Center Hospitalier Felix Guyon

Saint-Léger-du-Bourg-Denis, France

Center Hospitalier Felix Guyon

Saint-Léger-du-Bourg-Denis, France
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Mas C.,Felix Guyon Hospital | Gerardin P.,University of Reunion Island | Chirpaz E.,Center Hospitalier Felix Guyon | Carbonnier M.,Neonatal Intensive Care Unit | And 3 more authors.
Early Human Development | Year: 2017

Aim To examine the rates of follow-up at two years of age and perinatal factors associated with non-compliance in an observational population-based cohort of very preterm children enrolled in a routine follow-up program. Method Data review of infants born between 2008 and 2012 in the Observatoire de La Grande Prématurité, Reunion Island cohort. All singletons born alive before 33 weeks of gestational age and resident on the island at two years of age were included. Patients were considered compliant if they were timely evaluated between 20–28 months of age, or non-compliant if they were not evaluated or evaluated after 28 months of age. Results Of the 802 survivors (mean gestational age of 30.3 ± 2.0 months, mean birthweight of 1364 ± 396 g), 468 (58.4%) were examined between 20–28 months, 119 (14.8%) after 28 months of age, and 215 (26.8%) were never evaluated, respectively. In multivariate analysis, factors associated with non-compliance were higher parity (> 2), past history of preterm delivery, maternal diabetes (preexisting or gestational), appropriate for gestational status, and centre of birth. Conclusion Sustainable follow-up of vulnerable neonates remains a challenge in clinical practice. Early predictors of non-compliance can be used to define individualized and local follow-up strategies in these infants at high risk for developmental disabilities. © 2017 Elsevier B.V.

PubMed | Hopital dEnfants de Brabois, Center Hospitalier Felix Guyon, Assistance Publique des Hopitaux de Paris AP HP, Hopital de Hautepierre and 12 more.
Type: Journal Article | Journal: Nature genetics | Year: 2015

Juvenile myelomonocytic leukemia (JMML) is a rare and severe myelodysplastic and myeloproliferative neoplasm of early childhood initiated by germline or somatic RAS-activating mutations. Genetic profiling and whole-exome sequencing of a large JMML cohort (118 and 30 cases, respectively) uncovered additional genetic abnormalities in 56 cases (47%). Somatic events were rare (0.38 events/Mb/case) and restricted to sporadic (49/78; 63%) or neurofibromatosis type 1 (NF1)-associated (8/8; 100%) JMML cases. Multiple concomitant genetic hits targeting the RAS pathway were identified in 13 of 78 cases (17%), disproving the concept of mutually exclusive RAS pathway mutations and defining new pathways activated in JMML involving phosphoinositide 3-kinase (PI3K) and the mTORC2 complex through RAC2 mutation. Furthermore, this study highlights PRC2 loss (26/78; 33% of sporadic JMML cases) that switches the methylation/acetylation status of lysine 27 of histone H3 in JMML cases with altered RAS and PRC2 pathways. Finally, the association between JMML outcome and mutational profile suggests a dose-dependent effect for RAS pathway activation, distinguishing very aggressive JMML rapidly progressing to acute myeloid leukemia.

PubMed | groupe hospitalier Sud Reunion, Center hospitalier Felix Guyon, Institute Gustave Roussy, Nantes University Hospital Center and 2 more.
Type: Journal Article | Journal: Anaesthesia, critical care & pain medicine | Year: 2016

The Formation de rfrents aux techniques dintubation difficile (FRTID) is a French continuing medical education program on difficult airway management. Its objectives are to train experts in the task of training other physicians in their hospitals for better guideline compliance. Our aim was to describe the curriculum of the experts and to evaluate the programs efficacy via a prospective survey.Each participant was asked to complete a questionnaire before (T0), immediately (T1), 6 (T6) and 12 (T12) months after the course. The main criterion was the proportion of the participants who declared that they had implemented at least one action to improve difficult airway management in their institution at 6 months. Other criteria included the proportion of participants who declared that they had modified their own clinical practice and the frequency of use of specific devices assessed on modified Likert numerical rating scales.Two hundred and forty-four participants were included in the survey. One hundred and three, 91 and 62 participants responded to the T1 (immediately after the course), T6 (6 months later) and T12 (12 months later) questionnaires, respectively; 73 physicians (i.e. 30% of all participants and 80% of the survey responders) declared that they had implemented at least one action likely to optimize the management of difficult airways. On the T6 and T12 questionnaires, 91% and 97% of the responders respectively declared that they had changed their clinical practice. The course has resulted in increased use of transtracheal oxygenation with manual devices (Manujet(), Enk()) and Seldinger cricothyroidotomy as well as paediatric difficult airway techniques such as paediatric sized elastic gum and Airtraq or fibrescopic intubation under general anaesthesia with spontaneous ventilation (through a laryngeal mask).These data encourage the training of experts in difficult airways. This curriculum is contributing to the dissemination of the recommendations among a large number of practitioners.

