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Carrières-sous-Poissy, France

Constantin J.-M.,Service de reanimation adulte | Chanques G.,Hopital Saint Eloi | De Jonghe B.,Center Hospitalier Of Poissy Saint Germain | Sanchez P.,Service danesthesie reanimation polyvalente | And 8 more authors.
Annales Francaises d'Anesthesie et de Reanimation | Year: 2010

Objectives: To assess the current use of sedation and analgesia in a large sample of French intensive care units (ICUs) and to define structural characteristics of the units that use a written procedure. Study design: Self-reported survey. Participants: Three hundred and sixty French ICUs were presented the questionnaire in September 2007. Results: Surveys were received from 228 (60.6%) ICUs. Midazolam was used in more than 50% of the patients in 79.2% of the ICUs and propofol in 22.2% of the ICUs. Sufentanil was the most frequently used morphinic. A sedation-scale was used in 68.8% of the units (80.3% Ramsay score). Sedation was assessed at least every 4. hours in 61% of ICUs. A pain-scale was used in 88.9% of the ICUs, but only 12.5% in the non-communicant patients. A written procedure was used in 29.4% of the units only. In multivariate analysis, use in the ICU of a written procedure for the early management of patients with septic shock and/or intensive insulin therapy was the single variable significantly associated with presence of a written procedure for sedation and analgesia (respectively OR 4.37; p<0.0001 and OR 5.64; p=0.032). Conclusion: Although more than two-third of the responding ICUs reported the use of sedation-and-pain-scales, frequency of assessment was low, and objective assessment of pain in the non-communicating patients was extremely uncommon. Similarly, the use of written procedure was low. The use of sedation-analgesia written procedure in an ICU seems strongly influenced by a more global involvement of the ICU in the protocolisation of complex care. These findings support the reinforcement of educational programs. © 2010.

Hermant P.,Center Hospitalier Of Poissy Saint Germain | Bellamy J.,Clinique Chirurgicale du Val dOr | Georges O.,Laboratoire Guigui
Revue des Maladies Respiratoires | Year: 2011

We report of the case of a 41-year-old patient, who had previously undergone thoracic surgery at the age of 16 for a single giant emphysematous bulla. The CT scan showed an abnormal middle mediastinal lesion containing an aerated cystic areas and areas of fat density. The patient underwent surgery and a well-defined mass was found between the mediastinum and the pulmonary hilum, which was able to be completely resected. Microscopic examination disclosed a composite tumour containing a bronchogenic cyst, a benign lipoma and two hamartochondromas. As no similar case had been reported previously, it was difficult to assert the nature of the lesion, which has been labelled as a "hamartoma". The main diagnoses which should be considered when an intra pulmonary fat density mass is disclosed, are discussed. © 2011 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Barnea E.R.,Society for the Investigation of Early Pregnancy | Barnea E.R.,Bioincept | Vialard F.,University of Versailles | Vialard F.,Center Hospitalier Of Poissy Saint Germain | And 5 more authors.
Journal of Reproductive Immunology | Year: 2016

Preeclampsia is a unique pregnancy disorder whose patho-physiology is initiated early in gestation, while clinical manifestations typically occur in mid-to-late pregnancy. Thus, prevention should optimally be initiated in early gestation. The intimate interaction between PIF, secreted early by viable embryos, and its host-mother provides insight into putative mechanisms of preeclampsia prevention.PIF is instrumental at the two critical events underlying preeclampsia. At first, shallow implantation leads to impaired placentation, oxidative stress, protein misfolding, and endothelial dysfunction. Later in gestation, hyper-oxygenation due to overflow of maternally derived oxygenated blood compromises the placenta. The first is likely involved in early preeclampsia occurrence due to reduced effectiveness of trophoblast/uterus interaction. The latter is observed with later-onset preeclampsia, caused by a breakdown in placental blood flow regulation. We reported that 1. PIF promotes implantation, endometrium receptivity, trophoblast invasion and increases pro-tolerance trophoblastic HLA-G expression and, 2. PIF protects against oxidative stress and protein misfolding, interacting with specific targets in embryo, 3. PIF regulates systemic immunity to reduce oxidative stress. Using PIF as an early preventative preeclampsia intervention could ameliorate or even prevent the disease, whose current main solution is early delivery. © 2015 Elsevier Ireland Ltd.

