1
|
Athanasakis K, Bala C, Kokkinos A, Simonyi G, Karoliová KH, Basse A, Bogdanovic M, Kang M, Low K, Gras A. The economic burden of obesity in 4 south-eastern European countries associated with obesity-related co-morbidities. BMC Health Serv Res 2024; 24:354. [PMID: 38504302 PMCID: PMC10953276 DOI: 10.1186/s12913-024-10840-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE To provide an assessment of the cost burden of obesity across a spectrum of obesity-related comorbidities (ORCs) for four countries in South-Eastern Europe (SEE). METHODS A micro-costing analysis from the public payer perspective was conducted to estimate direct healthcare costs associated with ten obesity-related comorbidities (ORCs) in Czech Republic, Greece, Hungary, and Romania. A survey was administered to obtain healthcare resource use and unit cost data. Cost estimates were validated by local steering committees which comprised at least one public sector clinician and a panel of independent industry experts. RESULTS Chronic kidney disease and cardiovascular diseases were the costliest ORCs across all 4 countries, where annual cost burden per ORC exceeded 1,500 USD per patient per year. In general, costs were driven by the tertiary care resources allocated to address treatment-related adverse events, disease complications, and associated inpatient procedures. CONCLUSIONS Our findings confirm that the high prevalence of obesity and its comorbidities result in substantial financial burden to all 4 SEE public payers. By quantifying the burden of obesity from a public healthcare perspective, our study aims to support policy efforts that promote health education and promotion in combating obesity in the region.
Collapse
Affiliation(s)
| | - Cornelia Bala
- University of Medicine and Pharmacy Iuliu Hațieganu, Cluj-Napoca, Romania
| | - Alexander Kokkinos
- Medical School of the National, Kapodistrian University of Athens, Athens, Greece
| | - Gabor Simonyi
- St. Imre University Teaching Hospital, Budapest, Hungary
| | | | | | | | | | | | | |
Collapse
|
2
|
Gogas Yavuz D, Akhtar O, Low K, Gras A, Gurser B, Yilmaz ES, Basse A. The Economic Impact of Obesity in Turkey: A Micro-Costing Analysis. Clinicoecon Outcomes Res 2024; 16:123-132. [PMID: 38476579 PMCID: PMC10929251 DOI: 10.2147/ceor.s446560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Background Turkey currently has the highest obesity prevalence among its European counterparts. 32% and 61% of the population live with obesity and overweight, respectively. Overweight and obesity are linked to non-communicable diseases that incur incremental health and economic costs. The significant public health concern warrants an assessment of the cost of obesity. Methods A micro-costing approach from the public payer perspective was conducted to estimate direct healthcare costs associated with ten obesity-related comorbidities (ORCs) in Turkey. Clinical practice guidelines and a systematic literature review informed ORCs and the respective cost categories. This was subsequently validated by a steering committee comprising seven experts. Seventy public sector physicians were surveyed to estimate healthcare resource use. Unit costs were derived from Social Security Institute's Healthcare Implementation Communique. Cost items were summed to determine the annual cost per patient per ORC, which was validated by the steering committee. Medical inflation was considered in a scenario analysis that varied resource unit costs. Results Chronic kidney disease, heart failure and type 2 diabetes are the costliest ORCs, incurring an annual cost of 28,600 TRY, 16,639 TRY and 11,993 TRY, respectively. Individuals in Turkey with any ORC triggered direct healthcare costs ranging 1857-28,600 TRY annually. Costs were driven by tertiary care resources arising from treatment-related adverse events, disease complications and inpatient procedures. In the scenario analysis, medical resource unit costs were inflated by 18.7% and 39.4%, triggering an average increase in cost across all ORCs of 1998 TRY and 4210 TRY, respectively. Conclusion Our findings confirm that obesity and its complications result in significant financial burden to the public healthcare system. By quantifying the burden of obesity across a comprehensive spectrum of ORCs, our study aims to support the economic case for investing in appropriate obesity interventions.
Collapse
Affiliation(s)
- Dilek Gogas Yavuz
- School of Medicine, Marmara University, Section of Endocrinology and Metabolism, Istanbul, Turkey
| | | | - Kaywei Low
- Healthcare Market Access, Ipsos, Singapore
| | | | | | | | - Amaury Basse
- Novo Nordisk, Novo Nordisk Region South East Europe, Middle East & Africa, Zurich, Switzerland
| |
Collapse
|
3
|
Pandji IF, Hardianti MS, Tubagus AD, Wibawa R, Hogg L, Tan KM, Gras A. Physician Perceptions of the Clinical, Economic and Humanistic Burden of Disease and Unmet Needs in Myelofibrosis: Preliminary Findings from the MPN Landmark Survey in Indonesia. Asian Pac J Cancer Prev 2023; 24:2837-2843. [PMID: 37642072 PMCID: PMC10685220 DOI: 10.31557/apjcp.2023.24.8.2837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
Background/ Objective: Myelofibrosis (MF) is a severe form of Myeloproliferative Neoplasms (MPNs). It is a rare disease in Indonesia and is reportedly associated with symptoms resulting in poor quality-of-life, pre-mature mortality, disability, and loss of productivity. As the disease is rare, there are limited published information around MF, particularly in Indonesia. METHODS A cross-sectional survey was designed and administered between November and December 2021 among practicing Haematologists-Medical Oncologists who are experienced in treating patients with MF. The objectives of the survey were to assess physician's understanding of the overall diagnosis of MF, the disease burden, current treatment practices and remaining unmet needs. Outcomes were analysed descriptively. RESULT The survey was completed by 30 respondents. The findings suggest that symptom burden is high and has a significant negative impact on quality-of-life. Treatment burden is also high which can result in high healthcare resource utilisation. Physicians expressed need for novel therapeutic options and improved access and coverage for such options. There is also a need to improve access and coverage for JAK V617F testing locally and local hospital infrastructures should be upgraded to ensure MF is accurately diagnosed. Patient may benefit from information on MPN, which may result in earlier presentation, diagnosis and treatment which can improve outcomes. CONCLUSION The findings align with previous international research reporting that symptoms and treatment burden are high, and that novel therapeutic options are needed. Additional patient research might be required to better understand the patient experience of MF and how this can be improved.
Collapse
Affiliation(s)
- Irani Fianza Pandji
- Department of Internal Medicine, Faculty of Medicine, Division of Hematology, Medical Oncology, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, West Java, Indonesia.
| | - Mardiah Suci Hardianti
- Division of Hematology, Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Special Region of Yogyakarta, Indonesia.
| | - Atmakusuma Djumhana Tubagus
- Department of Internal Medicine, Hematology and Medical Oncology Division, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Hospital, Jakarta, Indonesia.
| | | | | | | | | |
Collapse
|
4
|
Al-Sabah S, ElShamy A, Jois S, Low K, Gras A, Gulnar EP. The economic impact of obesity in Kuwait: a micro-costing study evaluating the burden of obesity-related comorbidities. J Med Econ 2023; 26:1368-1376. [PMID: 37853705 DOI: 10.1080/13696998.2023.2265721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/28/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE 44% of Kuwait's population live with obesity and the health consequences place a significant burden on the public health system. This study provides an assessment of the cost burden of obesity-related comorbidities (ORC). METHODS A retrospective micro-costing analysis was conducted to quantify the direct cost associated with ORCs. ORCs and their cost categories were informed by a systematic literature review and validated by a local steering committee comprising three experts. Seventy public sector clinicians and eight hospital procurement staff were surveyed to provide healthcare resource utilization estimates and medical resource cost data, respectively. The annual cost of each ORC and the cost drivers were also validated by the steering committee. RESULTS Individuals in Kuwait with any single ORC incurred direct healthcare costs ranging 1,748-4,205 KWD annually. Asthma, chronic kidney disease and type 2 diabetes were the costliest ORCs, incurring an annual cost that exceeds 3,500 KWD per patient. Hypertension, angina and atrial fibrillation were the least costly ORCs. In general, costs were driven by drug costs and resources allocated to address treatment-related adverse events. LIMITATIONS In the absence of an official patient registry in Kuwait, our study provides a conservative estimate of direct costs derived from a nationwide survey. Additionally, the cost estimates in this study assumes that a patient with obesity will only experience one ORC. In reality, multi-morbid states may incur additional costs that are not currently captured. CONCLUSIONS Our study confirms that ORCs generate a significant financial burden to the public payer. The study provides an economic case for policymakers to recognize the exigency for obesity prevention and control in accordance with the ORC prevalence, and the need for sustainable investments towards body-mass index management to prevent individuals from developing multiple comorbidities.
