Hopital Avicenne

Bobigny, France

Hopital Avicenne

Bobigny, France
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Mimoun S.,French National Institute for Agricultural Research | Andriamihaja M.,French National Institute for Agricultural Research | Chaumontet C.,French National Institute for Agricultural Research | Atanasiu C.,Hopital Avicenne | And 5 more authors.
Antioxidants and Redox Signaling | Year: 2012

Aims: Sulfide is released in the large intestine lumen by the microbiota and is an inhibitor of mitochondrial respiration and a genotoxic agent in colonocytes when present in excess. Deciphering how colonocytes metabolize sulfide is an important issue. Results: In this study, using the human colonic epithelial HT-29 Glc-/+ cells, we found that 50 μM sodium hydrogen sulfide represents the threshold of concentration above which respiration is decreased. The capacity of HT-29 Glc-/+ cells to oxidize lower concentration of sulfide was associated with the expression of transcripts corresponding to the enzymes of the sulfide oxidizing unit (SOU), that is, sulfide quinone reductase (SQR), dioxygenase ethylmalonic encephalopathy, and thiosulfate sulfur transferase (TST). Inhibition of cell O2 consumption by sulfide was reverted by zinc but not by calcium and iron. When the cells undergo either spontaneous or butyrate-induced differentiation, their capacity to oxidize sulfide was significantly increased. The expression levels of the genes corresponding to the enzymes of the SOU were not increased, whereas increased cellular maximal respiratory capacity and oxygen consumption by the dioxygenase were both measured. In human biopsies recovered from various parts of the large intestine, the three enzymes of the SOU were expressed. Innovation: SOU and cell respiratory capacity are crucial for sulfide detoxification in colonocytes. Conclusion: Sulfide oxidative capacity in the colonic mucosa is higher in differentiated than in proliferative epithelial cells. The cell respiratory capacity and SOU activity appear to represent major determinants allowing sulfide detoxification in colonic epithelial cells. © 2012 Mary Ann Liebert, Inc.

Roulot D.,University of Paris 13 | Buyck J.-F.,Hopital Avicenne | Warzocha U.,University of Paris 13 | Gambier N.,University of Paris 13 | And 3 more authors.
Gut | Year: 2011

Background: Liver stiffness measurement (LSM) has been used to measure fibrosis in patients with various types of chronic liver diseases. However, its usefulness as a screening procedure in apparently healthy people had not been evaluated to date. Methods: 1358 subjects >45 years old from a general population attending for a medical check-up were consecutively enrolled in the study. All subjects were submitted to medical examination and laboratory tests in addition to LSM, performed on the same day by a single operator. Subjects with LSM values >8 kPa were referred to a liver unit for further investigations. Results: 168 subjects were not considered for analysis due to missing data (n=23), LSM failure (n=51) or unreliable LSM values (n=94). Among the 1190 remaining subjects, 89 (7.5%) had LSM >8 kPa including nine patients with LSM >13 kPa. Despite the fact that normal liver tests were observed in 43% of them (38 out of 89), a specific cause of chronic liver disease was found in all cases. Non-alcoholic fatty liver disease (NAFLD) was the likely cause of chronic liver disease in 52 patients, alcoholic liver disease (ALD) in 20, and both causes were associated in seven additional patients. Hepatitis C virus and hepatitis B virus chronic hepatitis was documented in five and four cases, respectively, and primary biliary cirrhosis in one. Liver biopsy was obtained for 27 patients, including the nine patients with LSM >13 kPa, who were diagnosed with liver cirrhosis due to ALD (n=5), chronic hepatitis C (n=3) or chronic hepatitis B (n=1). The 18 remaining biopsies showed liver fibrosis in all cases except one (isolated steatosis), with ALD and NAFLD being present in six and eight cases, respectively. Conclusion: LSM proved to be a useful and specific procedure to screen for cirrhosis in the general population and to detect undiagnosed chronic liver disease in apparently healthy subjects.

Tallet A.V.,Institute Paoli Calmettes | Azria D.,French Institute of Health and Medical Research | Barlesi F.,Aix - Marseille University | Spano J.-P.,University Paris - Sud | And 3 more authors.
Radiation Oncology | Year: 2012

Whole brain radiation therapy (WBRT) is an effective treatment in brain metastases and, when combined with local treatments such as surgery and stereotactic radiosurgery, gives the best brain control. Nonetheless, WBRT is often omitted after local treatment due to its potential late neurocognitive effects. Publications on radiation-induced neurotoxicity have used different assessment methods, time to assessment, and definition of impairment, thus making it difficult to accurately assess the rate and magnitude of the neurocognitive decline that can be expected. In this context, and to help therapeutic decision making, we have conducted this literature review, with the aim of providing an average incidence, magnitude and time to occurrence of radio-induced neurocognitive decline. We reviewed all English language published articles on neurocognitive effects of WBRT for newly diagnosed brain metastases or with a preventive goal in adult patients, with any methodology (MMSE, battery of neurcognitive tests) with which baseline status was provided. We concluded that neurocognitive decline is predominant at 4 months, strongly dependant on brain metastases control, partially solved at later time, graded 1 on a SOMA-LENT scale (only 8% of grade 2 and more), insufficiently assessed in long-term survivors, thus justifying all efforts to reduce it through irradiation modulation. © 2012 Tallet et al.; licensee BioMed Central Ltd.