Moindjie H.,University of Versailles | Dos Santos E.,University of Versailles | Dos Santos E.,Center Hospitalier Of Poissy Saint Germain | Loeuillet L.,Center Hospitalier Of Poissy Saint Germain | And 8 more authors.
Biology of Reproduction | Year: 2014

Preimplantation factor (PIF) is a peptide secreted by viable mammalian embryos. Moreover, it can be detected in the circulation of pregnant women. Recently, it was shown that PIF promotes invasion in trophoblast cell lines in vitro. Successful human embryo implantation depends on a deep and highly controlled invasion of extravillous trophoblast (EVT) in the maternal endometrium. Trophoblast invasion is regulated in part by matrix metalloproteinase (MMP) activity and integrin expression. The present study demonstrates the presence of PIF in early pregnancy and characterizes its effects on primary human trophoblast invasion. At the fetomaternal interface, intense PIF labeling by immunohistochemistry was present during early gestation in villous trophoblasts and EVTs. A decrease of labeling was observed at term. Furthermore, PIF significantly promoted invasion of human EVT isolated from first-trimester placenta. The proinvasive regulatory effect of PIF in EVT was associated with 1) increased MMP9 activity and 2) reduced tissue inhibitor of metalloproteinase-1 (TIMP1) mRNA expression. PIF also regulated alpha v and alpha 1 integrin mRNA expressions. Last, the proinvasive effect of PIF appeared to be mediated by the mitogenactivated protein kinase (MAPK), phosphoinositide-3-kinase (PI3K), and Janus-kinase signal transducer and activator of transcription (JAK-STAT) signaling pathways. In summary, this work describes the direct, positive effect of PIF on the control of human trophoblastic cell invasion by modulation of MMP/TIMP balance and integrin expression. Moreover, these results suggest that PIF is involved in pathological pregnancies characterized by insufficient or excessive trophoblast invasion. © 2014 by the Society for the Study of Reproduction, Inc.

Duval F.,University of Versailles | Dos Santos E.,University of Versailles | Dos Santos E.,Center Hospitalier Of Poissy Saint Germain | Poidatz D.,University of Versailles | And 5 more authors.
Biology of Reproduction | Year: 2016

The placenta exchanges nutrients between the mother and thefetus and requires a constant abundant energy supply. Adiponectin(a cytokine produced primarily by adipose tissue) controlsglucose and lipid homeostasis. It is well-known that maternalserum adiponectin levels are inversely related to birth weight,suggesting that adiponectin has a negative effect on fetal growth.This effect appears to be related to the control of nutrienttransporters in human placenta. However, the underlyingmolecular mechanisms have not yet been characterized. In thepresent work, we studied adiponectin's direct effect on humanprimary cytotrophoblasts from first-trimester placenta. Ourresult showed that in placental cells, adiponectin 1) inhibitsthe expression of the major glucose transporters (GLUT1 andGLUT12) and sodium-coupled neutral amino acid transporters(SNAT1, SNAT2, and SNAT4), 2) enhances total ATP productionbut decreases lactate production, 3) inhibits mitochondrialbiogenesis and function, and 4) stimulates cell death byenhancing the expression of the pro-apoptotic B-cell lymphoma-2 (BCL-2)-associated X protein (BAX) and tumor protein P53(TP53) gene expression and inducing the caspase activity. SmallinterferingRNA mediating the down-regulation of adiponectinreceptors (ADIPOR1 and ADIPOR2) was used to demonstratethat adiponectin effects on placental nutrient transport andapoptosis seemed to be essentially mediated by these specificreceptors. Taken as a whole, these results strongly suggest thatadiponectin regulates human placental function by limitingnutrient transporter expression and inducing apoptosis. Thesefindings may help us to better understand adiponectin's role inplacental pathologies such as intrauterine growth restriction,which is characterized by fetal weight loss and drastic apoptosisof placental cells. © 2016 by the Society for the Study of Reproduction.

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