Créteil, France


Créteil, France
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Aussel C.,Groupe hospitalier Henri Mondor | Aussel C.,University of Paris Descartes | Cynober L.,University of Paris Descartes | Cynober L.,France Inter
Nutrition Clinique et Metabolisme | Year: 2013

Serum albumin level is the most widely used diagnostic and follow-up marker of malnutrition. However, there are numerous contradictions between in-practice use of serum albumin and results of scientific studies, exemplified in the fact that serum albumin is used to diagnose malnutrition even though it values are neither correlated to protein mass nor decreased in characterized malnutrition such as marasmus or anorexia nervosa. Furthermore, protein restriction does not systematically lead to hypoalbuminemia, and efficient nutritional management does not always increase serum albumin levels. Serum albumin level is also a marker or morbidity-mortality independently of nutritional status. The serum albumin values used as diagnosis cut-off levels for malnutrition status, as set by health authorities or learned societies, are taken from studies where serum albumin levels correlated to non-anthropometric parameters such as mean hospital stay, infections, bedsores or rehospitalization, making it a marker of morbidity-mortality rather than malnutrition. Nevertheless, serum albumin level should remain part of the nutritional status assessment, either alone or - ideally - as part of a composite body weight index such as the Nutritional Risk Index or the Geriatric Nutritional Risk Index in order to guide the implementation of a nutritional strategy integrating the risks of malnutrition-related complications defined by the index. It is time the French health authority (Haute Autorité de santé [HAS]) recommendations to be updated to take this burgeoning evidence into account. © 2013 .

Malfertheiner P.,Otto Von Guericke University of Magdeburg | Bazzoli F.,University of Bologna | Delchier J.-C.,Groupe Hospitalier Henri Mondor | Celinski K.,Medical University of Lublin | And 3 more authors.
The Lancet | Year: 2011

Background: Helicobacter pylori is associated with benign and malignant diseases of the upper gastrointestinal tract, and increasing antibiotic resistance has made alternative treatments necessary. Our aim was to assess the efficacy and safety of a new, single-capsule treatment versus the gold standard for H pylori eradication. Methods: We did a randomised, open-label, non-inferiority, phase 3 trial in 39 sites in Europe, comparing the efficacy and safety of 10 days of quadruple therapy with omeprazole plus a single three-in-one capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline (quadruple therapy) versus 7 days of omeprazole, amoxicillin, and clarithromycin (standard therapy) in adults with recorded H pylori infection. Patients were randomly assigned treatment according to a predetermined list independently generated by Quintiles Canada (Ville St-Laurent, QC, Canada). Our study was designed as a non-inferiority trial but was powered to detect superiority. Our primary outcome was H pylori eradication, established by two negative 13C urea breath tests at a minimum of 28 and 56 days after the end of treatment. Our assessment for non-inferiority was in the per-protocol population, with subsequent assessment for superiority in the intention-to-treat population (ie, all participants randomly assigned treatment). This study is registered with, number NCT00669955. Findings: 12 participants were lost to follow-up and 101 were excluded from the per-protocol analysis. In the per-protocol population (n=339), the lower bound of the CI for treatment with quadruple therapy was greater than the pre-established non-inferiority margin of -10% (95% CI 15.1-32.3; p<0.0001). In the intention-to-treat population (n=440), eradication rates were 80% (174 of 218 participants) in the quadruple therapy group versus 55% (123 of 222) in the standard therapy group (p<0.0001). Safety profiles for both treatments were similar; main adverse events were gastrointestinal and CNS disorders. Interpretation: Quadruple therapy should be considered for first-line treatment in view of the rising prevalence of clarithromycin-resistant H pylori, especially since quadruple therapy provides superior eradication with similar safety and tolerability to standard therapy. Funding: Axcan Pharma Inc. © 2011 Elsevier Ltd.

