Les Hopitaux Universitaires Of Strasbourg

Strasbourg, France

Les Hopitaux Universitaires Of Strasbourg

Strasbourg, France
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Epailly E.,Les Hopitaux Universitaires Of Strasbourg | Albanell J.,Autonomous University of Barcelona | Andreassen A.,University of Oslo | Bara C.,Hannover Medical School | And 11 more authors.
Clinical Transplantation | Year: 2011

Although malignancy is a major threat to long-term survival of heart transplant (HT) recipients, clear strategies to manage immunosuppression in these patients are lacking. Several lines of evidences support the hypothesis of an anticancer effect of proliferation signal inhibitors (PSIs: mammalian target of rapamycin [mTOR] inhibitors) in HT recipients. This property may arise from PSI's ability to replace immunosuppressive therapies that promote cancer progression, such as calcineurin inhibitors or azathioprine, and/or through their direct biological actions in preventing tumor development and progression. Given the lack of randomized studies specifically exploring these issues in the transplant setting, a collaborative group reviewed current literature and personal clinical experience to reach a consensus aimed to provide practical guidance for the clinical conduct in HT recipients with malignancy, or at high risk of malignancy, with a special focus on advice relevant to potential role of PSIs. © 2011 John Wiley & Sons A/S.

Francois S.,Laval University | Sarra-Bournet C.,Laval University | Jaffre A.,Laval University | Chakfe N.,Les Hopitaux Universitaires Of Strasbourg | And 2 more authors.
Journal of Biomedical Materials Research - Part B Applied Biomaterials | Year: 2010

It was previously showed that PLLA nanofiber mesh promoted good endothelial cell proliferation. A new technique was developed to produce nanofibers by air jet spinning inside the tubular shape of vascular prostheses and to characterize this nanofiber mesh. Polymer macromolecule stability was assessed by gel permeation chromatography. Thermal analyses were conducted with differential scanning calorimetry and dynamic mechanical analysis on PLLA nanofibers obtained with 4% and 7% solutions (w/v) in chloroform. Polyethylene terephthalate (PET) was also treated with atmospheric pressure dielectric barrier discharge under air or nitrogen atmosphere to optimize PLLA nanofiber adherence, assessed by peel tests. Air spinning induced a reduction of number-average molecular weight (Mn) for the 7% PLLA solution but not for the 4% solution. The nanofibers were more crystalline and less sensible to viscoelastic relaxation as a function of aging in the 4% solution than in the 7% solution. Discharge treatment of the PET promoted identical surface modification on PET film and PET textile surfaces. Moreover, the best PLLA nanofibers adhesion results were obtained under nitrogen atmosphere. This study demonstrates that it is possible to coat the internal side of tubular vascular prostheses with PLLA nanofibers, and provides a better understanding of the air spinning process as well as optimizing nanofibers adhesion. © 2010 Wiley Periodicals, Inc.

Boissonnat P.,Hospices Civils de Lyon | Gaillard S.,University of Lyon | Mercier C.,Hospices Civils de Lyon | Mercier C.,University of Lyon | And 14 more authors.
Trials | Year: 2012

Background: Using reduced doses of Cyclosporine A immediately after heart transplantation in clinical trials may suggest benefits for renal function by reducing serum creatinine levels without a significant change in clinical endpoints. However, these trials were not sufficiently powered to prove clinical outcomes.Methods: In a prospective, multicentre, open-label, parallel-group controlled trial, 95 patients aged 18 to 65 years old, undergoing de novo heart transplantation were centrally randomised to receive either a low (130 < trough CsA concentrations <200 μg/L, n = 47) or a standard dose of Cyclosporine A (200 < trough CsA concentrations <300 μg/L, n = 48) for the three first post-transplant months along with mycophenolate mofetil and corticosteroids. Participants had a stable haemodynamic status, a serum creatinine level <250 μmol/L and the donors' cold ischemia time was under six hours; multiorgan transplants were excluded. The change in serum creatinine level over 12 months was used as the main criterion for renal function. Intention-to-treat analysis was performed on the 95 randomised patients and a mixed generalised linear model of covariance was applied.Results: At 12 months, the mean (± SD) creatinine value was 120.7 μmol/L (± 35.8) in the low-dose group and 132.3 μmol/L (± 49.1) in the standard-dose group (P = 0.162). Post hoc analyses suggested that patients with higher creatinine levels at baseline benefited significantly from the lower Cyclosporine A target. The number of patients with at least one rejection episode was not significantly different but one patient in the low-dose group and six in the standard-dose group required dialysis.Conclusions: In patients with de novo cardiac transplantation, early Cyclosporine A dose reduction was not associated with renal benefit at 12 months. However, the strategy may benefit patients with high creatinine levels before transplantation.Trial registration: ClinicalTrials.gov NCT00159159. © 2012 Boissonnat et al.; licensee BioMed Central Ltd.