Robin S.,Center Hospitalier Felix Guyon | Ramful D.,Center Hospitalier Felix Guyon | Zettor J.,Center Hospitalier Felix Guyon | Benhamou L.,Center Hospitalier Felix Guyon | And 5 more authors.
European Journal of Pediatrics | Year: 2010

Introduction: The aim of this study was to describe a pediatric case series of Chikungunya infection associated with extensive bullous skin lesions, a severe and unknown form of the disease, during the 2005-2006 outbreak in La Réunion Island. Materials and methods: Retrospective descriptive hospital-based study in children presenting blisters ≥10% of total body surface area with laboratory-confirmed Chikungunya infection. Results: Eight boys and five girls with a mean age of 3.4 months were included. Blistering began after an average of 2 days after onset of fever and affected 21.5% (10% to 35%) of the total body surface area. Reverse transcription-polymerase chain reaction of blister fluid (n=5) was positive with a mean viral load sometimes higher than in concurrent serum. Histopathologic examination (n=10) showed intraepidermal blisters. Hospitalization and repeated dressing changes under general anesthesia were required. No death occurred. On follow-up, long term repigmentation was excellent with sometimes cosmetic sequelae. Conclusion: Chikungunya should be included in the differential diagnosis of febrile blistering dermatoses in small infants in epidemic areas. © 2009 Springer-Verlag.

Hoareau L.,University of Reunion Island | Bencharif K.,University of Reunion Island | Rondeau P.,University of Reunion Island | Murumalla R.,University of Reunion Island | And 5 more authors.
Journal of Inflammation | Year: 2010

Background. The development of obesity has been linked to an inflammatory process, and the role of adipose tissue in the secretion of pro-inflammatory molecules such as IL-6 or TNFalpha has now been largely confirmed. Although TNFalpha secretion by adipose cells is probably induced, most notably by TLR ligands, the activation and secretion pathways of this cytokine are not yet entirely understood. Moreover, given that macrophagic infiltration is a characteristic of obesity, it is difficult to clearly establish the level of involvement of the different cellular types present within the adipose tissue during inflammation. Methods. Primary cultures of human adipocytes and human peripheral blood mononuclear cells were used. Cells were treated with a pathogen-associated molecular pattern: LPS, with and without several kinase inhibitors. Western blot for p38 MAP Kinase was performed on cell lysates. TNFalpha mRNA was detected in cells by RT-PCR and TNFalpha protein was detected in supernatants by ELISA assays. Results. We show for the first time that the production of TNFalpha in mature human adipocytes is mainly dependent upon two pathways: NFkappaB and p38 MAP Kinase. Moreover, we demonstrate that the PI3Kinase pathway is clearly involved in the first step of the LPS-pathway. Lastly, we show that adipocytes are able to secrete a large amount of TNFalpha compared to macrophages. Conclusion. This study clearly demonstrates that the LPS induced activation pathway is an integral part of the inflammatory process linked to obesity, and that adipocytes are responsible for most of the secreted TNFalpha in inflamed adipose tissue, through TLR4 activation. © 2010 Hoareau et al; licensee BioMed Central Ltd.

Roche R.,University of Reunion Island | Festy F.,University of Reunion Island | Fritel X.,Center Hospitalier Felix Guyon
Journal of Cellular and Molecular Medicine | Year: 2010

Stress urinary incontinence (SUI), the most common type of incontinence in women, is a frequent and costly ailment responsible for an alteration in the quality of life. Although medical treatment gives some rather deceiving results, surgical techniques that include colposuspension or tension-free vaginal tape, employed in cases of urethral support defect, give a 5-year cure rate of more than 80%. However, these techniques could lead to complications or recurrence of symptoms. Recently, the initiation of urethral cell therapy has been undertaken by doctors and researchers. One principal source of autologous adult stem cells is generally used: muscle precursor cells (MPCs) which are the progenitors of skeletal muscle cells. Recently, a few research groups have shown interest in the MPCs and their potential for the treatment of urinary incontinence. However, using MPCs or fibroblasts isolated from a striated muscle biopsy could be questionable on several points. One of them is the in vitro cultivation of cells, which raises issues over the potential cost of the technique. Besides, numerous studies have shown the multipotent or even the pluripotent nature of stromal vascular fraction (SVF) or adipose-derived stem cells (ASCs) from adipose tissue. These cells are capable of acquiring in vitro many different phenotypes. Furthermore, recent animal studies have highlighted the potential interest of SVF cells or ASCs in cell therapy, in particular for mesodermal tissue repair and revascularization. Moreover, the potential interest of SVF cells or ASCs for the treatment of urinary incontinence in women is supported by many other characteristics of these cells that are discussed here. Because access to these cells via lipoaspiration is simple, and because they are found in very large numbers in adipose tissue, their future potential as a stem cell reservoir for use in urethral or other types of cell therapy is enormous. © 2009 The Authors Journal compilation © 2010 Foundation for Cellular and Molecular Medicine/Blackwell Publishing Ltd.