Mylius V.,University Paris Est Creteil | Mylius V.,University of Marburg | Borckardt J.J.,Medical University of South Carolina | Lefaucheur J.-P.,University Paris Est Creteil | Lefaucheur J.-P.,Groupe Hospitalier Henri Mondor
Pain | Year: 2012

Noninvasive cortical stimulation (NICS) can produce analgesic effects by means of repetitive transcranial magnetic stimulation or transcranial direct current stimulation (tDCS). Such effects have been demonstrated on chronic ongoing pain, as in acute provoked pain. The investigation of induced changes in the perception of experimental pain by NICS could help clinicians and researchers to better understand the mechanisms of action involved with these techniques and the role played by the cortex in the integration of nociceptive information. This review presents current literature data on the modulation of experimental pain perception by cortical stimulation. The observations found that NICS analgesic effects depend on the method used to provoke pain (referring to the type of nerve fibers and neural circuits that are recruited to mediate pain) and the parameters of cortical stimulation (especially the nature of the cortical target). The motor cortex (precentral cortical area) is the most widely used target for pain modulation. However, other targets, such as the dorsolateral prefrontal cortex, could be of particular interest to modulate various components of pain. Further developments in NICS techniques, such as image-guided navigated brain stimulation, might lead to improvement in the beneficial effects of NICS on pain. Finally, we discuss whether the results obtained in experimental pain can be transposed to the problem of chronic pain and whether they can be used to optimize cortical stimulation therapy for pain disorders. © 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Le Corvoisier P.,Groupe Hospitalier Henri Mondor | Roudot-Thoraval F.,Henri Mondor Hospital | Cazalens T.,French National Health Insurance System | Canoui-Poitrine F.,University Paris Est Creteil | Montagne O.,French Institute of Health and Medical Research
British Journal of General Practice | Year: 2013

Background High levels of outpatient antibiotic use remain observed in many European countries. Several studies have shown a strong relationship between antibiotic use and bacterial resistance. Aim To assess the long-term effect of a standardised educational seminar on antibiotic prescriptions by GPs. Design and setting Randomised controlled trial of 171 GPs (of 203 initially randomised) in France. Method GPs in the control group (n = 99) received no antibiotic prescription recommendation. Intervention group GPs (n = 72) attended an interactive seminar presenting evidence-based guidelines on antibiotic prescription for respiratory infections. The proportion of prescriptions containing an antibiotic in each group and related costs were compared to the baseline up to 30 months following the intervention. Data were obtained from the National Health Insurance System database. Results In the intervention group, 4-6 months after the intervention, there was a significant decrease in the proportion of prescriptions containing an antibiotic from 15.2 ± 5.4% to 12.3 ± 5.8% (-2.8% [95% CI = -3.8 to -1.9], P<0.001). By contrast, an increase was observed in controls from 15.3 ± 6.0 to 16.4 ± 6.7% (+1.1% [95% CI = +0.4 to +1.8], P<0.01), resulting in a between-group difference of 3.93% ([95% CI = 2.75 to 5.11], P<0.001). The between-group difference was maintained 30 months after intervention (1.99% [95% CI = 0.56 to 3.42], P<0.01). Persistence of the intervention effect over the entire study period was confirmed in a hierarchical multivariate analysis. Conclusion This randomised trial shows that a standardised and interactive educational seminar results in a long-term reduction in antibiotic prescribing and could justify a large-scale implementation of this intervention. © British Journal of General Practice.

Gunawardana J.,BC Cancer Agency | Gunawardana J.,University of British Columbia | Chan F.C.,BC Cancer Agency | Chan F.C.,University of British Columbia | And 29 more authors.
Nature Genetics | Year: 2014

Classical Hodgkin lymphoma and primary mediastinal B cell lymphoma (PMBCL) are related lymphomas sharing pathological, molecular and clinical characteristics. Here we discovered by whole-genome and whole-transcriptome sequencing recurrent somatic coding-sequence mutations in the PTPN1 gene. Mutations were found in 6 of 30 (20%) Hodgkin lymphoma cases, in 6 of 9 (67%) Hodgkin lymphoma-derived cell lines, in 17 of 77 (22%) PMBCL cases and in 1 of 3 (33%) PMBCL-derived cell lines, consisting of nonsense, missense and frameshift mutations. We demonstrate that PTPN1 mutations lead to reduced phosphatase activity and increased phosphorylation of JAK-STAT pathway members. Moreover, silencing of PTPN1 by RNA interference in Hodgkin lymphoma cell line KM-H2 resulted in hyperphosphorylation and overexpression of downstream oncogenic targets. Our data establish PTPN1 mutations as new drivers in lymphomagenesis. © 2014 Nature America, Inc.

