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A novel human milk fortifier supports adequate growth in very low birth weight infants: a non-inferiority randomised controlled trial
No full textInternational audienceObjective To compare growth, tolerance and safety parameters in very preterm infants receiving human milk (HM) fortified with a multicomponent cow’s milk-based HM fortifier (HMF; control) versus a novel HMF-containing lipids (including docosahexaenoic acid and arachidonic acid), higher protein and lower carbohydrate levels (test). Our hypothesis was that weight growth velocity in the test group would be non-inferior to that in the control group. Design Double-blind, randomised controlled trial. Setting Nine European neonatal intensive care units. Patients HM-fed infants born at <32-week gestational age. Interventions Fortification of HM with Test or Control HMF for a minimum of 21 days. Primary outcome Weight growth velocity between baseline and intervention day 21. Results From March 2018 to July 2020, 102 and 103 infants were enrolled in the test and control groups, respectively. Weight growth velocity during the first 21 days in the test group (mean 18.4 g/kg/day) was non-inferior to that of controls (mean 18.5 g/kg/day), with a difference in estimated means of –0.175 g/kg/day (90% CI –1.34 to +0.99 g/kg/day; per-protocol population). No significant differences between groups were observed for gain in length, head circumference or anthropometric Z-scores. Rates of digestive intolerance, stool frequency and consistency were comparable. No significant differences were reported in common neonatal morbidities including necrotising enterocolitis (test: 2.9%, control: 6.9%, mean difference –4.0% (95% CI –11.1% to 2.2%); all subjects treated population). Conclusions Use of the novel HMF containing lipids, higher protein and lower carbohydrate levels supports adequate postnatal growth and appears safe and well tolerated in very preterm infants. Trial registration number NCT0331522
PFMG2025–integrating genomic medicine into the national healthcare system in France
No full textInternational audienceIntegrating genomic medicine into healthcare systems is a health policy challenge that requires continuously transferring scientific advances into clinics and ensuring equal access for patients. France was one of the first countries to integrate genome sequencing into clinical practice at a nationwide level, with the ambition to provide more accurate diagnostics and personalized treatments. Since 2016, the French government has invested €239M in the 2025 French Genomic Medicine Initiative (PFMG2025) which has so far focused on patients with rare diseases (RD), cancer genetic predisposition (CGP) and cancers. PFMG2025 has addressed numerous challenges to set up an operational organizational framework. As of December the 31st 2023, 12,737 results were returned to prescribers for RD/CGP patients (median delivery time: 202 days, diagnostic yield: 30.6%) and 3109 for cancer patients (median delivery time: 45 days). PFMG2025's future priorities encompass ensuring economic sustainability, strengthening links with research, empowering patients and practitioners, and fostering collaborations with European partners.Funding As of December the 31st 2023, €239M have been invested by the French government.</div
A case report of changes in asymmetric colour use in paintings produced over 3 years post-stroke by a patient with spatial neglect.
No full textInternational audienceThe most striking pathological manifestation of spatial cognition is visuospatial neglect in which patients omit contralesional stimuli by failing to process important features on the left side of visual or mental scenes.Despite decades of extensive neuropsychological exploration, this syndrome has still not revealed all its mysteries. Here we present the case of a person with visuospatial neglect who spontaneously produced 40 paintings in the 3 years following his stroke. By analysing the spatial distribution of colour entropy in these paintings over the course of recovery we found that these paintings contain perturbations that include changes in colour use. This approach, borrowed from statistical physics and information theory, revealed left-right asymmetries in boundary line length of monochromatic patches as well as in colour components. While the unpainted canvas surface disappeared as soon as 26 weeks post-stroke, left-right colour patch asymmetries displayed a slower recovery over one hundred weeks. Several hypotheses that can be tested in future research emerged from this study, including the possibility that these phenomenological findings demonstrate several distinct recovery mechanisms at work
Effectiveness and safety of upadacitinib induction therapy for 223 patients with crohn's disease: A GETAID multicentre cohort study
