared to low and moderate volume ICUs: 61[43-80] vs. 53 [39-72] and 56 [41-74] respectively (p Conclusion: Between 2000 and 2014, among ICUs of the CUB-REA registry, despite an increase in ARDS severity, ICU mortality decreased. There was a significantly lower ICU mortality in high volume ICUs. 1. Bellani G, Laffey JG, Pham T, et al.: Epidemiology, Patterns of Care, and Mortality for Patients With Acute Respiratory Distress Syndrome in Intensive Care Units in 50 Countries. JAMA 2016; 315:788-800 Session: A15 Critical Care: The Future of Critical Care? Regionalization and Closing the Gender Gap Abstract Presentation Time: Sunday, May 21, 10 a.m. ET Location: Room 146 C (Middle Bldg, Street Level), Walter E. Washington Convention Center
News Article | July 12, 2017
THERACLION (Paris:ALTHE) (Alternext, FR0010120402 - ALTHE), a company specialized in leading-edge medical equipment for echotherapy, today announced the publication in the Official Gazette of the order relating to the reimbursement for its medical device Echopulse® for the treatment of breast adenofibromas, pursuant to Article L. 165-1-1 of the Code of Social Security: https://www.legifrance.gouv.fr/eli/arrete/2017/6/28/SSAH1719144A/jo/texte This flat-rate coverage is for a period of four years, including one year of inclusion period, one and a half years of follow-up, six months of data analysis and one year of re-evaluation processes by the French’s National Health Authority (HAS). It will be effective in a multicenter, randomized study comparing treatment with Echopulse® to reference treatment by surgery. The amount of the package includes patient care and the associated hospitalization expenses and is thus set per patient at 1,300 €. In case a sufficient expected benefit is obtained at the end of the study, the Economic Committee for Health Products or, as the case may be, the health insurance, will fix a final pricing for breast fibroadenoma treatment with echotherapy. Twelve highly reputed centers from all over France, both from the private and the public sector, will participate in the study: Groupe Hospitalier Diaconesses Croix Saint-Simon (Paris), CHU Strasbourg, Hôpital Tenon (Paris), Hôpital Saint Louis (Paris), Hôpital Pitié-Salpêtrière (Paris), Hôpital Européen (Marseille), Centre Hospitalier Valenciennes, CHU Montpellier, Clinique Mutualiste La Sagesse (Rennes), Polyclinique de l'Atlantique (Saint Herblain), American Hospital of Paris (Neuilly-sur-Seine), Polyclinique Majorelle (Nancy). All treatments performed in these centers will be reimbursed by the French Health Insurance. Thus, six hundred patients, among which 150 within the study, will be eligible for this coverage. "Obtaining the Forfait Innovation is great news for Theraclion and for the entire healthcare ecosystem in France. First of all, it was the culmination of an extremely demanding selection procedure that allowed Theraclion to establish a relationship of trust with the Ministry of Health and the French National Health Authority. French reimbursement of echotherapy will be a major factor in accelerating the development of Theraclion and encouraging it to continue on the path of innovation. It is worth noting that Theraclion is the first French company to obtain the Forfait Innovation in its revised form, paving the way for other French Medtech companies who are ready to embark on the national market," explains David Caumartin, CEO of Theraclion. About Forfait Innovation On February 16th, 2015, the French Ministry of Health has issued a decree introducing a new derogatory reimbursement process for innovative health technologies, called Forfait Innovation. The two main objectives of this new system are to accelerate patient access to medical innovations and to support the development of companies that are behind them. About Theraclion Theraclion is a French company specializing in high-tech medical equipment using therapeutic ultrasound. Drawing on leading-edge technologies, Theraclion has designed and manufactured an innovative solution for echotherapy, the Echopulse®, allowing non-invasive tumor treatment through ultrasound-guided high-intensity focused ultrasound. Theraclion is ISO 13485 certified and has received the CE mark for non-invasive ablation of breast fibroadenomas and thyroid nodules. Based in Malakoff, near Paris, France Theraclion has brought together a team of 34 people, 50% of whom are dedicated to R&D and clinical trials. For more information, please visit Theraclion’s website: www.theraclion.com.
