La Guerche-de-Bretagne, France
La Guerche-de-Bretagne, France

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Barlesi F.,Aix - Marseille University | Mazieres J.,University Paul Sabatier | Merlio J.-P.,University of Bordeaux 1 | Debieuvre D.,Hopital Emile Muller | And 30 more authors.
The Lancet | Year: 2016

Background The molecular profiling of patients with advanced non-small-cell lung cancer (NSCLC) for known oncogenic drivers is recommended during routine care. Nationally, however, the feasibility and effects on outcomes of this policy are unknown. We aimed to assess the characteristics, molecular profiles, and clinical outcomes of patients who were screened during a 1-year period by a nationwide programme funded by the French National Cancer Institute. Methods This study included patients with advanced NSCLC, who were routinely screened for EGFR mutations, ALK rearrangements, as well as HER2 (ERBB2), KRAS, BRAF, and PIK3CA mutations by 28 certified regional genetics centres in France. Patients were assessed consecutively during a 1-year period from April, 2012, to April, 2013. We measured the frequency of molecular alterations in the six routinely screened genes, the turnaround time in obtaining molecular results, and patients' clinical outcomes. This study is registered with ClinicalTrials.gov, number NCT01700582. Findings 18 679 molecular analyses of 17 664 patients with NSCLC were done (of patients with known data, median age was 64·5 years [range 18-98], 65% were men, 81% were smokers or former smokers, and 76% had adenocarcinoma). The median interval between the initiation of analysis and provision of the written report was 11 days (IQR 7-16). A genetic alteration was recorded in about 50% of the analyses; EGFR mutations were reported in 1947 (11%) of 17 706 analyses for which data were available, HER2 mutations in 98 (1%) of 11 723, KRAS mutations in 4894 (29%) of 17 001, BRAF mutations in 262 (2%) of 13 906, and PIK3CA mutations in 252 (2%) of 10 678; ALK rearrangements were reported in 388 (5%) of 8134 analyses. The median duration of follow-up at the time of analysis was 24·9 months (95% CI 24·8-25·0). The presence of a genetic alteration affected first-line treatment for 4176 (51%) of 8147 patients and was associated with a significant improvement in the proportion of patients achieving an overall response in first-line treatment (37% [95% CI 34·7-38·2] for presence of a genetic alteration vs 33% [29·5-35·6] for absence of a genetic alteration; p=0·03) and in second-line treatment (17% [15·0-18·8] vs 9% [6·7-11·9]; p<0·0001). Presence of a genetic alteration was also associated with improved first-line progression-free survival (10·0 months [95% CI 9·2-10·7] vs 7·1 months [6·1-7·9]; p<0·0001) and overall survival (16·5 months [15·0-18·3] vs 11·8 months [10·1-13·5]; p<0·0001) compared with absence of a genetic alteration. Interpretation Routine nationwide molecular profiling of patients with advanced NSCLC is feasible. The frequency of genetic alterations, acceptable turnaround times in obtaining analysis results, and the clinical advantage provided by detection of a genetic alteration suggest that this policy provides a clinical benefit. Funding French National Cancer Institute (INCa). © 2016 Elsevier Ltd.


PubMed | Brest University Hospital Center, Center Hospitalier Of Bretagne Sud, Center hospitalier Yves le Foll and Service de medecine interne
Type: | Journal: La Revue de medecine interne | Year: 2016

