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Murviel-lès-Montpellier, France

Biron-Andreani C.,CHRU Montpellier

In 2010, venous thromboembolism (VTE) was the third leading cause of mortality among pregnant women in France accounting for 0.95 deaths per 100 000 deliveries; one-third of the deaths were considered to be avoidable. The highest risk period is postpartum and the increased risk persists for 6 weeks postpartum. During this period, the risk of pulmonary embolism is higher than the risk of deep vein thrombosis. Risk factors differ in the antepartum and postpartum period, but both clinical and genetic risk factors are important for predicting VTE during pregnancy and postpartum. Recent data indicate that 50% of postpartum women had two or more risk factors and that interactions between these risk factors are important; obesity, in particular, warrants consideration. VTE risk assessment should therefore be performed and repeated in every pregnant woman. This has been highlighted in the guidelines of the Royal College of Obstetricians and Gynaecologists. With better identification of postpartum risk factors, health care providers may be able to reduce the rate of maternal deaths resulting from pulmonary embolism. © 2013 LES LABORATOIRES SERVIER, an incorporated company of SERVIER - All Rights Reserved. Source

Benlakhal F.,Laboratoire dHematologie Saint Eloi | Mura T.,CHRU Montpellier | Mura T.,Center dInvestigation Clinique | Mura T.,French Institute of Health and Medical Research | And 4 more authors.
Journal of Thrombosis and Haemostasis

Background:Inherited factor (F)VII deficiency is the commonest of the rare bleeding disorders, with a wide set of hemorrhagic features. Other than for the severe clinical forms (for which treatment guidelines are well defined), consistent recommendations regarding perioperative replacement management do not exist for mild and asymptomatic FVII-deficient patients. Objectives:The present study aimed to evaluate the influence of bleeding history, FVII procoagulant activity levels (FVII:C) and the type of surgical procedure on the management of inherited FVII-deficient patients before surgery. Patients:One hundred and fifty-seven surgical procedures, performed without replacement therapy, in 83 unrelated FVII-deficient patients (median FVII:C=5%, range 0.6%-35%) were analyzed. Results:The overall bleeding rate was 15.3%. We found a significant relationship between previous deep traumatic hematomas and bleeding at surgery, although relationships with previous common epistaxis, easy bruising and menorrhagia were not significant. The receiver-operating characteristic (ROC) curve analysis performed on the first 83 procedures allowed us to define a cut-off value of 7% with a sensitivity of 87% (negative predictive value: 94%). To enhance the sensitivity, and to take into account the potential variation resulting from non-standardized FVII:C measurements, we would suggest applying a threshold of 10%. Conclusion:We have proposed recommendations for the perioperative management of FVII-deficient patients based on FVII:C levels, a thorough bleeding history and the type of surgery involved. By applying these recommendations, minor procedures that risk only external or controlled hemorrhage can be performed in asymptomatic or mildly affected adults, even those with FVII:C levels below 10%. © 2011 International Society on Thrombosis and Haemostasis. Source

Herbet G.,CHRU Montpellier | Herbet G.,French Institute of Health and Medical Research | Herbet G.,Montpellier University | Lafargue G.,University of Lille Nord de France | And 6 more authors.
Brain Structure and Function

According to recently proposed interactive dual-process theories, mentalizing abilities emerge from the coherent interaction between two physically distinct neural systems: (1) the mirror network, coding for the low-level embodied representations involved in pre-reflective sociocognitive processes and (2) the mentalizing network per se, which codes for higher level representations subtending the reflective attribution of psychological states. However, although the latest studies have shown that the core areas forming these two neurocognitive systems do indeed maintain effective connectivity during mentalizing, it is unclear whether an intact mirror system (and, more specifically, its anterior node, namely the posterior inferior frontal cortex) is a prerequisite for accurate mentalistic inferences. Intraoperative brain mapping via direct electrical stimulation offers a unique opportunity to address this issue. Electrical stimulation of the brain creates a “virtual” lesion, which provides functional information on well-defined parts of the cerebral cortex. In the present study, five patients were mapped in real time while they performed a mentalizing task. We found six responsive sites: four in the lateral part of the right pars opercularis and two in the dorsal part of the right pars triangularis. On the subcortical level, two additional sites were located within the white matter connectivity of the pars opercularis. Taken as a whole, our results suggest that the right inferior frontal cortex and its underlying axonal connectivity have a key role in mentalizing. Specifically, our findings support the hypothesis whereby transient, functional disruption of the mirror network influences higher order mentalistic inferences. © 2014, Springer-Verlag Berlin Heidelberg. Source