News Article | September 11, 2017
LEUVEN, Belgium--(BUSINESS WIRE)--Materialise NV (Nasdaq:MTLS) announced today that U.S. patients can now benefit from their patient-specific implants, 3D-printed in titanium for maxillofacial surgery. As the first 3D-printed titanium maxillofacial implants to receive clearance for the U.S. market, the decision marks a further extension to Materialise’s longstanding collaboration with DePuy Synthes, who will distribute the device in the U.S. The TRUMATCH® titanium 3D-printed implants are part of a personalized total solution for orthognathic surgery, also known as corrective jaw surgery, as well as for facial reconstruction. From virtual surgical planning to the 3D-printed implants used in combination with 3D-printed surgical guides, the system can help achieve better aesthetic results and minimize surgery time for patients. It has achieved positive results in European and Australian markets since its introduction in 2016. These are the first 3D-printed titanium maxillofacial implants to receive clearance for the U.S. market, making 3D printing technology more accessible than ever for the U.S. healthcare industry. The solution relies on the Materialise backbone of services, tapping into their software development, clinical engineering and 3D printing production facilities. “As the first of our extensive selection of implants to receive clearance for the U.S. markets, the decision is a real milestone for our medical department,” said Brigitte de Vet, Vice President of Materialise Medical, “Thanks to our partnership with DePuy Synthes, our devices will be able to provide better healthcare for as many patients as possible.” “For seven years now I’ve experienced the benefits of 3D-printed implants firsthand – they simplify maxillofacial surgery and allow me to perform procedures more accurately, saving time in the OR and improving patient outcomes. Moreover, they offer new treatment possibilities, allowing me to perform more complex surgeries or multiple procedures in a single intervention whereas without the implants several interventions would be necessary,” said Dr. Thomas Schouman, CMF surgeon at Groupe Hospitalier Pitié Salpêtrière, France. Materialise incorporates more than 25 years of 3D printing experience into a range of software solutions and 3D printing services, which together form the backbone of the 3D printing industry. Materialise’s open and flexible solutions enable players in a wide variety of industries, including healthcare, automotive, aerospace, art and design, and consumer goods, to build innovative 3D printing applications that aim to make the world a better and healthier place. Headquartered in Belgium, with branches worldwide, Materialise combines the largest group of software developers in the industry with one of the largest 3D printing facilities in the world. For additional information, please visit: www.materialise.com. Materialise Medical, which has pioneered many of the leading medical applications of 3D printing, enables researchers, engineers and clinicians to revolutionize innovative patient-specific treatment. Materialise Medical’s open and flexible platform of software and services, Materialise Mimics, forms the foundation of certified Medical 3D Printing, in clinical as well as research environments, offering virtual planning software tools, 3D-printed anatomical models, and patient-specific surgical guides and implants. For additional information, please visit: medical.materialise.com DePuy Synthes, part of the Johnson & Johnson Medical Devices Companies, provides one of the most comprehensive orthopaedics portfolios in the world. DePuy Synthes solutions, in specialties including joint reconstruction, trauma, craniomaxillofacial, spinal surgery and sports medicine, are designed to advance patient care while delivering clinical and economic value to health care systems worldwide. For more information, visit www.depuysynthes.com. Some of the statements in this press release are "forward-looking" and are made pursuant to the safe harbor provision of the Private Securities Litigation Reform Act of 1995. These forward-looking statements include statements relating to, among other things, our planned commercialization efforts and regulatory approvals of our technologies as well as the success thereof and our research and development projects. These forward-looking statements are based upon the expectations of management under current assumptions at the time of this press release. We caution you that forward-looking statements are not guarantees of future performance and involve known and unknown risks, uncertainties and other factors that are in some cases beyond our control that may cause our actual results to differ materially from our expectations. We are providing this information as of the date of this press release and do not undertake any obligation to update any forward-looking statements contained in this presentation as a result of new information, future events or otherwise, unless we have obligations under the federal securities laws to update and disclose material developments related to previously disclosed information.