Collapse
Affiliation(s)
- Salman Al-Sabah
- Department of Surgery, School of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Sharanya Jois
- Healthcare Market Access & HEOR, Ipsos Pte Ltd, Singapore, Singapore
| | - Kaywei Low
- Healthcare Market Access & HEOR, Ipsos Pte Ltd, Singapore, Singapore
| | - Adrien Gras
- Healthcare Market Access & HEOR, Ipsos Pte Ltd, Singapore, Singapore
| | | |
Collapse
|
5
|
Scholly J, Gras A, Guye M, Bilger M, Valenti Hirsch MP, Hirsch E, Timofeev A, Vidailhet P, Bénar CG, Bartolomei F. Connectivity Alterations in Emotional and Cognitive Networks During a Manic State Induced by Direct Electrical Stimulation. Brain Topogr 2022; 35:627-635. [PMID: 36071370 DOI: 10.1007/s10548-022-00913-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 08/27/2022] [Indexed: 11/28/2022]
Abstract
Mania is characterized by affective and cognitive alterations, with heightened external and self-awareness that are opposite to the alteration of awareness during epileptic seizures. Electrical stimulations carried out routinely during stereotactic intracerebral EEG (SEEG) recordings for presurgical evaluation of epilepsy may represent a unique opportunity to study the pathophysiology of such complex emotional-behavioral phenomenon, particularly difficult to reproduce in experimental setting. We investigated SEEG signals-based functional connectivity between different brain regions involved in emotions and in consciousness processing during a manic state induced by electrical stimulation in a patient with drug-resistant focal epilepsy. The stimulation inducing manic state and an asymptomatic stimulation of the same site, as well as a seizure with alteration of awareness (AOA) were analyzed. Functional connectivity analysis was performed by measuring interdependencies (nonlinear regression analysis based on the h2 coefficient) between broadband SEEG signals and within typical sub-bands, before and after stimulation, or before and during the seizure with AOA, respectively. Stimulation of the right lateral prefrontal cortex induced a manic state lasting several hours. Its onset was associated with significant increase of broadband-signal functional coupling between the right hemispheric limbic nodes, the temporal pole and the claustrum, whereas significant decorrelation between the right lateral prefrontal and the anterior cingulate cortex was observed in theta-band. In contrast, ictal alteration of awareness was associated with increased broadband and sub-bands synchronization within and between the internal and external awareness networks, including the anterior and middle cingulate, the mesial and lateral prefrontal, the inferior parietal and the temporopolar cortex. Our data suggest the existence of network- and frequency-specific functional connectivity patterns during manic state. A transient desynchronization of theta activity between the external and internal awareness network hubs is likely to increase awareness, with potential therapeutic effect.
Collapse
Affiliation(s)
- Julia Scholly
- Service d'Epileptologie et de Rythmololgie Cérébrale, Hôpital Timone, AP-HM, Marseille, France. .,Aix Marseille Univ, CNRS, CRMBM, Marseille, France. .,Service d'Epileptologie et Rythmologie Cérébrale, Hôpital Timone, AP-HM, 264 Rue St Pierre, 13005, Marseille, France.
| | - Adrien Gras
- Consultation-Liaison Psychiatry Unit, University Hospital of Strasbourg, Strasbourg, France
| | - Maxime Guye
- Service d'Epileptologie et de Rythmololgie Cérébrale, Hôpital Timone, AP-HM, Marseille, France.,Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | - Mathias Bilger
- Medical and Surgical Epilepsy Unit, University Hospital of Strasbourg, Strasbourg, France
| | | | - Edouard Hirsch
- Medical and Surgical Epilepsy Unit, University Hospital of Strasbourg, Strasbourg, France
| | - Alexander Timofeev
- Medical and Surgical Epilepsy Unit, University Hospital of Strasbourg, Strasbourg, France
| | - Pierre Vidailhet
- Consultation-Liaison Psychiatry Unit, University Hospital of Strasbourg, Strasbourg, France
| | - Christian G Bénar
- Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| | - Fabrice Bartolomei
- Service d'Epileptologie et de Rythmololgie Cérébrale, Hôpital Timone, AP-HM, Marseille, France.,Aix Marseille Univ, INSERM, INS, Inst Neurosci Syst, Marseille, France
| |
Collapse
|
6
|
Wu T, Arrivault D, Duruflé M, Gras A, Binkowski F, Burger S, Yan W, Lalanne P. Efficient hybrid method for the modal analysis of optical microcavities and nanoresonators. J Opt Soc Am A Opt Image Sci Vis 2021; 38:1224-1231. [PMID: 34613317 DOI: 10.1364/josaa.428224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
We propose a novel hybrid method for accurately and efficiently analyzing microcavities and nanoresonators. The method combines the marked spirit of quasinormal mode expansion approaches, e.g., analyticity and physical insight, with the renowned strengths of real-frequency simulations, e.g., accuracy and flexibility. Real- and complex-frequency simulations offer a complementarity between accuracy and computation speed, opening new perspectives for challenging inverse design of nanoresonators.
Collapse
|
7
|
Gras A, Wardrope A, Hirsch E, Asadi Pooya AA, Duncan R, Gigineishvili D, Hingray C, Kanemoto K, Ladino L, LaFrance WC, McGonigal A, Pretorius C, Valenti Hirsch P, Vidailhet P, Zhou D, Reuber M. Use of suggestive seizure manipulation methods in the investigation of patients with possible psychogenic nonepileptic seizures-An international ILAE survey. Epilepsia Open 2021; 6:472-482. [PMID: 34288577 PMCID: PMC8408588 DOI: 10.1002/epi4.12521] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 02/05/2023] Open
Abstract
Video‐encephalographic (vEEG) seizure recordings make essential contributions to the differentiation of epilepsy and psychogenic nonepileptic seizures (PNES). The yield of vEEG examinations can be increased through suggestive seizure manipulation (SSM) (ie, activation/provocation/cessation procedures), but its use has raised ethical concerns. In preparation for guidelines on the investigation of patients with PNES, the ILAE PNES Task Force carried out an international survey to investigate practices of and opinions about SSM. An online questionnaire was developed by the ILAE PNES Task Force. Questions were asked at clinical unit or individual respondent level. All ILAE chapters were encouraged to send questionnaires to their members. The survey was open from July 1, 2019, to August 31, 2019. A total of 487 clinicians from 411 units across 94 countries responded. Some form of SSM was used in 296/411 units (72.0%). Over 90% reported the use of verbal suggestion, over 80% the use of activation procedures also capable of eliciting epileptic activity (hyperventilation or photic stimulation). Only 26.3% of units used techniques specifically intended to provoke PNES (eg, saline injection). Fewer than 10% of units had established protocols for SSM, only 20% of units required written patient consent, in 12.2% of units patients received explicitly false information to provoke seizures. Clinicians using SSM tended to perceive no ethical problems, whereas those not using SSM were likely to have ethical concerns about these methods. We conclude that the use of invasive nocebo techniques intended to provoke PNES in diagnostic settings has declined, but SSM is commonly combined with activation procedures also capable of eliciting epileptic activity. While research suggests that openness about the use of PNES‐specific nocebo techniques does not reduce diagnostic yield, very few units have suggestion protocols or seek patient consent. This could be addressed through establishing consensus guidance for the practice of SSM.