Guetin S.,Center Memoire Of Ressources Et Of Recherches | Guetin S.,University of Paris Descartes | Ginies P.,Center Devaluation Et Of Traitement Of La Douleur | Siou D.K.A.,Center Devaluation Et Of Traitement Of La Douleur | And 7 more authors.
Clinical Journal of Pain

OBJECTIVE: A music intervention method in the management of pain was recently developed while taking account of recommendations in the scientific literature. The objective of this study was to assess the usefulness of this music intervention to the management of patients with chronic pain. METHODS: A controlled, single-blind, randomized trial was used. Eighty-seven patients presenting with lumbar pain, fibromyalgia, inflammatory disease, or neurological disease were included in the study. During their hospitalization, the intervention arm (n=44) received at least 2 daily sessions of music listening between D0 and D10, associated with their standard treatment, and then pursued the music intervention at home until D60 using a multimedia player in which the music listening software program had been installed. The control arm received standard treatment only (n=43). The end points measured at D0, D10, D60, and D90 were: pain (VAS), anxiety-depression (HAD) and the consumption of medication. RESULTS: At D60 in the music intervention arm, this technique enabled a more significant reduction (P<0.001) in pain (6.3±1.7 at D0 vs. 3±1.7 at D60) when compared with the arm without music intervention (6.2±1.5 at D0 vs. 4.6±1.7 at D60). In addition, music intervention contributed to significantly reducing both anxiety/depression and the consumption of anxiolytic agents. DISCUSSION: These results confirm the value of music intervention to the management of chronic pain and anxiety/depression. This music intervention method appears to be useful in managing chronic pain as it enables a significant reduction in the consumption of medication. © 2012 Lippincott Williams & Wilkins, Inc. Source

Guillem F.,University Paris Diderot | Kannengiesser C.,University Paris Diderot | Oudin C.,APHP | Lenoir A.,French Institute of Health and Medical Research | And 17 more authors.
Human Mutation

Mutations of the TMPRSS6 gene, which encodes Matriptase-2, are responsible for iron-refractory iron-deficiency anemia. Matriptase-2 is a transmembrane protease that downregulates hepcidin expression. We report one frameshift (p.Ala605ProfsX8) and four novel missense mutations (p.Glu114Lys, p.Leu235Pro, p.Tyr418Cys, p.Pro765Ala) found in IRIDA patients. These mutations lead to changes in both the catalytic and noncatalytic domains of Matriptase-2. Analyses of the mutant proteins revealed a reduction of autoactivating cleavage and the loss of N-Boc-Gln-Ala-Arg-p-nitroanilide hydrolysis. This resulted either from a direct modification of the active site or from the lack of the autocatalytic cleavage that transforms the zymogen into an active protease. In a previously described transfection assay measuring the ability of Matriptase-2 to repress the hepcidin gene (HAMP) promoter, all mutants retained some, if not all, of their transcriptional repression activity. This suggests that caution is called for in interpreting the repression assay in assessing the functional relevance of Matriptase-2 substitutions. We propose that Matriptase-2 activity should be measured directly in the cell medium of transfected cells using the chromogenic substrate. This simple test can be used to determine whether a sequence variation leading to an amino acid substitution is functionally relevant or not. © 2012 Wiley Periodicals, Inc. Source

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