Duclos M.,Service de medecine du sport et des explorations fonctionnelles | Duclos M.,University of Auvergne | Duche P.,University Blaise Pascal | Guezennec C.-Y.,Center national du Rugby | And 4 more authors.
Science and Sports | Year: 2010

Objectives: Physical activity is recommended at every stage of the care of obesity in adults and in children, with a high level of scientific evidences. The objective of this review is to propose practical answers to key-questions of physicians faced to prescription of regular physical activity in obese subjects. Methodology: Five " question-reply" were developed: (1) what are the costs of obesity? Of sedentary lifestyle? Of strategies to promote physical activity in obese subjects? (2) What are the benefits of regular physical activity in obese subjects? (3) What type of activity should be prescribed and/or avoided? (4) Is there contra-indications to physical activity in obese subjects? (5) How measuring habitual physical activity in obese subjects? Results and conclusion: This review leads to a consensus statement of the French Society for Sports Medicine and proposes a " check list" that may help the physician to prescribe physical activity in obese subjects. © 2010 Elsevier Masson SAS.

Khoffi F.,CNRS Textile Mechanics and Physics Laboratory | Khoffi F.,Institute DAnatomie Pathologique | Dieval F.,CNRS Textile Mechanics and Physics Laboratory | Dieval F.,Institute DAnatomie Pathologique | And 4 more authors.
Physics Procedia | Year: 2011

The objective of this study is to develop a technique for measuring the compliance of the textile vascular prostheses without membrane. The principle of this test is to investigate the dimensional changes of prostheses, using imaging techniques, submitted to internal pressure. The internal compliance is broken into three categories: the radial compliance, the longitudinal compliance and the volumetric compliance. The results have shown a significant difference in compliance between the polyethylene terephthalate (PET) vascular grafts and the healthy host arteries. © 2011 Published by Elsevier B.V.

Bogni S.,University of Bern | Ortner M.-A.,University of Bern | Vajtai I.,University of Bern | Jost C.,University of Bern | And 3 more authors.
Gastrointestinal Endoscopy | Year: 2012

Background: Complete closure of gastrotomy is the linchpin of safe natural orifice transgastric endoscopic surgery. Objective: To evaluate feasibility and efficacy of a new method of gastrotomy closure by using a sutureless laser tissue-soldering (LTS) technique in an ex vivo porcine stomach. Design: In vitro experiment. Setting: Experimental laboratory. Interventions: Histological analysis and internal and external liquid pressure with and without hydrochloric acid exposure were determined comparing gastrotomy closure with LTS and with hand-sewn surgical sutures. Main Outcome Measurements: Comparison of LTS and hand-sewn surgical gastrotomy closure. The primary outcome parameter was the internal leak pressure. Secondary parameters were the difference between internal and external leak pressures, the impact of an acid environment on the device, histological changes, and feasibility of endoscopic placement. Results: The internal liquid leak pressure after LTS was almost twice as high as after hand-sewn surgical closure (416 ± 53 mm Hg vs 229 ± 99 mm Hg; P = .01). The internal leak pressure (416 ± 53 mm Hg) after LTS was higher than the external leak pressure (154 ± 46 mm Hg; P < .0001). An acidic environment did not affect leak pressure after LTS. Endoscopic LTS closure was feasible in all experiments. Histopathology revealed only slight alterations beneath the soldering plug. Limitations: In vitro experiments. Conclusions: Leak pressure after LTS closure of gastrotomy is higher than after hand-sewn surgical closure. LTS is a promising technique for closure of gastrotomies and iatrogenic perforations. Further experiments, in particular survival studies, are mandatory. © 2012 American Society for Gastrointestinal Endoscopy.