Collapse
Affiliation(s)
- Adrien Gras
- Liaison Psychiatry Unit, 1 Place de l'Hopital, University Hospitals Strasbourg, Strasbourg, France
| | - Alistair Wardrope
- Academic Neurology Unit, Royal Hallamshire Hospital, The University of Sheffield, Sheffield, UK.,Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Edouard Hirsch
- Liaison Psychiatry Unit, 1 Place de l'Hopital, University Hospitals Strasbourg, Strasbourg, France.,Epilepsy Unit "Francis Rohmer", INSERM Federation de Médecine Translationelle, CHU-University Strasbourg, Strasbourg, France
| | - Ali A Asadi Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rod Duncan
- Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - David Gigineishvili
- Department of Neurology and Neurosurgery, Sarajashvili Institute of Neurology, Tbilisi State University, Tbilisi, Georgia
| | | | | | - Lady Ladino
- Neurology Section, Epilepsy Program, Hospital Pablo Tobon Uribe, Medellin, Colombia.,Universidad de Antioquia, Medellin, Colombia
| | - William Curt LaFrance
- Neuropsychiatry and Behavioral Neurology, Rhode Island Hospital, Providence, RI, USA.,Neurology and Psychiatry, Brown University, Providence, RI, USA
| | - Aileen McGonigal
- Clinical Neurophysiology and Epileptology Department, Hospital Timone, Marseille, France.,Institut de Neurosciences des Systèmes, Aix-Marseille Universite, Marseille, France
| | - Chrisma Pretorius
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | | | - Pierre Vidailhet
- Liaison Psychiatry Unit, 1 Place de l'Hopital, University Hospitals Strasbourg, Strasbourg, France.,Fédèration de Medecine Translationelle, Université de Strasbourg, Strasbourg, France
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University West China Hospital, Chengdu, China
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, The University of Sheffield, Sheffield, UK.,Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| |
Collapse
|
8
|
Scherlinger M, Felten R, Gallais F, Nazon C, Chatelus E, Pijnenburg L, Mengin A, Gras A, Vidailhet P, Arnould-Michel R, Bibi-Triki S, Carapito R, Trouillet-Assant S, Perret M, Belot A, Bahram S, Arnaud L, Gottenberg JE, Fafi-Kremer S, Sibilia J. Refining "Long-COVID" by a Prospective Multimodal Evaluation of Patients with Long-Term Symptoms Attributed to SARS-CoV-2 Infection. Infect Dis Ther 2021; 10:1747-1763. [PMID: 34245450 PMCID: PMC8270770 DOI: 10.1007/s40121-021-00484-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction COVID-19 long-haulers, also decribed as having “long-COVID” or post-acute COVID-19 syndrome, represent 10% of COVID-19 patients and remain understudied. Methods In this prospective study, we recruited 30 consecutive patients seeking medical help for persistent symptoms (> 30 days) attributed to COVID-19. All reported a viral illness compatible with COVID-19. The patients underwent a multi-modal evaluation, including clinical, psychologic, virologic and specific immunologic assays and were followed longitudinally. A group of 17 convalescent COVID-19 individuals without persistent symptoms were included as a comparison group. Results The median age was 40 [interquartile range: 35–54] years and 18 (60%) were female. At a median time of 152 [102–164] days after symptom onset, fever, cough and dyspnea were less frequently reported compared with the initial presentation, but paresthesia and burning pain emerged in 18 (60%) and 13 (43%) patients, respectively. The clinical examination was unremarkable in all patients, although the median fatigue and pain visual analog scales were 7 [5–8] and 5 [2–6], respectively. Extensive biologic studies were unremarkable, and multiplex cytokines and ultra-sensitive interferon-α2 measurements were similar between long-haulers and convalescent COVID-19 individuals without persistent symptoms. Using SARS-CoV-2 serology and IFN-γ ELISPOT, we found evidence of a previous SARS-CoV-2 infection in 50% (15/30) of patients, with evidence of a lack of immune response, or a waning immune response, in two patients. Finally, psychiatric evaluation showed that 11 (36.7%), 13 (43.3%) and 9 (30%) patients had a positive screening for anxiety, depression and post-traumatic stress disorder, respectively. Conclusions Half of patients seeking medical help for post-acute COVID-19 syndrome lack SARS-CoV-2 immunity. The presence of SARS-CoV-2 immunity, or not, had no consequence on the clinical or biologic characteristics of post-acute COVID-19 syndrome patients, all of whom reported severe fatigue, altered quality of life and psychologic distress. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00484-w.
Collapse
Affiliation(s)
- Marc Scherlinger
- Rheumatology Department, Centre Hospitalier Universitaire de Strasbourg, 1 Avenue Molière, 67098, Strasbourg, France. .,Centre National de Référence Des Maladies Auto-Immunes Et Systémiques Rares, Est/Sud-Ouest (RESO), Service de Rhumatologie du CHU de Strasbourg, 1 Avenue Molière, 67200, Strasbourg Cedex, France.
| | - Renaud Felten
- Rheumatology Department, Centre Hospitalier Universitaire de Strasbourg, 1 Avenue Molière, 67098, Strasbourg, France.,Centre National de Référence Des Maladies Auto-Immunes Et Systémiques Rares, Est/Sud-Ouest (RESO), Service de Rhumatologie du CHU de Strasbourg, 1 Avenue Molière, 67200, Strasbourg Cedex, France
| | - Floriane Gallais
- Virology Diagnostic Laboratory, Centre Hospitalier Universitaire de Strasbourg, 3 Rue Koeberlé, 67000, Strasbourg, France
| | - Charlotte Nazon
- Virology Diagnostic Laboratory, Centre Hospitalier Universitaire de Strasbourg, 3 Rue Koeberlé, 67000, Strasbourg, France
| | - Emmanuel Chatelus
- Rheumatology Department, Centre Hospitalier Universitaire de Strasbourg, 1 Avenue Molière, 67098, Strasbourg, France.,Centre National de Référence Des Maladies Auto-Immunes Et Systémiques Rares, Est/Sud-Ouest (RESO), Service de Rhumatologie du CHU de Strasbourg, 1 Avenue Molière, 67200, Strasbourg Cedex, France
| | - Luc Pijnenburg
- Rheumatology Department, Centre Hospitalier Universitaire de Strasbourg, 1 Avenue Molière, 67098, Strasbourg, France.,Centre National de Référence Des Maladies Auto-Immunes Et Systémiques Rares, Est/Sud-Ouest (RESO), Service de Rhumatologie du CHU de Strasbourg, 1 Avenue Molière, 67200, Strasbourg Cedex, France
| | - Amaury Mengin
- Centre Hospitalier Universitaire de Strasbourg, 1 Avenue Molière, 67098, Strasbourg, France
| | - Adrien Gras
- Centre Hospitalier Universitaire de Strasbourg, 1 Avenue Molière, 67098, Strasbourg, France
| | - Pierre Vidailhet
- Centre Hospitalier Universitaire de Strasbourg, 1 Avenue Molière, 67098, Strasbourg, France
| | - Rachel Arnould-Michel
- Rheumatology Department, Centre Hospitalier Universitaire de Strasbourg, 1 Avenue Molière, 67098, Strasbourg, France.,Centre National de Référence Des Maladies Auto-Immunes Et Systémiques Rares, Est/Sud-Ouest (RESO), Service de Rhumatologie du CHU de Strasbourg, 1 Avenue Molière, 67200, Strasbourg Cedex, France
| | - Sabrina Bibi-Triki
- Laboratoire D'ImmunoRhumatologie Moléculaire, Institut National de La Santé Et de La Recherche Médicale (INSERM) UMR_S 1109, Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Raphaël Carapito
- Laboratoire D'ImmunoRhumatologie Moléculaire, Institut National de La Santé Et de La Recherche Médicale (INSERM) UMR_S 1109, Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Sophie Trouillet-Assant
- National Reference Centre for Rare Rheumatic and AutoImmune Diseases in childrEn RAISE, Hospices Civils de Lyon, CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 69007, Lyon, France
| | - Magali Perret
- National Reference Centre for Rare Rheumatic and AutoImmune Diseases in childrEn RAISE, Hospices Civils de Lyon, CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 69007, Lyon, France
| | - Alexandre Belot
- National Reference Centre for Rare Rheumatic and AutoImmune Diseases in childrEn RAISE, Hospices Civils de Lyon, CIRI, Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, 69007, Lyon, France
| | - Seiamak Bahram
- Laboratoire D'ImmunoRhumatologie Moléculaire, Institut National de La Santé Et de La Recherche Médicale (INSERM) UMR_S 1109, Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Laurent Arnaud
- Rheumatology Department, Centre Hospitalier Universitaire de Strasbourg, 1 Avenue Molière, 67098, Strasbourg, France.,Centre National de Référence Des Maladies Auto-Immunes Et Systémiques Rares, Est/Sud-Ouest (RESO), Service de Rhumatologie du CHU de Strasbourg, 1 Avenue Molière, 67200, Strasbourg Cedex, France.,Laboratoire D'ImmunoRhumatologie Moléculaire, Institut National de La Santé Et de La Recherche Médicale (INSERM) UMR_S 1109, Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Jacques-Eric Gottenberg