No full textInternational audienceBackground: Real-world effectiveness and safety of upadacitinib in patients with Crohn's disease (CD) remain unclear.Aims: This study aimed to evaluate the effectiveness and safety of upadacitinib in a real-world cohort.Methods: From September 2022 to June 2024, all consecutive patients with refractory luminal CD treated with once daily upadacitinib 45 mg in 29 French GETAID centres were retrospectively included. The primary outcome was steroid-free clinical remission (SFCR) at week 12, defined as a Harvey-Bradshaw Index (HBI) of < 4. Clinical response (decrease of ≥ 3 points in HBI and/or HBI < 4), clinical remission, biomarker remission, endoscopic and/or radiologic response and safety were also assessed.Results: Among the 223 patients included, all were previously exposed to at least one biologic (median 4, IQR [3, 4]) and 119 (53.8%) had prior intestinal resection. At week 12, SFCR was achieved in 107/197 (54%), clinical response in 129/197 (65%) and clinical remission in 111/197 (56%). A total of, 90 out of 173 (52%) achieved biomarker remission. Endoscopic and/or radiologic response was observed in 18/38 (47%) patients. Clinical response of extraintestinal manifestations was observed in 37/47 (79%) patients and clinical remission in 29/47 (62%). A total of, 65 adverse events (AEs) occurred in 58 patients (26%), including 17 serious AEs, 16 disease exacerbation and one case of colonic EBV-associated lymphoproliferative disorder. Acne was reported in 24/223 (11%) patients.Conclusion: In this real-world cohort of highly refractory CD patients, upadacitinib induction resulted in a clinical response in about two-thirds of patients and in SFCR in half of the patients, with an acceptable safety profile
Long-Term Efficacy and Safety of Rituximab in Patients With Pemphigus Foliaceus Compared With Pemphigus Vulgaris
No full textInternational audienceNo abstract availabl
Impact of Anesthesia on Electroconvulsive Therapy–Related Impairments in Global Cognitive Function in Patients With Treatment-Resistant Depression
No full textInternational audienceIntroduction Electroconvulsive therapy (ECT) in patients with treatment-resistant depression frequently leads to impairments in global cognitive function. Propofol and etomidate are the 2 most frequently used drugs for anesthetic induction during ECT. However, only few studies compared their differential impact on ECT-related impairments in global cognitive function. Methods We studied retrospectively 75 patients hospitalized at Centre Hospitalier Le Vinatier (Bron, France) who met the DSM-V criteria for major depressive disorder and were treated with bilateral ECT to compare the effects of propofol and etomidate on ECT-related cognitive impairment. Global cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), and symptom severity was assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), both before and after treatment. The primary endpoint of the study was the change in MoCA score. Results We found no significant difference in MoCA score variation between the etomidate and propofol groups. There were also no significant differences in MADRS score variation, responder, remission rate or ECT parameters between the 2 groups (except duration of electroencephalogram crisis). Conclusions In this retrospective study, choice of etomidate or propofol as anesthetic agent had no impact on the adverse effects associated with ECT on global cognitive function in patients with treatment-resistant depression
Atopic dermatitis in the French cohort CONSTANCES ( PreDDA study): Focus on persistence and remission in adulthood
No full textInternational audienc
Déterminants des modalités d'usage de substances chez les patients avec narcolepsie de type 1: une étude comparative transversale multicentrique
No full textInternational audienceIn this multi-center cross-sectional study, we compared substance use patterns (SUPs) between patients with narcolepsy type 1 (NT1) and controls, and investigated, among patients, factors associated with the consumption of the main psychoactive substances. Methods: Adult patients with NT1 and controls completed questionnaires about tobacco, alcohol, and cannabis use patterns. Unadjusted bivariable then multivariate analyses (adjusted for sex, age, education, family status, and depression) were performed to compare SUPs between controls and patients, and to explore sociodemographic, psycho-behavioral, and clinical determinants of consumptions. Results: We included 235 patients (63.8 % women, 36.4 ± 14.7 years) and 166 controls (69.9 % women, 40.3 ± 14.4 years). Substances co-consumptions were frequent in both groups. Patients with NT1 were more frequently current smokers (32.3 % vs. 20.1 %, p < 0.01) or e-cigarettes users (12.1 % vs 2.4 %, p < 0.001) than controls, while no difference was observed for cannabis use and alcohol misuse. Only the increased likelihood of vaping remained significant in adjusted analysis. Among NT1 patients, smoking was associated with disrupted nighttime sleep (OR[95%CI] = 2.28[1.02-5.12], p < 0.05) and less obesity (OR = 0.24[0.09-0.59], p < 0.05). Alcohol misuse was associated with sleep paralysis (OR = 2.11[1.13-3.91], p < 0.05) and treatments (modafinil: OR = 2.14[1.15-4.01], p < 0.05; sodium oxybate: OR = 0.41[0.17-0.97], p < 0.05). Tobacco and cannabis consumptions were associated with lower physical activity (OR = 0.46 [0.24-0.87], p < 0.05 and OR = 0.25 [0.10-0.66], p < 0.01). Alcohol misuse and cannabis use were associated with rule breaking behaviors (OR = 5.89[1.61-21.60], p < 0.05 and OR = 8.52 [1.79-40.48], p = 0.01). Conclusion: Patients with NT1 do not seem less vulnerable to psychoactive substance use/misuse. Consumptions patterns are associated with multiple dimensions of the disease including sleep-related symptoms, comorbidities, treatments, and psycho-behavioral factors.</div