Guerin-Dubourg A.,University of Reunion Island | Guerin-Dubourg A.,Center hospitalier Felix Guyon | Catan A.,University of Reunion Island | Bourdon E.,University of Reunion Island | Rondeau P.,University of Reunion Island
Diabetes and Metabolism | Year: 2012

Aim: Albumin, a major protein in the blood circulation, can undergo increased glycation in diabetes. From recent studies, it has become evident that glycation has important implications for albumin actions and impact on cell functioning. This study compares the structural and functional properties of albumin glycated by glucose and methylglyoxal (MGO) with those of albumin purified from diabetic patients. Methods: Human serum albumin (HSA) was purified from diabetic patients and control subjects using affinity chromatography, and oxidation parameters in various albumin preparations were determined. Tryptophan and 1-anilino-8-naphthalene sulphonic acid (ANSA) probe fluorescence, redox state, antioxidant and copper-binding capacities of the different preparations of albumin were also determined and compared. Results: Occurrence of oxidative modifications was enhanced in albumin whether purified from diabetic patients, or glycated by glucose or MGO, after determination of their fructosamine and free thiol and amino group contents, carbonyl content and antioxidant activities. Whereas more quantitative changes in oxidative and structural parameters were observed in the glucose- and MGO-modified albumins, significant impairment of albumin function (free-radical-scavenging and copper-binding capacities) were demonstrated in the HSA purified from diabetics. These findings reveal different structural and functional features of diabetic HSA compared with in vitro models. Conclusion: This study provides new information supporting albumin as an important biomarker for monitoring diabetic pathophysiology. In addition, it reconfirms the influence of experimental conditions in which advanced glycation end-products (AGEs) are generated in tests designed to mimic the pathological conditions of diabetes. © 2011 Elsevier Masson SAS.

PubMed | Angers University Hospital Center, Center Hospitalier Felix Guyon and French Institute of Health and Medical Research
Type: | Journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases | Year: 2015

Acinetobacter baumannii can be responsible for community-acquired infections in tropical climates like that of Reunion Island. The epidemiology of these community-acquired A. baumannii infections is not well understood. The aim of this study was to characterize A. baumannii strains isolated from patients at the time of admission to the university hospital of Saint-Denis, from environmental samples, and from pets.In this exploratory study, samples were collected by swabbing the rectum and mouth. A. baumannii isolates from positive samples were identified by VITEK 2 system, blaOXA-51-like gene PCR, and partial sequencing of the rpoB gene. Antimicrobial susceptibility testing was then performed. Strains were further analysed by multilocus sequence typing and pulsed-field gel electrophoresis.A high prevalence of A. baumannii carriage was found in pets (8.5%). Only one A. baumannii isolate was resistant to carbapenems (isolated from a patient). A wide variety of A. baumannii, assigned to different sequence types, were isolated from pets, humans, and the environment.This study shows that A. baumannii strains are present outside the hospital setting in Reunion Island and show great diversity. Further studies are needed to explore these extra-hospital reservoirs of A. baumannii in Reunion Island in greater detail and to determine their possible means of dissemination.

PubMed | Groupe hospitalier sud Reunion, Center hospitalier Felix Guyon and Center hospitalier Louis Pradel
Type: | Journal: Revue de pneumologie clinique | Year: 2016

Lung transplantation (LT) is a therapeutic option for patients with terminal respiratory failure and high risk of mortality in two years. Until now, this activity is not performed in Reunion Island. The candidate potential are thus directed to the metropolitan reference centres causing logistics and financials constraints. This work presents a current situation of the pulmonary transplantation in Reunion Island. This retrospective study includes patients from Reunion Island with respiratory insufficiency who have been transferred to metropolitan centres to apply to LT. The selection was made from January, 2005till May, 2015. Twenty-nine patients included, aged from 14to 64years, were transferred to metropolitan France: 13patients with cystic fibrosis, 13patients with pulmonary fibrosis, 1patients with bronchiectasis, 1patient with chronic obstructive pulmonary disease (COPD) and 1patient with pulmonary arterial hypertension. Fifteen patients underwent LT (4live in Reunion Island, 5live in metropolitan France and 6are dead), 1patient is alive on waiting list, 3died on the waiting list, 7patients were refused for transplantation and 3patients are lost to follow-up. The number of patients transferred for LT increases over 10years with a maximal incidence in 2013of 7repatriated patients including 3transplanted patients. LT could be performed in half of our patients with possible come back and follow-up on Reunion Island. Indications follow the current trends except an under representation of COPD.

Gauzere B.-A.,Center Hospitalier Felix Guyon
Revue Francophone des Laboratoires | Year: 2011

The chikungunya virus infection in the indian Ocean : what lessons Chikungunya virus is an emerging alphavirus that has caused major epidemics in India and islands off the east coast of Africa since 2005, particularly in Réunion, a french territory. Lessons have been learned the hard way in the field of the severe emerging presentations of the disease and its vector the tiger mosquito that is expending worldwide. Importations into Europe including one that led to epidemic transmission in Italy during 2007, underscore the risk of endemic establishment elsewhere. Several research programmes are being conducted, boosting previously declining virology and medical entomology. © 2011 - Elsevier Masson SAS - Tous droits réservés.

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