Offner D.,Les Hopitaux Universitaires Of Strasbourg | Musset A.-M.,Les Hopitaux Universitaires Of Strasbourg | Thiel M.-J.,Center Europeen Denseignement Et Of Recherche En Ethique Ceere Of Luniversite Of Strasbourg
Ethique et Sante | Year: 2012

The fast evolution of dentistry of these last decades has to make the dentists wonder about their exercise, and especially regarding the norms, which are created for the aesthetic rehabilitations of the smile. Indeed, with the craze of patients for dental aesthetic which is allowed by the evolution of the techniques of dentistry and highlighted in the medias to end as a culture of the smile, the dentists get in the race to the standardization of the smile, trying to fix it in establishing norms and guidelines. It is pretty important to question the depth of this normalization, and to discern if limits would allow being more cautious about it. This analyze would be much more relevant by knowing what already happens in other countries like South Africa. The normalization of the smile could exceed the limits that ethics would set, if it hasn't already been done. © 2011 Elsevier Masson SAS.

Garbouj H.,Tunisian Research Laboratory Sport Performance Optimisation | Lonsdorfer-Wolf E.,Les Hopitaux Universitaires Of Strasbourg | Haj Sassi R.,Jendouba University | Bahlau J.,Les Hopitaux Universitaires Of Strasbourg | Lonsdorfer J.,Les Hopitaux Universitaires Of Strasbourg
Science and Sports | Year: 2016

Introduction: The benefits of exercise training in patients with chronic obstructive pulmonary disease (COPD) are no longer debating. However, the major challenge to overcome in subjects with COPD is to offer them a short-term training program allowing them to improve their exercise tolerance. Synthesis of the facts and results: Sixty patients with moderate or severe COPD performed a maximal exercise test before and after a short endurance training program. An improvement of the maximum tolerated power and delay of onset of ventilatory threshold were obtained at the end of the program. Conclusion: An intermittent short-term endurance exercise training where loads are individualized allows improving exercise tolerance in patients with moderate and moderately severe COPD. © 2015 Elsevier Masson SAS.

PubMed | Les Hopitaux Universitaires Of Strasbourg
Type: Journal Article | Journal: Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie | Year: 2013

Extracorporeal shock wave lithotripsy (ESWL) is a treatment of urinary stones with the uses of shock wave. The principle of ESWL will be exposed. The ways to localize the stones are then discussed with the mode of anesthesia. One session of ESWL will be presented in details. Contraindications, indications, prerequisit, complications and results will be briefly described.

PubMed | University of Rome La Sapienza and Les Hopitaux Universitaires Of Strasbourg
Type: | Journal: Cardiovascular and interventional radiology | Year: 2017

The Cardiovascular and Interventional Radiological Society of Europe (CIRSE) prompted an initiative to frame the current European status of anesthetic practices for interventional radiology, in consideration of the current variability of IR suite settings, staffing and anesthetic practices reported in the literature and of the growing debate on sedation administered by non-anesthesiologists, in Europe.Anonymous online survey available to all European CIRSE members to assess IR setting, demographics, peri-procedural care, anesthetic management, resources and staffing, pain management, data collection, safety, management of emergencies and personal opinions on the role CIRSE should have in promoting anesthetic care for interventional radiology.Predictable differences between countries and national regulations were confirmed, showing how significantly many local factors (type and size of centers, the availability of dedicated inpatient bed, availability of anesthesia staff) can affect the routine practice and the expansion of IR as a subspecialty. In addition, the perception of the need for IR to acquire more sedation-related skills is definitely stronger for those who practice with the lowest availability of anesthesia care.Significant country variations and regulations along with a controversial position of the anesthesia community on the issue of sedation administered by non-anesthesiologists substantially represent the biggest drawbacks for the expansion of peri-procedural anesthetic care for IR and for potential initiatives at an European level.

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