Enhancing Asleep Deep Brain Stimulation Targeting for Essential Tremor Using Machine Learning: The OPTIVIM Phase 2 Study
No full textInternational audienceBACKGROUND AND OBJECTIVES: Deep brain stimulation (DBS) is an effective treatment of essential tremor, but the optimal target and how to reach it with the best accuracy remain controversial. The OptimDBS algorithm is based on Kernel Ridge Regression and was trained on a database of patients who underwent DBS with optimal postoperative outcomes. Using 3-dimensional T1-weighted MRI as the only input, it calculates the stereotactic coordinates of an effective DBS target for treating tremor. The aim of the study was to evaluate the efficacy and safety of OptimDBS-guided asleep DBS without peroperative clinical and electrophysiological controls in an independent cohort of patients. METHODS: The OPTIVIM study was a prospective, single-arm, multicenter Phase 2 trial. The primary outcome was tremor reduction and improvement in activities of daily living as assessed by the Fahn-Tolosa-Marin scale 3 months after surgery. Secondary outcomes included reduction in tremor amplitude on accelerometry, quality of life (modified Parkinson's Disease Questionnaire-39), ataxia (Scale for the Assessment and Rating of Ataxia), adverse events, and anatomic location of active contacts and the volume of tissue activated, all measured 3 months after surgery. RESULTS: Twenty-two patients from 2 centers were enrolled. Fahn-Tolosa-Marin scores improved by 61.3% (95% CI: 53.7%-68.9%). Accelerometry (mean ± SD) showed a reduction in postural tremor amplitude of 81% ± 56% on the right side and 84% ± 35% on the left side. Modified Parkinson's Disease Questionnaire-39 scores (median [Q1-Q3]) improved by 55% [24.3%-77.8%]. Scale for the Assessment and Rating of Ataxia scores remained stable (median [Q1-Q3], preoperative vs postoperative: 4 [3-6] vs 3 [2-6]). There were no serious adverse events. Active contacts were located in the posterior subthalamic area (59%) or the ventral-intermediate nucleus of the thalamus (20%), with 100% of volume of tissue activated overlapping the ventral-intermediate nucleus of the thalamus or posterior subthalamic area. CONCLUSION: The results of OptimDBS-guided asleep DBS seem to be comparable with those reported in the literature for awake and asleep DBS and ablative techniques. Long-term evaluations with larger cohorts are needed to confirm these results.</div
Carbapenemase-producing Enterobacterales in the hospital water environment: a narrative review
No full textInternational audienceBackground: Carbapenemase-producing Enterobacterales (CPE) have emerged as critical threats to global health. These bacteria are increasingly responsible for challenging outbreaks within hospital settings, leading to increased morbidity and mortality rates. They can be found in hospital water environments, where their presence may pose significant risks for patient acquisition, potentially facilitating transmission through direct and indirect contact.Objectives: This narrative review aimed to summarize current knowledge regarding CPE in the hospital water environment, elucidate their role in patient acquisition, and evaluate effective decontamination strategies.Sources: A comprehensive literature search was conducted using the PubMed database, identifying studies published from inception to July 2025. Additionally, manual reference checks were performed to ensure thorough coverage of relevant literature.Content: CPE are commonly detected in the hospital water environment, particularly in sinks, toilets, and shower drains. Evidence suggests a reciprocal relationship between environmental contamination by CPE and patient acquisition. Various decontamination methods, including chemical and thermal treatments as well as reservoir replacement, have been explored. Although some methods demonstrate efficacy, they often present challenges related to implementation and sustainability.Implications: Addressing CPE in the hospital water environment is crucial for preventing outbreaks and protecting patient safety. Implementing comprehensive infection control measures and environmental cleaning protocols could significantly reduce the risk of CPE transmission, ultimately improving patient outcomes and public health. The findings underscore the need for ongoing research to better understand contamination dynamics and the effectiveness of decontamination strategies