- Rheumatology Department, Centre Hospitalier Universitaire de Strasbourg, 1 Avenue Molière, 67098, Strasbourg, France.,Centre National de Référence Des Maladies Auto-Immunes Et Systémiques Rares, Est/Sud-Ouest (RESO), Service de Rhumatologie du CHU de Strasbourg, 1 Avenue Molière, 67200, Strasbourg Cedex, France.,IBMC, UPR3572, CNRS, Strasbourg, France
| | - Samira Fafi-Kremer
- Virology Diagnostic Laboratory, Centre Hospitalier Universitaire de Strasbourg, 3 Rue Koeberlé, 67000, Strasbourg, France.,Laboratoire D'ImmunoRhumatologie Moléculaire, Institut National de La Santé Et de La Recherche Médicale (INSERM) UMR_S 1109, Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Jean Sibilia
- Rheumatology Department, Centre Hospitalier Universitaire de Strasbourg, 1 Avenue Molière, 67098, Strasbourg, France. .,Centre National de Référence Des Maladies Auto-Immunes Et Systémiques Rares, Est/Sud-Ouest (RESO), Service de Rhumatologie du CHU de Strasbourg, 1 Avenue Molière, 67200, Strasbourg Cedex, France. .,Laboratoire D'ImmunoRhumatologie Moléculaire, Institut National de La Santé Et de La Recherche Médicale (INSERM) UMR_S 1109, Institut Thématique Interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.
| |
Collapse
|
9
|
Rolling J, Mengin AC, Palacio C, Mastelli D, Fath M, Gras A, Von Hunolstein JJ, Schröder CM, Vidailhet P. COVID-19: Mental Health Prevention and Care for Healthcare Professionals. Front Psychiatry 2021; 12:566740. [PMID: 33833696 PMCID: PMC8021721 DOI: 10.3389/fpsyt.2021.566740] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic exposed health professionals to high stress levels inducing significant psychological impact. Our region, Grand Est, was the most impacted French region during the first COVID-19 wave. In this context, we created CoviPsyHUS, local mental health prevention and care system dedicated explicitly to healthcare workers affected by the COVID-19 pandemic in one of this region's tertiary hospitals. We deployed CoviPsyHUS gradually in 1 month. To date, CoviPsyHUS comprises 60 mental health professionals dedicated to 4 complementary components: (i) a mental health support hotline (170 calls), (ii) relaxation rooms (used by 2,120 healthcare workers with 110 therapeutic workshops offered), (iii) mobile teams (1,200 contacts with healthcare staff), and (iv) a section dedicated to patients and their families. Among the critical points to integrate mental health care system during a crisis, we identified: (i) massive dissemination of mental health support information with multimodal communication, (ii) clear identification of the mental health support system, (iii) proactive mobile teams to identify healthcare professionals in difficulty, (iv) concrete measures to relieve the healthcare professionals under pressure (e.g., the relay in communication with families), (v) support for primary needs (body care (physiotherapy), advice and first-line therapy for sleep disorders), and (vi) psychoeducation and emotion management techniques. The different components of CoviPsyHUS are vital elements in meeting the needs of caregivers in situations of continuous stress. The organization of 4 targeted, modular, and rapidly deployable components makes CoviPsyHUS an innovative, reactive, and replicable mental health prevention and care system that could serve as a universal support model for other COVID-19 affected teams or other exceptional health crises in the future.
Collapse
Affiliation(s)
- Julie Rolling
- Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, Strasbourg, France.,Medico-Psychological Emergency Unit, Strasbourg University Hospital, Strasbourg, France.,Department of Psychiatry, Mental Health and Addictology, Strasbourg University Hospital, Strasbourg, France.,CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
| | - Amaury C Mengin
- Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, Strasbourg, France.,Department of Psychiatry, Mental Health and Addictology, Strasbourg University Hospital, Strasbourg, France.,INSERM U1114, Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, Strasbourg, France
| | - Cédric Palacio
- Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, Strasbourg, France.,Medico-Psychological Emergency Unit, Strasbourg University Hospital, Strasbourg, France.,Department of Psychiatry, Mental Health and Addictology, Strasbourg University Hospital, Strasbourg, France
| | - Dominique Mastelli
- Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, Strasbourg, France.,Medico-Psychological Emergency Unit, Strasbourg University Hospital, Strasbourg, France.,Department of Psychiatry, Mental Health and Addictology, Strasbourg University Hospital, Strasbourg, France
| | - Morgane Fath
- Department of Psychiatry, Mental Health and Addictology, Strasbourg University Hospital, Strasbourg, France
| | - Adrien Gras
- Department of Psychiatry, Mental Health and Addictology, Strasbourg University Hospital, Strasbourg, France
| | | | - Carmen M Schröder
- Department of Psychiatry, Mental Health and Addictology, Strasbourg University Hospital, Strasbourg, France.,CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France.,Federation of Translational Medicine of Strasbourg, Strasbourg, France
| | - Pierre Vidailhet
- Regional Center for Psychotraumatism Great East, Strasbourg University Hospital, Strasbourg, France.,Medico-Psychological Emergency Unit, Strasbourg University Hospital, Strasbourg, France.,Department of Psychiatry, Mental Health and Addictology, Strasbourg University Hospital, Strasbourg, France.,INSERM U1114, Cognitive Neuropsychology, and Pathophysiology of Schizophrenia, Strasbourg, France.,Federation of Translational Medicine of Strasbourg, Strasbourg, France
| |
Collapse
|
10
|
Markoula S, Liampas A, Rubboli G, Duncan J, Velis DN, Schulze-Bonhage A, Guekht A, Bartholomeyczik K, Tisi JD, Gras A, Lossius MI, Villani F, Staack AM, Hospes A, Baaijen JC, van Straaten ECW, Ronner HE, Casciato S, D'Aniello A, Mascia A, Santos SF, Bentes C, Aledo-Serrano Á, Gil-Nagel A, Dimova P, Hećimović H, Özkara Ç, Malmgren K, Papacostas S, Kelemen A, Reuber M, Trinka E, Ryvlin P. A European questionnaire survey on epilepsy monitoring units' current practice for postoperative psychogenic nonepileptic seizures' detection. Epilepsy Behav 2020; 112:107355. [PMID: 32745960 DOI: 10.1016/j.yebeh.2020.107355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In cases undergoing epilepsy surgery, postoperative psychogenic nonepileptic seizures (PNES) may be underdiagnosed complicating the assessment of postsurgical seizures' outcome and the clinical management. We conducted a survey to investigate the current practices in the European epilepsy monitoring units (EMUs) and the data that EMUs could provide to retrospectively detect cases with postoperative PNES and to assess the feasibility of a subsequent postoperative PNES research project for cases with postoperative PNES. METHODS We developed and distributed a questionnaire survey to 57 EMUs. Questions addressed the number of patients undergoing epilepsy surgery, the performance of systematic preoperative and postoperative psychiatric evaluation, the recording of sexual or other abuse, the follow-up period of patients undergoing epilepsy surgery, the performance of video-electroencephalogram (EEG) and postoperative psychiatric assessment in suspected postoperative cases with PNES, the existence of electronic databases to allow extraction of cases with postoperative PNES, the data that these bases could provide, and EMUs' interest to participate in a retrospective postoperative PNES project. RESULTS Twenty EMUs completed the questionnaire sheet. The number of patients operated every year/per center is 26.7 ( ± 19.1), and systematic preoperative and postoperative psychiatric evaluation is performed in 75% and 50% of the EMUs accordingly. Sexual or other abuse is systematically recorded in one-third of the centers, and the mean follow-up period after epilepsy surgery is 10.5 ± 7.5 years. In suspected postoperative PNES, video-EEG is performed in 85% and psychiatric assessment in 95% of the centers. An electronic database to allow extraction of patients with PNES after epilepsy surgery is used in 75% of the EMUs, and all EMUs that sent the sheet completed expressed their interest to participate in a retrospective postoperative PNES project. CONCLUSION Postoperative PNES is an underestimated and not well-studied entity. This is a European survey to assess the type of data that the EMUs surgical cohorts could provide to retrospectively detect postoperative PNES. In cases with suspected PNES, most EMUs perform video-EEG and psychiatric assessment, and most EMUs use an electronic database to allow extraction of patients developing PNES.