Thiriez C.,Groupe Hospitalier Henri Mondor | Gurruchaga J.-M.,Groupe Hospitalier Henri Mondor | Goujon C.,Groupe Hospitalier Henri Mondor | Fenelon G.,Groupe Hospitalier Henri Mondor | And 2 more authors.
Neurotherapeutics | Year: 2014

Epidural spinal cord stimulation (SCS) is currently proposed to treat intractable neuropathic pain. Since the 1970s, isolated cases and small cohorts of patients suffering from dystonia, tremor, painful leg and moving toes (PLMT), or Parkinson's disease were also treated with SCS in the context of exploratory clinical studies. Despite the safety profile of SCS observed in these various types of movement disorders, the degree of improvement of abnormal movements following SCS has been heterogeneous among patients and across centers in open-label trials, stressing the need for larger, randomized, double-blind studies. This article provides a comprehensive review of both experimental and clinical studies of SCS application in movement disorders. © 2014 The American Society for Experimental NeuroTherapeutics, Inc.

Schortgen F.,Groupe Hospitalier Henri Mondor | Schortgen F.,University Paris Est Creteil | Asfar P.,University of Angers | Asfar P.,French Institute of Health and Medical Research
American Journal of Respiratory and Critical Care Medicine | Year: 2015

Sepsis and acute kidney injury (AKI) represent an important burden in intensive care unit clinical practices. The Journal published important contributions in sepsis for novel therapeutic approaches suggesting that combined molecular targets (e.g., dual inhibition of IL-1β and IL-18, and coadministration of endothelial progenitor cells and stromal cell-derived factor-1a analog) could perform better. The clinical effectiveness of 1,25-dihydroxyvitamin D was reported in a double-blind, randomized, placebo-controlled trial. Although its experimental properties appeared favorable in the pro-and antiinflammatory cytokine balance, 1,25-dihydroxyvitamin D failed to improve survival. Strategies for decreasing antimicrobial resistances are of particular importance. Effective (aerosolized antibiotics for ventilator-associated pneumonia) and ineffective (procalcitonin algorithm for antibiotic deescalation) approaches were published. In 2014, several publications raised an important point shared by survivors from sepsis and/or AKI. The increased number of survivors over time brought out long-term sequelae, leading to a poor outcome after hospital discharge. Among them, cardiovascular events and chronic kidney disease may explain the significant increase in the risk of death, which can persist up to 10 years and significantly increases the use of health care. Postdischarge survival represents a new target for future research in sepsis and AKI to find how we can prevent and manage long-term sequelae. A milestone of the year was the Ebola outbreak. The Journal contributed to our better understanding of Ebola virus disease with a paper underlying the crucial role of a large implementation of pragmatic supportive care, including fluid infusion and correction of metabolic abnormalities, to save more lives. Copyright © 2015 by the American Thoracic Society.

Schortgen F.,Groupe Hospitalier Henri Mondor | Schortgen F.,French Institute of Health and Medical Research | Clabault K.,University of Rouen | Katsahian S.,Groupe Hospitalier Henri Mondor | And 12 more authors.
American Journal of Respiratory and Critical Care Medicine | Year: 2012

Rationale: Fever control may improve vascular tone and decrease oxygen consumption, but fever may contribute to combat infection. Objectives: To determine whether fever control by external cooling diminishes vasopressor requirements in septic shock. Methods: In a multicenter randomized controlled trial, febrile patients with septic shock requiring vasopressors, mechanical ventilation, and sedation were allocated to external cooling (n = 101) to achieve normothermia (36.5-37°C) for 48 hours or no external cooling (n = 99). Vasopressors were tapered to maintain the same blood pressure target in the two groups. The primary endpoint was the numberof patients with a 50% decrease in baseline vasopressor dose after 48 hours. Measurements and Main Results: Body temperature was significantly lower in the cooling group after 2 hours of treatment (36.8 ± 0.7 vs. 38.4 ± 1.1°C; P < 0.01). A 50% vasopressor dose decrease was significantly more common with external cooling from 12 hours of treatment (54 vs. 20%; absolute difference, 34%; 95% confidence interval [95% CI], -46 to -21; P < 0.001) but not at 48 hours (72 vs. 61%; absolute difference,11%; 95% CI, -23 to 2). Shock reversal during the intensive care unit stay was significantly more common with cooling (86 vs. 73%; absolute difference,13%; 95% CI, 2 to 25; P=0.021). Day-14 mortality was significantly lower in the cooling group (19 vs. 34%; absolute difference, -16%; 95% CI, -28 to -4; P = 0.013). Conclusions: In this study, fever control using external cooling was safe and decreased vasopressor requirements and early mortality in septic shock. Copyright © 2012 by the American Thoracic Society.