Anti-3-hydroxy-3-mthylglutaryl-coenzymeA reductase antibody-associated necrotizing autoimmune myopathy has been recently described (2011). This myopathy is distinct from statin toxic myopathy. Our objective is to report on the clinical and para-clinical characteristics of this myopathy and to show the difficulties of therapeutic care.We describe 4cases of patients followed-up in Brittany, France. All data have been analyzed retrospectively. The mean age of our patients was 59.5years, with a sex ratio of 1. The clinical presentation was homogeneous, with a subacute painful proximal and symmetrical weakness, without extra-muscular involvement. Other presentations have been described (including pseudo-dystrophic presentation). All patients had a previous statin medication (mean duration of 3.75years) although this criteria is not a requisite. All patients had high levels of creatine kinase and abnormal electromyographic examination. The pathological pattern on muscular biopsy was a necrotizing myopathy without significant inflammatory cells infiltration. Cardio-respiratory function was normal and no associated neoplasia was found. Over the follow-up, we observed a marked corticosteroid-dependence, not improved by immunosuppressive drugs (azathioprine and methotrexate). The benefit of intravenous immunoglobulin was clear with, sometimes, prolonged responses.An early diagnosis of this myopathy is necessary in order to introduce an immunotherapy associated with a close monitoring. The therapeutic strategy (within which the stead of intravenous immunoglobulin seems increased) remains to be defined and long-term prospective studies are thus needed.


Zemb P.,Cabinet de Gynecologie Obstetrique | Bellec J.-Y.,Center Hospitalier Of Bretagne Sud
Reproduction Humaine et Hormones | Year: 2010

Usual antepartum semiology (short-term variability of fetal heart rate, amount of amniotic fluid, etc.) can indicate the fetal homeostatic status, and thus the placental efficiency. A clinical study concerning the predictability of fetal tolerance to labor using this antepartum semiology leads us to conclude the following dominant factual chronology: after several weeks of complex fluctuations, an appearance of placental efficiency decrease is likely to precede parturition by an average of 6 to 72 hours. We interpret the suspected chronology as relying on two phenomena: 1) an effective oscillation of the placental efficiency, involving an intermittent hypoxic stimulation 2) a paradoxical sedative effect of the fetal cortisol pulsatile crescendo initiator of parturition (simulating some of the low placental efficiency semiology). The unstable equilibrium generated by the balance (hypoxic stimulation/trophoblastic and fetal reactivity) could be effective since early in the pregnancy, influencing especially the setting of the corticotrophin-releasing hormone placental clock. By else, the high nuchal translucency thickness could be due to a fetal hypercortisolism. Finally, postnatal, the sudden infant death syndrome could be due to the resurgence of the prenatal sedative effect exerted by an hypoxic stimulation. © Editions ESKA 2010.


Gallerne V.-A.,Generate | Gallerne V.-A.,Center Hospitalier Of Bretagne Sud | Gillioz A.-S.,Generate | Gillioz A.-S.,Center Hospitalier Of Bretagne Sud | And 2 more authors.
Revue de Geriatrie | Year: 2012

Objective: To describe current French cognitive behavioral units (UCC). Methods: A descriptive study based on a structured phone interview questionnaire. The list of UCC used in this study was updated by the French government on February 1 st 2010. Results: Sixteen UCC were studied over a 10-day period in June 2010. The majority of interlocutors were head-nurses, less frequently doctors responsible of units, and both of them in only one case. Results showed that UCC were significantly heterogeneous in human resources, architectural means, rehabilitation techniques, and patients' profiles. The neuropsychiatry Inventory (NPI) was largely used in the assessment of care efficiency. In term of standard specifications, these recently implemented UCC most often evolve according to their own experience because of lack of efficiency studies in literature. Conclusion: The heterogeneity observed in this study highlights the need for exchanging between the different UCC, and creating adequate efficiency assessment tools. Furthermore the study initiates debate on some ethical points, and the network of structures in relation with these units.


Cariou M.-E.,Center Hospitalier Of Bretagne Sud | Joncquez A.-L.,Center Hospitalier Of Bretagne Sud | Prades N.,Center Hospitalier Of Bretagne Sud | Schmitt F.,Center Hospitalier Of Bretagne Sud
Immuno-Analyse et Biologie Specialisee | Year: 2013

We present a case of vitamin B12 deficiency in a five-month-old infant with failure to thrive and psychomotor delay. Blood cell count showed neutropenia and macrocytic anaemia with megaloblastic bone marrow. Vitamin B12 level was very low and associated with increased urinary methylmalonic acid, which confirmed vitamin B12 deficiency. Mother's unrecognized pernicious anaemia was reported in this infant exclusively breastfed. Vitamin B12 supply was effective on anaemia and psychomotor delay. This case figures out the importance of an early diagnosis in front of failure to thrive, given the risk of incomplete neurologic recovery due to vitamin B12 deficiency. © 2013 Elsevier Masson SAS.


