495 results match your criteria: "Cochin University Hospital[Affiliation]"

Factors associated with early failure of peroral endoscopic myotomy in achalasia.

Gastrointest Endosc

March 2024

Gastroenterology and Hepatology Department, INSERM CIC 1401, Haut-Lévêque University Hospital, Bordeaux, France. Electronic address:

Article Synopsis
  • Achalasia is effectively treated with peroral endoscopic myotomy (POEM), but factors that contribute to early failure in treatment need further investigation, particularly in European populations.
  • A retrospective study of 746 patients revealed an early failure rate of 9.4%, with significant predictors including age ≤45 years, achalasia types I and III, and severe adverse events during the procedure.
  • The study highlighted that a high Eckardt score before the procedure is also a key factor, emphasizing the need to monitor retrosternal pain levels post-operation for better outcomes.
View Article and Find Full Text PDF

Sepsis-associated encephalopathy is a severe neurologic syndrome characterized by a diffuse dysfunction of the brain caused by sepsis. This review provides a concise overview of diagnostic tools and management strategies for SAE at the acute phase and in the long term. Early recognition and diagnosis of SAE are crucial for effective management.

View Article and Find Full Text PDF

BRAF and MEK inhibitors are cornerstones of the redifferentiation strategy in metastatic radioactive iodine (RAI)-resistant mutant thyroid cancers. We explored the exposure-toxicity relationship for dose-limiting toxicity (DLT) onset in patients treated with dabrafenib and/or trametinib and investigated whether plasma exposure was associated with RAI reuptake. We conducted a retrospective monocentric study in which we reviewed the electronic medical records of patients treated in our institution with a tumor redifferentiation strategy, for whom plasma concentration of dabrafenib, its active metabolite hydroxy-dabrafenib, and trametinib was measured.

View Article and Find Full Text PDF

Background: The ETAPES program is a national telemedicine experiment conducted in France between 2018 and 2023 to investigate whether home non-invasive ventilation (NIV) telemonitoring improves healthcare pathways in patients with chronic respiratory failure (CRF) and impacts healthcare organization. The program provides a combination of therapeutic education and NIV telemonitoring with data processed by an algorithm generating alerts. The TELVENT study objective was to analyze the evolution of ventilation quality in patients included in the ETAPES program.

View Article and Find Full Text PDF

The choroidal nervous system: a link between mineralocorticoid receptor and pachychoroid.

Acta Neuropathol

November 2023

Centre de Recherche des Cordeliers, Inserm, Université Paris Cité, Sorbonne Université, Physiopathology of Ocular Diseases: Therapeutic Innovations, 15 rue de l'Ecole de Médecine, 75006, Paris, France.

Central serous chorioretinopathy (CSCR) belongs to the pachychoroid spectrum, a pathological phenotype of the choroidal vasculature, in which blood flow is under the choroidal nervous system (ChNS) regulation. The pathogenesis of CSCR is multifactorial, with the most recognised risk factor being intake of glucocorticoids, which activate both the gluco- and the mineralocorticoid (MR) receptors. As MR over-activation is pathogenic in the retina and choroid, it could mediate the pathogenic effects of glucocorticoids in CSCR.

View Article and Find Full Text PDF

Hip fractures after 60 years of age in France in 2005-2017: Nationwide sample of statutory-health-insurance beneficiaries.

Orthop Traumatol Surg Res

November 2023

Équipe Ecamo, CRESS (Centre of Research in Epidemiology, Statistics), Inserm, UMR 1153, université Paris-Cité, Paris, France; Service de chirurgie orthopédique et traumatologique, Cochin University Hospital, Assistance publique-Hôpitaux de Paris, université Paris-Cité, Paris, France.

Background: Proximal femoral factures (PFFs) constitute a heavy medical, social, and economic burden. Overall, orthopaedic conditions vary widely in France regarding the patients involved and treatments applied. For PFFs specifically, data are limited.

View Article and Find Full Text PDF

Background And Aims: Several different scoring systems for early risk stratification after out-of-hospital cardiac arrest have been developed, but few have been validated in large datasets. The aim of the present study was to compare the well-validated Out-of-hospital Cardiac Arrest (OHCA) and Cardiac Arrest Hospital Prognosis (CAHP)-scores to the less complex MIRACLE2- and Target Temperature Management (TTM)-scores.

Methods: This was a post-hoc analysis of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial.

View Article and Find Full Text PDF

Objectives: To determine the feasibility, safety, and efficacy of a biomarker-guided implementation of a kidney-sparing sepsis bundle (KSSB) of care in comparison with standard of care (SOC) on clinical outcomes in patients with sepsis.