Dunne J.W.,Royal Perth Hospital | Dunne J.W.,Groupe Hospitalier Henri Mondor | Gracies J.-M.,Groupe Hospitalier Henri Mondor | Hayes M.,Concord Repatriation Hospital | And 3 more authors.
Clinical Rehabilitation | Year: 2012

Objective: To examine the safety and efficacy of onabotulinumtoxinA (Botox) for plantarflexor overactivity following stroke. Design: Double-blind randomized controlled trial, open-label extension phase. Setting: Neurology rehabilitation facilities. Subjects: Eighty-five subjects with lower limb hypertonia received 200 U (n = 28) or 300 U (n = 28) of onabotulinumtoxinA or saline (n = 29) injection. Primary measures: Plantarflexor Ashworth scores at 12 weeks post injection and adverse events. Secondary measures: self-reported spasm frequency and pain, physician rating of hypertonia severity, gait quality and active dorsiflexion. Results: Differences were not seen between onabotulinumtoxinA groups; hence data were pooled. Incidence of adverse events was not different between groups (P = 0.61). Reduction in hypertonia was not different between groups at 12 weeks (P = 0.53); however for subjects with Ashworth scores of >3 at baseline, 14/31 in the onabotulinumtoxinA group demonstrated a reduction of >1 grade versus 1/17 receiving placebo injection (P = 0.01). Overall, onabotulinumtoxinA-injected subjects demonstrated significantly greater improvement in spasm frequency (22/54 versus 4/29, P = 0.01), pain reduction (8/54 versus 1/29, P = 0.02), active dorsiflexion (8/54 versus 1/29 P = 0.03) and gait quality (17/54 versus 6/29, P = 0.02) than controls. In the open-label phase, a second onabotulinumtoxinA injection was associated with greater hypertonia reduction (P = 0.005) and gait quality (P = 0.002) compared with single injection. Conclusions: OnabotulinumtoxinA injection for ankle flexor overactivity after stroke was safe and well tolerated but did not alter local spasticity at 12 weeks; it did reduce spasms and improve gait quality. There were no detectable differences between higher and lower doses. A second injection may be associated with greater change. © The Author(s) 2012 Reprints and permissions.

Duret C.,CRF Les Trois Soleils | Hutin E.,Groupe Hospitalier Henri Mondor | Lehenaff L.,CRF Les Trois Soleils | Gracies J.-M.,Groupe Hospitalier Henri Mondor
Restorative Neurology and Neuroscience | Year: 2015

Purpose: Upper limb robot-assisted rehabilitation is a highly intensive therapy, mainly recommended after stroke. Whether robotic therapy is suitable for subacute patients with severe impairments including cognitive disorders is unknown. This retrospective study explored factors impacting on motor performance achieved in a 16-session robotic training combined with standard rehabilitation. Methods: Seventeen subacute inpatients (age 53 ± 18; 49 ± 26 days post-stroke) were assessed at baseline using upper extremity motor impairments scales, Functional Independence Measure, aphasia and neglect scores. Number of movements and robotic assistance were compared between Session2(S2),8(8) and 16(S16), Motricity Index between pre and post-treatment. Correlation analyses explored predictors of motor performance. Results: Overall, number of movements and Motricity Index increased significantly while robot-assistance decreased. The mean number of movements per session correlated positively with baseline motor capacities but not with age, aphasia and neglect. However, the increase in Motricity index correlated negatively with baseline Motricity index and the increase in the number of movements correlated negatively with the number of movements at S2. Conclusion: High intensity robot-assisted training may be associated with motor improvement in subacute hemiparesis. More severely impaired patients may derive greater benefit from robot-assisted training; age, aphasia and neglect do not represent exclusion criteria. © 2015 - IOS Press and the authors. All rights reserved.

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