Schmitt B.,Center Hospitalier Of Bretagne Sud | Vicenzi M.,Laboratoires Le Stum | Garrel C.,Institut Universitaire de France | Denis F.M.,Laboratoires Le Stum
Redox Biology | Year: 2015

Glutathione (GSH) is critical to fight against oxidative stress. Its very low bioavailability limits the interest of a supplementation. The purpose of this study was to compare the bioavailability, the effect on oxidative stress markers and the safety of a new sublingual form of GSH with two commonly used dietary supplements, N-acetylcysteine (NAC) and oral GSH. The study was a three-week randomized crossover trial. 20 Volunteers with metabolic syndrome were enrolled. GSH levels and several oxidative stress markers were determined at different times during each 21-days period. Compared to oral GSH group, an increase of total and reduced GSH levels in plasma and a higher GSH/GSSG ratio (p=0.003) was observed in sublingual GSH group. After 3 weeks of administration, there was a significant increase of vitamin E level in plasma only in sublingual GSH group (0.83. μmol/g; p=0.04). Our results demonstrate the superiority of a new sublingual form of GSH over the oral GSH form and NAC in terms of GSH supplementation. © 2015 The Authors.


Favier J.-C.,Center Hospitalier Of Bretagne Sud | Da Conceicao M.,Center Hospitalier Of Grasse | Levron A.,Center Hospitalier Of Bretagne Sud | Argo V.,Center Hospitalier Of Bretagne Sud
Praticien en Anesthesie Reanimation | Year: 2015

Fiberoptic intubation in the gold standard in case of predicted difficult intubation. It can be performed under local anaesthesia but most of the time it is done under sedation, using propofol, remifentanil or even inhaled sevoflurane. During intubation, non-invasive ventilation can be performed through specific masks allowing the introduction of the fiberoptic. The nasal route is more frequently used than the oral route that requires more time, and has to be guided with an oral device, although it would be less traumatic. © 2014 Elsevier Masson SAS.


Patients receiving palliative care experience extreme vulnerability reminding them of the fragility of their human condition. How are they to trust nurses bearing bad news in these crucial moments? Trust is built on team coherence and rigorous support. © 2013 Published by Elsevier Masson SAS.


PubMed | Center Hospitalier Of Bretagne Sud, Institut Universitaire de France and Laboratoires Le Stum
Type: | Journal: Redox biology | Year: 2015

Glutathione (GSH) is critical to fight against oxidative stress. Its very low bioavailability limits the interest of a supplementation. The purpose of this study was to compare the bioavailability, the effect on oxidative stress markers and the safety of a new sublingual form of GSH with two commonly used dietary supplements, N-acetylcysteine (NAC) and oral GSH. The study was a three-week randomized crossover trial. 20 Volunteers with metabolic syndrome were enrolled. GSH levels and several oxidative stress markers were determined at different times during each 21-days period. Compared to oral GSH group, an increase of total and reduced GSH levels in plasma and a higher GSH/GSSG ratio (p=0.003) was observed in sublingual GSH group. After 3 weeks of administration, there was a significant increase of vitamin E level in plasma only in sublingual GSH group (0.83 mol/g; p=0.04). Our results demonstrate the superiority of a new sublingual form of GSH over the oral GSH form and NAC in terms of GSH supplementation.


PubMed | Center Hospitalier Of Bretagne Sud
Type: | Journal: Soins; la revue de reference infirmiere | Year: 2013

Patients receiving palliative care experience extreme vulnerability reminding them of the fragility of their human condition. How are they to trust nurses bearing bad news in these crucial moments? Trust is built on team coherence and rigorous support.

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