Collapse
Affiliation(s)
- Sofia Markoula
- Department of Neurology, University Hospital of Ioannina, Ioannina, Greece
| | - Andreas Liampas
- Department of Neurology, University Hospital of Ioannina, Ioannina, Greece.
| | - Guido Rubboli
- Adult Department, Danish Epilepsy Center, Epilepsihospitalet, Dianalund, Denmark
| | - John Duncan
- UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, London, United Kingdom
| | - Demetrios N Velis
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | | | - Alla Guekht
- Moscow Research and Clinical Center for Neuriopsychiatry, Russian National Research Medical University, Moscow, Russia
| | | | - Jane de Tisi
- UCL Queen Square Institute of Neurology, Department of Clinical and Experimental Epilepsy, London, United Kingdom
| | - Adrien Gras
- Psychiatry Department, Strasbourg University Hospital, Strasbourg, France
| | | | - Flavio Villani
- Division of Clinical Epileptology and Experimental Neurophysiology, "Carlo Besta" Neurological Institute Foundation, Milan, Italy
| | | | - Annette Hospes
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | - Johannes C Baaijen
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | - Elisabeth C W van Straaten
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | - Hanneke E Ronner
- Department of Neurology, Department of Clinical Neurophysiology and MEG, VU University Medical Center, Amsterdam, Netherlands
| | - Sara Casciato
- Epilepsy Surgery Centre, IRCCS NEUROMED, Pozzilli, Italy
| | | | | | - Susana Ferrao Santos
- Refractory Epilepsy Centre at Cliniquesuniversitaires Saint-Luc, University Hospital, Brussels, Belgium
| | - Carla Bentes
- EEG/Sleep Laboratory, Department of Neurosciences, Hospital de Santa Maria - CHLN, University Hospital, Lisbon, Portugal
| | - Ángel Aledo-Serrano
- Department of Neurology, Hospital Ruber Internacional & Hospital La Luz, Madrid, Spain
| | - Antonio Gil-Nagel
- Department of Neurology, Hospital Ruber Internacional & Hospital La Luz, Madrid, Spain
| | - Petia Dimova
- Epilepsy Surgery Center, Department of Neurosurgery, St. Ivan Rilski University Hospital, Sofia, Bulgaria
| | - Hrvoje Hećimović
- Epilepsy Center, Department of Neurology, University Hospital, Zagreb, Croatia
| | - Çiğdem Özkara
- Department of Neurology, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Kristina Malmgren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Gothenburg University, Göteborg, Sweden
| | - Savvas Papacostas
- Department of Neurology Clinic B, The Cyprus Institute of Neurology & Genetics, Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Anna Kelemen
- National Institute of Psychiatry and Neurology, Department of Neurology, University of Pécs, Budapest, Hungary
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield, United Kingdom
| | - Eugen Trinka
- Paracelsus Medical University Salzburg, Department of Neurology, Christian Doppler University Hospital, Salzburg, Austria
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| |
Collapse
|
11
|
Oo M, Chen S, Akhtar O, Gras A. PCN75 Characterization of Oncology Managed Entry Agreements (MEA) in APAC and Assessment of Payer Considerations. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
12
|
Gras A, Lalanne P, Duruflé M. Nonuniqueness of the quasinormal mode expansion of electromagnetic Lorentz dispersive materials. J Opt Soc Am A Opt Image Sci Vis 2020; 37:1219-1228. [PMID: 32609681 DOI: 10.1364/josaa.394206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/06/2020] [Indexed: 06/11/2023]
Abstract
Any optical structure possesses resonance modes, and its response to an excitation can be decomposed onto the quasinormal and numerical modes of a discretized Maxwell operator. In this paper, we consider a dielectric permittivity that is an N-pole Lorentz function of the frequency. Even for discretized operators, the literature proposes different formulas for the coefficients of the quasinormal-mode expansion, and this comes as a surprise. We propose a general formalism, based on auxiliary fields, which explains why and evidences that there is, in fact, an infinity of mathematically sound possible expansion coefficients. The nonuniqueness is due to a choice of the linearization of Maxwell's equations with respect to frequency and of the choice of the form of the source term. Numerical results validate the different formulas and compare their accuracy.
Collapse
|
13
|
Lalanne P, Yan W, Gras A, Sauvan C, Hugonin JP, Besbes M, Demésy G, Truong MD, Gralak B, Zolla F, Nicolet A, Binkowski F, Zschiedrich L, Burger S, Zimmerling J, Remis R, Urbach P, Liu HT, Weiss T. Quasinormal mode solvers for resonators with dispersive materials. J Opt Soc Am A Opt Image Sci Vis 2019; 36:686-704. [PMID: 31044992 DOI: 10.1364/josaa.36.000686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 02/27/2019] [Indexed: 06/09/2023]
Abstract
Optical resonators are widely used in modern photonics. Their spectral response and temporal dynamics are fundamentally driven by their natural resonances, the so-called quasinormal modes (QNMs), with complex frequencies. For optical resonators made of dispersive materials, the QNM computation requires solving a nonlinear eigenvalue problem. This raises a difficulty that is only scarcely documented in the literature. We review our recent efforts for implementing efficient and accurate QNM solvers for computing and normalizing the QNMs of micro- and nanoresonators made of highly dispersive materials. We benchmark several methods for three geometries, a two-dimensional plasmonic crystal, a two-dimensional metal grating, and a three-dimensional nanopatch antenna on a metal substrate, with the perspective to elaborate standards for the computation of resonance modes.
Collapse
|
14
|
Abstract
Este trabajo presenta una síntesis de la prospección etnobotánica llevada a cabo en la comarca del Ripollès entre los años 2004 y 2013. Mediante entrevistas semiestructuradas con 163 informantes nacidos entre 1915 y 1988, hemos obtenido información sobre nombres y usos populares de 457 táxones (incluyendo especies, subespecies y variedades), 15 de los cuales solamente han sido determinados hasta el nivel de género. Sobre estas plantas, los informantes han referido 7192 reportes de uso. En este artículo incluimos comentarios generales sobre diversos usos (medicinales, alimentarios y de otro tipo) y presentamos, en dos apéndices, el catálogo completo de la etnoflora comarcal.