Design: Adaptive, multicenter, randomized clinical trial.

Setting: Five University Hospitals in Europe and North America.

View Article and Find Full Text PDF
Article Synopsis
  • Diagnosing acute heart failure (AHF) in elderly patients with acute dyspnea is challenging, prompting the study of various biomarkers for improved accuracy.
  • A multicenter study in France assessed the effectiveness of five biomarkers (NT-proBNP, hs-cTnI, ST2, galectin-3, CD146) in diagnosing AHF among 238 elderly patients over a four-year period.
  • While individual biomarker accuracies varied, NT-proBNP alone provided the best diagnostic accuracy (0.72), and combining the biomarkers did not significantly improve upon this.
View Article and Find Full Text PDF
Article Synopsis
  • The TTM2 trial found no significant difference in mortality or poor functional outcomes between targeted hypothermia and targeted normothermia 6 months after out-of-hospital cardiac arrest (OHCA).
  • A detailed analysis aimed to assess brain dysfunction and cognitive function in survivors, focusing on societal participation after OHCA.
  • This study involved 1861 comatose adults across 61 hospitals in 14 countries, with follow-up conducted by masked assessors showing no differences in functional outcomes between the two temperature control methods.
View Article and Find Full Text PDF

How anesthesiology can deal with innovation and new technologies?

Minerva Anestesiol

February 2024

Department of Anesthesia and Intensive Care, Cochin University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.

Innovation and new technologies have always impacted significantly the anesthesiology practice all along the perioperative course, as it is recognized as one of the most transformative medical specialties specifically regarding patient's safety. Beside a number of major changes in procedures, equipment, training, and organization that aggregated to establish a strong safety culture with effective practices, anesthesiology is also a stakeholder in disruptive innovation. The present review is not exhaustive and aims to provide an overview on how innovation could change and improve anesthesiology practices through some examples as telemedicine (TM), machine learning and artificial intelligence (AI).

View Article and Find Full Text PDF

INTRODUCTION : Residual colorectal neoplasia (RCN) after previous endoscopic mucosal resection is a frequent challenge. Different management techniques are feasible including endoscopic full-thickness resection using the full-thickness resection device (FTRD) system and endoscopic submucosal dissection (ESD). We aimed to compare the efficacy and safety of these two techniques for the treatment of such lesions.

View Article and Find Full Text PDF
Article Synopsis
  • * Out of 364 patients, 66.5% experienced poor functional outcomes after one year, with a significant portion (52.2%) having died, while age, comorbidities, initial coma score, and stroke type were key factors linked to worse outcomes.
  • * Notably, delays in starting mechanical ventilation after stroke diagnosis appeared to improve survival chances, and over half of the survivors reported ongoing physical and mental health issues one year later.
View Article and Find Full Text PDF

Introduction: Delirium is a severe complication that is associated with short-term adverse events, prolonged hospital stay and neurological sequelae in survivors. Automated pupillometry is an easy-to-use device that allows for accurate objective assessment of the pupillary light responses in comatose patients in the intensive care unit (ICU). Whether automated pupillometry might predict delirium in critically ill patients is not known.

View Article and Find Full Text PDF

About 5% of the patients with metastatic colorectal cancers (mCRC) present microsatellite instability (MSI)/deficient mismatch repair system (dMMR). While metastasectomy is known to improve overall and progression-free survival in mCRC, specific results in selected patients with dMMR/MSI mCRC are lacking. Our study aimed to describe metastasectomy results, characterize histological response and evaluate pathological complete response (pCR) rate in patients with dMMR/MSI mCRC.

View Article and Find Full Text PDF

Fatal neonatal listeriosis following L. monocytogenes horizontal transmission highlights neonatal susceptibility to orally acquired listeriosis.

Cell Rep Med

July 2023

Institut Pasteur, Université Paris Cité, INSERM U1117, Biology of Infection Unit, 75015 Paris, France; Institut Pasteur, National Reference Center and WHO Collaborating Center Listeria, 75015 Paris, France; Necker-Enfants Malades University Hospital, Division of Infectious Diseases and Tropical Medicine, APHP, Institut Imagine, 75015 Paris, France. Electronic address:

We report a case of fulminant fatal neonatal listeriosis due to horizontal transmission of Listeria monocytogenes (Lm) in a neonatal double room. Genomic analyses reveal a close genetic relationship between clinical isolates, supporting cross-contamination. Oral inoculation experiments in adult and neonatal mice show that neonates are susceptible to a low Lm inoculum and that this susceptibility results from the immaturity of the neonatal gut microbiota.