Azar N.,Groupe Hospitalier |
Leblond V.,Groupe Hospitalier |
Ouzegdouh M.,Groupe Hospitalier |
Button P.,Procex Solutions Ltdwales United Kingdom
Journal of Clinical Apheresis | Year: 2017
Introduction: The Pitié Salpêtrière Hospital Hemobiotherapy Department, Paris, France, has been providing extracorporeal photopheresis (ECP) since November 2011, and started using the Therakos® CELLEX® fully integrated system in 2012. This report summarizes our single-center experience of transitioning from the use of multi-step ECP procedures to the fully integrated ECP system, considering the capacity and cost implications. Materials and Methods: The total number of ECP procedures performed 2011-2015 was derived from department records. The time taken to complete a single ECP treatment using a multi-step technique and the fully integrated system at our department was assessed. Resource costs (2014€) were obtained for materials and calculated for personnel time required. Time-driven activity-based costing methods were applied to provide a cost comparison. Results: The number of ECP treatments per year increased from 225 (2012) to 727 (2015). The single multi-step procedure took 270 min compared to 120 min for the fully integrated system. The total calculated per-session cost of performing ECP using the multi-step procedure was greater than with the CELLEX® system (€1,429.37 and €1,264.70 per treatment, respectively). Conclusions: For hospitals considering a transition from multi-step procedures to fully integrated methods for ECP where cost may be a barrier, time-driven activity-based costing should be utilized to gain a more comprehensive understanding the full benefit that such a transition offers. The example from our department confirmed that there were not just cost and time savings, but that the time efficiencies gained with CELLEX® allow for more patient treatments per year. © 2017 Wiley Periodicals, Inc.
Tan J.Y.,University of Oxford |
Vance K.W.,University of Oxford |
Varela M.A.,University of Cape Town |
Watson L.M.,University Pierre and Marie Curie |
And 16 more authors.
Nature Structural and Molecular Biology | Year: 2014
What causes the tissue-specific pathology of diseases resulting from mutations in housekeeping genes? Specifically, in spinocerebellar ataxia type 7 (SCA7), a neurodegenerative disorder caused by a CAG-repeat expansion in ATXN7 (which encodes an essential component of the mammalian transcription coactivation complex, STAGA), the factors underlying the characteristic progressive cerebellar and retinal degeneration in patients were unknown. We found that STAGA is required for the transcription initiation of miR-124, which in turn mediates the post-transcriptional cross-talk between lnc-SCA7, a conserved long noncoding RNA, and ATXN7 mRNA. In SCA7, mutations in ATXN7 disrupt these regulatory interactions and result in a neuron-specific increase in ATXN7 expression. Strikingly, in mice this increase is most prominent in the SCA7 disease-relevant tissues, namely the retina and cerebellum. Our results illustrate how noncoding RNA-mediated feedback regulation of a ubiquitously expressed housekeeping gene may contribute to specific neurodegeneration.
Vambergue A.,Service de Diabetologie |
Perimenis P.,Groupe Hospitalier
Correspondances en MHND | Year: 2015
The intra uterine diabetic environment affects the fetoplacental unit. The fetoplacental unit has to adapt itself to an influx of nutriments (glucose, amino acids, lipids) in excess. In case of maternal diabetes, the placenta sets up hormonal, infl ammatory and immune adaptative mechanisms. In case of maternal diabetes, the PPARs (peroxisome proliferatoractivated receptors) are involved in the placentation, in the modifi cation of the mediators of the infl ammation, and in the lipid metabolism. These adaptative mechanisms have for consequence a modifi cation of transfers, immune responses and angiogenesis associated with an oxidative stress. These placental adaptative mechanisms will have consequences in clinical practice, as abnormalities of growth, macrosomia or intra-uterine growth restriction (IUGR).
Reyes S.,University Paris Diderot |
Kurtz A.,University Paris Diderot |
Herve D.,University Paris Diderot |
Tournier-Lasserve E.,Groupe Hospitalier |
Chabriat H.,University Paris Diderot
Journal of Neurology | Year: 2012
Genetic counselling has been poorly investigated in cerebrovascular diseases. Characteristics, motivations and long-term outcome of presymptomatic tests (PT) in subjects at risk of CADASIL (Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy) were investigated at the National Centre for Rare Vascular Diseases of the Brain and/or Retina (CERVCO). Sociodemographic, motivational and psychological variables were collected between 2003 and 2010 for PT applicants. Multidisciplinary consultations (with a geneticist, neurologist and psychologist) were proposed over a 6 month period. When PT showed a deleterious mutation of the NOTCH3 gene, cognitive performances, mood, autonomy and quality of life were also assessed. Over 7 years, only 33 subjects asked for a PT of CADASIL. They were predominantly women, lived as a couple, had children and were of high sociocultural level. The dropout rate after the first step of the procedure was 63%. The characteristics of the 11 subjects who reached the end of the procedure did not differ from the 22 who dropped out. Six were carriers of the deleterious mutation and were still asymptomatic after a mean follow-up of 19 months. They did not experience any particular negative event and all of them indicated a high score of overall quality of life. Indeed, two carriers gave birth to their first child. These initial data in CADASIL show that PT is rarely requested and that there is a high dropout rate. Our study also highlights that a multidisciplinary and multistep procedure in genetic counselling testing appears useful to obtain minimal harmful consequences of genetic testing. © Springer-Verlag 2012.