[ct] Aquest treball presenta una síntesi de la prospecció etnobotànica duta a terme a la comarca del Ripollès entre els anys 2004 i 2013. A través d’entrevistes semiestructurades amb 163 informants nascuts entre 1915 i 1988, hem obtingut informació sobre noms i usos populars de 457 tàxons (comptant-hi espècies, subespècies i varietats), 15 dels quals només han estat determinats fins al nivell de gènere. Sobre aquestes plantes, els informants han fet 7192 reports d’ús. En aquest article fem comentaris generals sobre els diversos usos (medicinals, alimentaris i d’altra mena) i presentem, en dos apèndixs, el catàleg complet de l’etnoflora comarcal.
Collapse
|
15
|
Gras A, Broughton J. A cost-effectiveness model for the use of a cannabis-derived oromucosal spray for the treatment of spasticity in multiple sclerosis. Expert Rev Pharmacoecon Outcomes Res 2016; 16:771-779. [PMID: 26750641 DOI: 10.1586/14737167.2016.1140574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Severity of spasticity in multiple sclerosis (MS) directly correlates with the level and cost of care required. This study assessed whether a tetrahydrocannabinol/cannabidiol (THC/CBD) oromucosal spray for treatment of moderate-severe MS spasticity is a cost-effective use of healthcare resources in Wales. METHODS A Markov model was developed to compare THC/CBD plus standard of care (SoC) treatments with SoC alone. RESULTS At 30 years, total incremental cost for THC/CBD plus SoC treatment was estimated at £3,836/patient (ICER: £10,891/quality-adjusted life year [QALY]). Hospital admission costs had the greatest effect on the base case ICER. Inclusion of carer cost led to incremental cost of -£33,609/patient (ICER: -£95,423/QALY). CONCLUSIONS The THC/CBD spray was found to be cost-effective for the treatment of spasticity in MS, and dominant, if home carer costs were included. Use of THC/CBD has the potential to generate cost savings by significantly improving the symptoms of moderate to severe MS spasticity.
Collapse
Affiliation(s)
| | - Julie Broughton
- b Health Economics Outcomes Research , Bayer plc , Newbury , UK
| |
Collapse
|
16
|
Stevenson VL, Gras A, Bárdos JI, Broughton J. The high cost of spasticity in multiple sclerosis to individuals and society. Mult Scler 2015; 21:1583-92. [PMID: 25623252 DOI: 10.1177/1352458514566416] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/26/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Spasticity is an extremely common, distressing and disabling symptom of multiple sclerosis. Limited data suggest the associated health care costs correlate with increasing severity and place a high economic burden on individuals, health care systems and society. OBJECTIVE The aim of this study was to quantify the impact of multiple sclerosis spasticity on health care resources and the associated costs at different levels of severity in people with multiple sclerosis in the United Kingdom. METHODS An online survey was carried out to understand the resources used in the management of spasticity in multiple sclerosis. The questionnaire asked health care specialists to estimate their involvement and the resource use associated with different levels of spasticity, and the survey outputs were used to derive the resource costs. RESULTS The level and cost of care substantially increased with the degree of spasticity. Key factors contributing to high annual costs per patient were home care, hospital admissions and high-cost items, such as hospital beds. CONCLUSIONS Based on the survey results, it can be assumed that managing spasticity early and effectively could result in substantial cost savings, in addition to the improvements in health-related quality of life.
Collapse
Affiliation(s)
- V L Stevenson
- The National Hospital for Neurology and Neurosurgery, UCLH NHS Trust, UK
| | - A Gras
- Market Access/Health, GfK, UK
| | | | - J Broughton
- Health Economics Outcomes Research, Bayer plc, UK
| |
Collapse
|
17
|
Gras A. Borderline halluciné, psychiatre perplexe. Eur Psychiatry 2014. [DOI: 10.1016/j.eurpsy.2014.09.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
La présence d’hallucinations chez un patient souffrant d’un trouble de personnalité borderline (TPB), ou état limite, est une situation clinique courante qui peut mettre le psychiatre en difficulté. En effet, l’hallucination n’étant pas reconnue comme un symptôme appartenant au tableau clinique de ce trouble, sa présence pose la question du diagnostic différentiel avec la schizophrénie. Or l’histoire du concept de TPB est celle d’une progressive autonomisation vis-à-vis du groupe des psychoses, passant d’un trouble para-psychotique dans les années 1940 à une troisième voie structurelle, indépendante de la névrose et de la psychose, dans les années 1980. Dès lors, le constat clinique d’hallucinations dans le TPB vient rouvrir un débat de plus de 40 ans sur la place de cette entité au sein de la nosologie psychiatrique. L’étude de la littérature scientifique récente sur ce sujet apporte des éclaircissements. Des hallucinations, essentiellement acoustico-verbales, sont retrouvées chez environ 30 % des patients souffrant de TPB. La plupart d’entre elles sont transitoires, déclenchées par des situations de stress, mais certaines durent plusieurs années. Sur le plan clinique, elles ont les mêmes caractéristiques que les hallucinations retrouvées dans la schizophrénie en termes de fréquence, de durée, de localisation spatiale, de niveau sonore et de contrôlabilité. Les seules différences sémiologiques sont un contenu plus négatifs (voix insultantes) et une détresse plus intense du sujet vis-à-vis de ces phénomènes hallucinatoires. Le terme de « pseudo-hallucinations », souvent utilisé à tord dans cette situation, devrait être abandonné car il disqualifie le vécu des patients et n’est pas cliniquement pertinent. En outre, l’attitude qui consiste à attribuer systématiquement les symptômes hallucinatoires du TPB à une comorbidité (prises de toxiques associées, troubles de l’humeur) n’est pas justifiée au regard de la littérature. Ainsi, dans l’état actuel des connaissances, les hallucinations peuvent être considérées comme un symptôme du TPB.
Collapse
|
18
|
Abstract
INTRODUCTION Hallucinations constitute understudied symptoms in borderline personality disorders (BPD), which can be observed in about 30% of the patients, essentially in the auditory modality. Most of these experiences are transitory, triggered by intermittent stressors, but chronicity remains a major cause of concern. In order to better circumscribe hallucinations in BPD, we summarized the literature on this particular phenomenon. METHODS We conducted a review using Medline, Scopus and Google Scholar databases up to March 2013, using the following keywords combinations: "borderline personality disorder", "hallucinat*" and "psychotic symptoms". Papers were included in the review if they were published in an English or French language peer-reviewed journal; the study enrolled patients with BPD; and the diagnosis was made according to the Diagnostic and Statistical Manual (DSM) criteria. Fifteen studies published between 1985 and 2012, merging a total of 635 patients, were retained. RESULTS The hallucinatory experiences observed in BPD appeared phenomenologically similar to those described in the schizophrenia spectrum in terms of vividness, duration, spatial localization, beliefs about malevolence or omnipotence. Conversely, the hallucinatory content appeared more negative and potentially more distressful. Crucially, this literature search also revealed that these symptoms have long been regarded as "pseudo-hallucinations" (or "hallucination-like symptoms"). This concept was judged of poor scientific validity, inducing stigma for BPD patients in that it casts doubt on the authenticity of these experiences while disqualifying the related distress. This situation points out that research should focus more on understanding hallucinations in BPD than questioning their existence. Interestingly, recent comorbidity studies reopened a 40-year debate on the potential links that may exist between BPD and psychosis. Initially considered as a para-psychotic disorder, BPD was effectively redefined as an independent category by Otto F. Kernberg, leading to the DSM-III definition, excluding any psychotic symptom. However, hallucinations per se remain insufficient to diagnose schizophrenia, while comorbid substance use disorders as well as mood disorders, cannot explain all the hallucination occurrences in BPD. By referring to the "psychotic-reactivity-to-stress" framework, we proposed to understand hallucinations in BPD in relation to a hyperactivity of the hypothalamic-pituitary-adrenal axis and of the dopaminergic system under stress. Childhood trauma may have a central role in such a model. The prevalence of childhood trauma is high in BPD but this factor was also evidenced strongly linked with hallucinations in non-clinical populations. Comparisons are finally made and discussed between hallucinations occurring in BPD and those observed in posttraumatic stress disorder, another frequent comorbid disorder. CONCLUSION Almost a third of patients with BPD experiences hallucinations, and future studies will have to clarify the pathophysiology of this symptom, still poorly understood. Both the models of psychotic-reactivity-to-stress, as well as the role of childhood trauma in the context of a gene X environment interaction, appear to be promising cues for future research.