View Article and Find Full Text PDF

Background: Clinician-reported outcome (ClinRO) measures are emerging as useful contributors to assessments of treatment benefits. The objective of this study was to collect ClinRO measures of physical and cognitive impairments after convulsive status epilepticus (CSE) requiring intensive care unit admission.

Methods: We conducted a post hoc analysis of the data from HYBERNATUS, a multicenter open-label controlled trial that randomized 270 critically ill patients with CSE requiring mechanical ventilation in 11 French intensive care units to therapeutic hypothermia (32-34 °C for 24 h) plus standard care or standard care alone.

View Article and Find Full Text PDF

Severe and fatal neonatal infections linked to a new variant of echovirus 11, France, July 2022 to April 2023.

Euro Surveill

June 2023

Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Imagine Institute, Institut National de la Santé et de la Recherche Médicale U1163, Paris, France.

Article Synopsis
  • A new variant of echovirus 11 has been identified as the cause of nine severe neonatal infections, primarily affecting male infants, with a notable occurrence among twins.
  • The affected infants, aged 3-5 days at the time of illness, presented with severe sepsis and liver failure.
  • This variant, discovered in France since April 2022, has led to an increase in fatal neonatal enterovirus infections compared to previous years, prompting calls for national and international health alerts.
View Article and Find Full Text PDF

Background: In recent years, an increasing prevalence of obesity in inflammatory bowel disease (IBD) has been observed. However, only a few studies have focused on the impact of overweight and obesity on IBD-related disability.

Aims: To identify the factors associated with obese and overweight patients with IBD, including IBD-related disability.

View Article and Find Full Text PDF
Article Synopsis
  • The FACET study is a clinical trial aimed at assessing an electronic device suite's effectiveness in detecting hand-foot skin reactions in patients with metastatic colorectal cancer who are on regorafenib treatment.
  • The study involves 38 patients across six centers in France, monitored over two treatment cycles (about 56 days) with tools like connected insoles and a mobile app to gather patient feedback and educational resources.
  • The trial seeks to enhance the usability of the device suite before a larger study and also discusses potential challenges in using digital tools in everyday medical practice.
View Article and Find Full Text PDF

CT-scan after cardiac arrest: Allegro ma non troppo.

Resuscitation

July 2023

Medical Intensive Care Unit, Cochin University Hospital (AP-HP), Paris, France; University Paris Cité - Medical School, Paris, France. Electronic address:

View Article and Find Full Text PDF

Association Between Plasma Rituximab Concentration and the Risk of Major Relapse in Antineutrophil Cytoplasmic Antibody-Associated Vasculitides During Rituximab Maintenance Therapy.

Arthritis Rheumatol

November 2023

Department of Pharmacokinetics and Pharmacochemistry, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, and Université Paris Cité, UMR8038 CNRS, U1268 INSERM, Faculté de Pharmacie, PRES Sorbonne Paris Cité, CARPEM, Paris, France.

Objective: Interindividual variability in response to rituximab remains unexplored in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides. Rituximab pharmacokinetics (PK) and pharmacodynamics (PD) as well as genetic polymorphisms could contribute to variability. This ancillary study of the MAINRITSAN 2 trial aimed to explore the relationship between rituximab plasma concentration, genetic polymorphisms in PK/PD candidate genes, and clinical outcomes.

View Article and Find Full Text PDF
Article Synopsis
  • Fatigue is a common issue in patients with inflammatory bowel disease (IBD), with 54.1% experiencing fatigue and 37.1% reporting severe fatigue.
  • Patients with active IBD experience significantly higher levels of fatigue compared to those with inactive disease.
  • Key factors affecting fatigue include age, gender, sick leave, physical pain, emotional well-being, and sleep quality, suggesting that a holistic treatment approach is essential for managing IBD-related fatigue.
View Article and Find Full Text PDF
Article Synopsis
  • The RECORDS trial investigates how different adult patients with sepsis respond to corticosteroids by categorizing them into distinct groups based on their likelihood of responding to treatment.
  • It is a large, placebo-controlled study that includes 1800 adults with conditions like pneumonia and septic shock, randomly assigning them to receive either corticosteroids or placebo for 7 to 10 days.
  • The primary goal is to assess the impact of corticosteroids on mortality and organ dysfunction after 90 days, with the findings expected to be shared at conferences and published in scientific journals.
View Article and Find Full Text PDF