Verny M.,Groupe hospitalier |
Berrut G.,Nantes University Hospital Center
Geriatrie et Psychologie Neuropsychiatrie du Vieillissement | Year: 2012
The definition of normal pressure hydrocephalus (NPH), in adults, associates clinical signs (Adams and Hakim triad) involving gait disorders, urinary incontinence and dementia, associated with aspects on brain imaging that are consistent with this hypothesis and also normal or slightly increased intracranial pressure. The aim of this study was to clarify the techniques and methods facilitating the diagnosis of NPH. The literature review has been conducted from the Medline database without date limitation including the keywords "normal pressure hydrocephalus" and "diagnosis." They should appear in the article title. From the 43 initially sorted, only 13 have been selected using exclusion criteria. The proposed methods are very sparse and focused on the improvement after surgical shunt. This focus is independent from the diagnosis criteria proposed in 2005. This introduces an ambiguity in the interpretation of the results. In practice, the diagnosis of NPH is more difficult in the elderly population where differential diagnoses are frequent, particularly vascular lesions (notably microangiopathy) and Alzheimer's disease. The more invasive techniques as continuous spinal drainage (usually during 3 days) or some features of CSF dynamics (Rout, compliance) seem to be the best predictors of after shunt improvement. However, these techniques are difficult to use in routine in the elderly. The combination of Evans index and corpus callosum angle on MRI is very useful to improve the differential diagnosis with cerebral atrophy. Spinal tap test (lumbar puncture with the removal of 40 mL of CSF) can be repeated two or three times for consecutive days to improve the predictive value before shunting. Gait and balance often improve after shunt, more than cognition and bladder disorders. In the elderly population, the prognosis after 3 years is non conclusive despite initial improvement. Poor prognosis seems to be due to associated pathologies in particular neurodegenerative diseases. This should be considered in decision-making of CSF shunt.
El Rachkidi R.,Groupe Hospitalier |
Sari-Leret M.-L.,Groupe Hospitalier |
Wolff S.,Groupe Hospitalier
Spine | Year: 2011
Study Design: A case report with review of the literature. Objective: To present a first case of an atraumatic bilateral pedicle fracture of L5 in a patient with long-term risedronate therapy and without any previous history of surgery or fracture. Summary of Background Data: A few cases of bilateral osteoporotic pedicle fractures have been reported. All were associated with previous or concomitant corporeal compression fractures. Atypical femoral fractures were recently described with long-term bisphosphonate treatment. To our knowledge, there are no previous reports of isolated bilateral pedicle fracture associated with prolonged bisphosphonate therapy. Methods: A 66-year-old woman treated with risedronate for 10 years and without any history of trauma presented with exacerbation of low back pain. No fracture was noted in her past medical history. Results: A complete workup showed an isolated bilateral recent fracture of the L5 pedicles without evident etiology. Consolidation was achieved after 3 months of bracing. Conclusion: We reported the first case of isolated bilateral pedicle fracture in a patient treated with risedronate for 10 years. This may be another atypical fracture in long-term bisphosphonate treatment. © 2011 Lippincott Williams & Wilkins.
Laincer A.,Groupe Hospitalier |
Lukat S.,Groupe Hospitalier |
Dalle-Pecal M.,Groupe Hospitalier |
Divine C.,Groupe Hospitalier
Pharmacien Hospitalier et Clinicien | Year: 2016
Introduction. As part of 2014 patient security week, a medicine chest simulation took place at the hospital in order to communicate on correct storage and use of drugs at home. Method. A home medicine chest has been reproduced in the hospital hall and then within the cardiac re-adaptation hospital day. The medicine chest included seventeen products such as drugs and medical devices, of which eleven purposely contained errors. The objective for the attendees (patients, visitors and hospital staff) consisted in identifying mistakes. Results. Thirty-six people took part in this event. Average number of mistakes was eight (between two and eleven). The three most notified errors were the presence of a cleaning product bottle (100 %), unable to identify loose pills (97 %) and single dose kept after opening (86 %). Ninety-four percent of attendees consider that they have learnt useful information and 53 % of them claim that they are willing to change organization of their own medicine chest. Conclusion. The home medicine chest simulation is a tool to educate in an enjoyable way on health topics and is interesting to set up within health institutions. © 2015 Elsevier Masson SAS.