Collapse
Affiliation(s)
- A Gras
- Université Droit et Santé Lille (UL2), UFR de Médecine, 59045 Lille cedex, France; Pôle de psychiatrie, hôpital Fontan, CHRU de Lille, rue André-Verhaeghe, CS 70001, 59037 Lille cedex, France.
| | - A Amad
- Université Droit et Santé Lille (UL2), UFR de Médecine, 59045 Lille cedex, France; Pôle de psychiatrie, hôpital Fontan, CHRU de Lille, rue André-Verhaeghe, CS 70001, 59037 Lille cedex, France
| | - P Thomas
- Université Droit et Santé Lille (UL2), UFR de Médecine, 59045 Lille cedex, France; Pôle de psychiatrie, hôpital Fontan, CHRU de Lille, rue André-Verhaeghe, CS 70001, 59037 Lille cedex, France
| | - R Jardri
- Université Droit et Santé Lille (UL2), UFR de Médecine, 59045 Lille cedex, France; Pôle de psychiatrie, hôpital Fontan, CHRU de Lille, rue André-Verhaeghe, CS 70001, 59037 Lille cedex, France
| |
Collapse
|
19
|
Singh S, Gras A, Fiez-Vandal C, Martinez M, Wagner R, Byrne B. Screening for high-yielding Pichia pastoris clones: the production of G protein-coupled receptors as a case study. Methods Mol Biol 2012; 866:65-73. [PMID: 22454115 DOI: 10.1007/978-1-61779-770-5_7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Pichia pastoris is an established host for the production of a wide range of recombinant proteins including membrane proteins. The system has a particularly good track record for the production of G protein-coupled receptors (GPCRs). Generation and screening of expression clones with this system use standard molecular biology techniques. Multiple clones can be generated and screened in a matter of a few weeks making this similar to Escherichia coli in terms of speed. In addition, basic buffer components and the lack of expensive equipment make small-scale expression screening in P. pastoris very cost-effective. Here we describe the procedures used for small-scale GPCR production screening.
Collapse
Affiliation(s)
- Shweta Singh
- Division of Molecular Biosciences, Imperial College London, London, UK
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, progressive disease that carries a high socioeconomic burden. Spasticity (rigidity and spasms) is common in MS and a key contributor to MS-related disability. OBJECTIVES This study evaluated the cost-effectiveness of Sativex®, a 9-d-tetrahydrocannabinol/cannabidiol-based oromucosal spray that acts as an endocannabinoid system modulator. Sativex was recently approved for the management of resistant MS spasticity as add-on medication. METHODS A Markov model-based analysis was performed over a 5-year horizon from a German and Spanish healthcare payer perspective. The incremental cost of Sativex was low compared with current spasticity treatments, and provided a quality-adjusted life-year gain over the current standard of care. RESULTS The base-case incremental cost-effectiveness ratio for Sativex was estimated at €11,214/quality-adjusted life-year in Germany, while the drug was the dominant option in Spain, providing savings of €3496/patient over a 5-year period (year of costing: 2010). This was seen because the lower severity of spasticity in patients who had improved led to reduced resource consumption (e.g., physiotherapy and medications). CONCLUSION Despite having a relatively high acquisition cost, Sativex was shown to be a cost-effective treatment option for patients with MS-related spasticity.
Collapse
Affiliation(s)
- John Slof
- Universitat Autònoma de Barcelona, Campus de la UAB, Bellaterra, Spain
| | | |
Collapse
|
21
|
Singh S, Gras A, Fiez-Vandal C, Martinez M, Wagner R, Byrne B. Large-scale production of membrane proteins in Pichia pastoris: the production of G protein-coupled receptors as a case study. Methods Mol Biol 2012; 866:197-207. [PMID: 22454125 DOI: 10.1007/978-1-61779-770-5_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
One of the major advantages of using Pichia pastoris is that it is readily adapted to large-scale culture in bioreactors. Bioreactors allow precise regulation of cell growth parameters increasing both yields and reproducibility of the culture. P. pastoris cultures grow to very high cell densities which helps minimise culture volume and facilitates downstream processing of the sample. Here, we provide protocols for the large-scale production of the human adenosine A(2A) receptor (A(2A)R) and provide some details of how bioreactor cultures can be used for optimisation of expression of the human dopamine D2 receptor (D2DR).
Collapse
Affiliation(s)
- Shweta Singh
- Division of Molecular Biosciences, Imperial College London, London, UK
| | | | | | | | | | | |
Collapse
|
22
|
Besiers C, Chavarin P, Fabrigli P, Benamara H, Rochette S, Gras A, Leyerloup S, Chabre C, Voitellier E, Fressy P, Courbil R, Garraud O. [Evaluation of continuous education in transfusion for professionals in medical blood banks]. Transfus Clin Biol 2011; 18:20-5. [PMID: 21237687 DOI: 10.1016/j.tracli.2010.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Accepted: 12/10/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE STUDY Like every actor in transfusion, staff members practising within blood banks of healthcare establishments have to follow a specific initial training and must frequently update their knowledge in blood transfusion. METHODS To address this need from these professionals, the Établissement français du sang Auvergne-Loire set up training sessions which content regularly evolved according to regulation recommendations. Every cycle consists in a total of 35hours of training, divided in five one-day modules. The comparison of the evaluation questionnaires offered at the beginning and at the end of each day allowed to measure the benefits provided by every module and to compare progress according to the number of modules previously followed. The analysis of satisfaction surveys contributed to improving the education towards a high level of satisfaction of every participant. RESULTS CONCLUSION At the end of its third year of existence, the 35hours education programme permitted to achieve a better level of training for all the staffs and the evolution towards an on-site continuing education format seems to better correspond to the personnel's expectations.
Collapse
Affiliation(s)
- C Besiers
- EFS Auvergne-Loire, site de Clermont-Ferrand, 58, rue Montalembert, 63058 Clermont-Ferrand cedex 1, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Odent-Malaure H, Argaud C, Aubrège C, Conductier R, Mompeyssin C, Dumontier P, Froget A, Motta Cano A, Gras A, Chavarin P, Garraud O. Hémovigilance donneur : bilan et perspectives en Auvergne-Loire. Transfus Clin Biol 2010. [DOI: 10.1016/j.tracli.2010.09.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
Castro E, Ginovart M, Gras A. Modeling of Pachysolen tannophilus batch cultures by individual-based simulations. J Biotechnol 2010. [DOI: 10.1016/j.jbiotec.2010.08.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
25
|
Singh S, Hedley D, Kara E, Gras A, Iwata S, Ruprecht J, Strange PG, Byrne B. A purified C-terminally truncated human adenosine A(2A) receptor construct is functionally stable and degradation resistant. Protein Expr Purif 2010; 74:80-7. [PMID: 20438843 DOI: 10.1016/j.pep.2010.04.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 04/26/2010] [Accepted: 04/26/2010] [Indexed: 10/19/2022]
Abstract
Recent high resolution structures of modified G-protein coupled receptors (GPCRs) have provided major insight into the mechanisms of receptor-ligand binding. However understanding of the complete mechanism of GPCR function remains limited. This study characterised C-terminally truncated versions of the human adenosine A(2A) receptor (A(2A)R) with a view to producing protein suitable for structural studies. The constructs terminated at residue A316, removing the intracellular C-terminal tail, or V334, producing a C-terminal tail equivalent in length to that of rhodopsin. Higher levels of functional receptor before and after solubilisation were obtained for both C-terminally truncated constructs compared to the wild-type receptor (WT) as assessed by radioligand binding analysis using [(3)H]ZM241385. The construct which yielded the highest level of functional receptor, V334 A(2A)R, was purified in DDM to high homogeneity with a final yield of 2 mg/L. Binding analysis revealed that the purified receptor had a specific activity of 20.2+/-1.2 nmol/mg, close to the theoretical maximum. Pure V334 A(2A)R was resistant to degradation over 15 days when stored at 4 degrees C or 20 degrees C and showed remarkable functional stability when stored at 4 degrees C, retaining 84% of initial functionality after 30 days. This construct is an excellent candidate for structural studies.
Collapse
Affiliation(s)
- Shweta Singh
- Membrane Protein Crystallography Group, Division of Molecular Biosciences, Imperial College London, South Kensington, London, SW7 2AZ, UK
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Courbil R, Gras A, Motta Cano A, Chenus F, Julien H, Garraud O. Guide d’organisation des cérémonies de remises des diplômes et des insignes de reconnaissance en faveur des donneurs de sang bénévoles. Transfus Clin Biol 2009; 16:30-8. [DOI: 10.1016/j.tracli.2009.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 01/09/2009] [Indexed: 10/21/2022]
|
27
|
Singh S, Gras A, Fiez-Vandal C, Ruprecht J, Rana R, Martinez M, Strange PG, Wagner R, Byrne B. Large-scale functional expression of WT and truncated human adenosine A2A receptor in Pichia pastoris bioreactor cultures. Microb Cell Fact 2008; 7:28. [PMID: 18847468 PMCID: PMC2570359 DOI: 10.1186/1475-2859-7-28] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Accepted: 10/10/2008] [Indexed: 11/16/2022] Open
Abstract
Background The large-scale production of G-protein coupled receptors (GPCRs) for functional and structural studies remains a challenge. Recent successes have been made in the expression of a range of GPCRs using Pichia pastoris as an expression host. P. pastoris has a number of advantages over other expression systems including ability to post-translationally modify expressed proteins, relative low cost for production and ability to grow to very high cell densities. Several previous studies have described the expression of GPCRs in P. pastoris using shaker flasks, which allow culturing of small volumes (500 ml) with moderate cell densities (OD600 ~15). The use of bioreactors, which allow straightforward culturing of large volumes, together with optimal control of growth parameters including pH and dissolved oxygen to maximise cell densities and expression of the target receptors, are an attractive alternative. The aim of this study was to compare the levels of expression of the human Adenosine 2A receptor (A2AR) in P. pastoris under control of a methanol-inducible promoter in both flask and bioreactor cultures. Results Bioreactor cultures yielded an approximately five times increase in cell density (OD600 ~75) compared to flask cultures prior to induction and a doubling in functional expression level per mg of membrane protein, representing a significant optimisation. Furthermore, analysis of a C-terminally truncated A2AR, terminating at residue V334 yielded the highest levels (200 pmol/mg) so far reported for expression of this receptor in P. pastoris. This truncated form of the receptor was also revealed to be resistant to C-terminal degradation in contrast to the WT A2AR, and therefore more suitable for further functional and structural studies. Conclusion Large-scale expression of the A2AR in P. pastoris bioreactor cultures results in significant increases in functional expression compared to traditional flask cultures.
Collapse
Affiliation(s)
- Shweta Singh
- Membrane Protein Crystallography Group, Division of Molecular Biosciences, Imperial College London, South Kensington, London, SW7 2AZ, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
Male crickets, Cycloptiloides canariensis (body length 5 mm), stridulate with their forewings, which are hidden during rest under the large shield-like pronotum. The wings are opened into the stridulatory position by bending the body between the pro- and mesothorax. The song is a 2 s trill composed on average of 260 pulses (syllables) with a carrier frequency of about 6 kHz. The sound-emitting structures on the wings have been studied by laser vibrometry and particle dusting. A distinct membrane area, which includes a prominent mirror cell, acts as a resonator, amplifying the fundamental carrier frequency produced by interactions between the file and plectrum. The resonating membrane is extremely thin (mirror cell thickness 0.2 µm), which is a physical requirement for maintaining the carrier frequency in the cricket-specific range. Covering the wings after singing is probably an adaptation to protect these delicate structures from damage by mechanical contact during social interactions, especially mating.
Collapse
|
29
|
Minet P, Bartsch P, Chevalier P, Raets D, Gras A, Dejardin-Closon MT, Lennes G. Quality of life of inoperable non-small cell lung carcinoma. A randomized phase II clinical study comparing radiotherapy alone and combined radio-chemotherapy. Radiother Oncol 1987; 8:217-30. [PMID: 3033751 DOI: 10.1016/s0167-8140(87)80245-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Eighty one patients with inoperable non-small cell lung carcinoma (NSCLC) were entered in a randomized phase II trial comparing split-dose irradiation alone to combined treatment radiotherapy and polychemotherapy (C.A.P. + V.D.S.). The quality of life and the survival of the patients were studied. We have defined three classes of quality of life responses based on the time elapsed before the performance status index drops. A higher quality of life failure rate was observed in the combined treatment group (p non-significant) but the time elapsed before the Karnofsky index drops is longer in the combined treatment group for the quality of life "no change" subgroup (p = 0.15). Survival and quality adjusted survival are similar in both treatment groups. The same conclusion holds for retrospective stratified treatment groups. The results of the study are presented according to the decision tree theory. We conclude that as far as the quality of life is concerned, polychemotherapy combined with the particular split-dose irradiation schedule used is an effective treatment of inoperable NSCLC. Its efficiency is comparable to, but not better than, the same radiotherapy schedule alone taken as a reference baseline.
Collapse
|
30
|
Abstract
A significant serum level of digoxin-like immunoreactive substance (DLIS) (greater than or equal to 0.5 ng/ml) has been found in healthy full-term neonates, in prematurely born neonates as well as in full-term but small for gestational age neonates. Neither the babies nor their mothers had received digoxin therapy. On the first day of life, the incidence of serum levels of DLIS greater than or equal to 0.5 ng/ml in the three groups of neonates were respectively 64% (32/50), 42% (8/19) and 77% (10/13). Longitudinal measurements in preterm and small for gestational age neonates indicate a progressive disappearance of DLIS from their serum, none of them having a significant serum level at 21 days of age. As long as the chemical structure, origin and physiological properties of DLIS remain unknown, clinicians must be cautious in interpreting the serum levels of digoxin used for therapeutical purpose in neonates.
Collapse
|
31
|
Bertomeu F, Gras A, Sánchez E, Richart C. [Refractory anemia of long duration and nephrotic syndrome caused by primary amyloidosis]. Rev Clin Esp 1985; 177:96-7. [PMID: 4048574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
32
|
Mosinger M, Molitor L, el-Feki M, Cartouzou G, Fiorentini H, Jouglard-Duplay J, Pic-Versino A, Gras A, Luccioni R, Jans R, Dantin B, Putz C, Heyart J. [Silicosis, sclerosing and hyalinizing mesenchymatosis; modifications and prevention of experimental silicosis by administration of synthetic products and hormones]. Arch Mal Prof 1969; 30:653-74. [PMID: 4992845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
33
|
Jouve A, Guiran JB, Viallet H, Gras A, Blanc M, Arnoux M, Rouvier M, Brunel JC. [Electrocardiographic changes during spontaneous angina crisis]. Arch Mal Coeur Vaiss 1969; 62:331-51. [PMID: 4995350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
34
|
Gras A, Jouve A. [Study of the association of a diuretic and a sympatholitic agent and its application in the treatment of hypertension]. Sem Hop 1969; 45:455-9. [PMID: 4307117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|