Cohen Y.,Hopital Avicenne | Karoubi P.,Hopital Avicenne | Adrie C.,Hopital Delafontaine | Gauzit R.,Hopital Hotel Dieu | And 3 more authors.
Critical Care Medicine | Year: 2010

Objective: Candida species represent the fourth cause of nosocomial bloodstream infections worldwide. Because Candida glabrata has become the second most frequently identified yeast and because the rate of fluconazole-resistant C. glabrata strains reaches 10% to 15%, initial antifungal therapy based on fluconazole in nonneutropenic hemodynamically stable patients, as recommended by current guidelines, may be an ineffective option. Our aim was to determine easy-to-identify risk factors for C. glabrata fungemia likely to guide and improve initial antifungal therapy. Design: Prospective multicenter cohort study. Setting: Five French intensive care units. Patients: Consecutive nonneutropenic patients without known Candida colonization who had blood culture-confirmed fungemia over a 4-yr period. Interventions: None. Measurements and Main Results: A total of 8206 patients were screened. One hundred fifty-four patients with blood culture-confirmed fungemia constituted the cohort, of whom 48 had C. glabrata fungemia and 106 had nonglabrata fungemia. Patients' baseline characteristics and in-intensive care unit events potentially related to C. glabrata fungemia were systematically recorded. Compared with patients with nonglabrata fungemia, patients with C. glabrata fungemia were older and more severely ill, had received more antibiotics, and were more likely to have undergone surgery. The stepwise logistic regression analysis identified six independent risk factors for C. glabrata fungemia: age >60 yrs, recent abdominal surgery, interval from intensive care unit admission to first positive blood culture ≤7 days, recent use of cephalosporins, solid tumor, and absence of diabetes mellitus. The model showed satisfying goodness of fit (Hosmer-Lemeshow statistic =.26) and discrimination (c statistic =.89). Conclusions: We found six early available and easy-to-identify risk factors for C. glabrata fungemia. When these factors are present, alternatives to fluconazole for initial antifungal therapy should be considered. Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

Canoui-Poitrine F.,University Paris Est Creteil | Veerabudun K.,University Paris Est Creteil | Larmignat P.,AP HP | Letournel M.,Hopital Avicenne | And 2 more authors.
PLoS ONE | Year: 2014

Background: Risk prediction of acute mountain sickness, high altitude (HA) pulmonary or cerebral edema is currently based on clinical assessment. Our objective was to develop a risk prediction score of Severe High Altitude Illness (SHAI) combining clinical and physiological factors. Study population was 1017 sea-level subjects who performed a hypoxia exercise test before a stay at HA. The outcome was the occurrence of SHAI during HA exposure. Two scores were built, according to the presence (PRE, n = 537) or absence (ABS, n = 480) of previous experience at HA, using multivariate logistic regression. Calibration was evaluated by Hosmer-Lemeshow chisquare test and discrimination by Area Under ROC Curve (AUC) and Net Reclassification Index (NRI). Results: The score was a linear combination of history of SHAI, ventilatory and cardiac response to hypoxia at exercise, speed of ascent, desaturation during hypoxic exercise, history of migraine, geographical location, female sex, age under 46 and regular physical activity. In the PRE/ABS groups, the score ranged from 0 to 12/10, a cut-off of 5/5.5 gave a sensitivity of 87%/87% and a specificity of 82%/73%. Adding physiological variables via the hypoxic exercise test improved the discrimination ability of the models: AUC increased by 7% to 0.91 (95%CI: 0.87-0.93) and 17% to 0.89 (95%CI: 0.85-0.91), NRI was 30% and 54% in the PRE and ABS groups respectively. A score computed with ten clinical, environmental and physiological factors accurately predicted the risk of SHAI in a large cohort of sea-level residents visiting HA regions. © 2014 Canouï-Poitrine et al.

Kambouchner M.,Hopital Avicenne | Bernaudin J.-F.,University Pierre and Marie Curie
American Journal of Industrial Medicine | Year: 2015

The 1930 International Labour Office Conference on silicosis in Johannesburg was a turning point in the history of silicosis and in the recognition of the associated pathologic patterns. Since 1930, pneumoconioses such as silicosis have become much rarer in developed countries and can now be diagnosed at an early stage based on clinical and radiologic criteria. However, in spite of these advances, pathologists must remember to look for silica in tissues, particularly when clinical and radiologic findings are more uncertain. Furthermore, nowadays pathologists essentially observe silicotic lesions as incidental findings adjacent to lung cancers. In addition to identifying the characteristic lesions, pathologists must also try to identify their causative agent, in the case of crystalline silica firstly by using polarized light examination, followed as appropriate by more sophisticated devices. Finally, pathologists and clinicians must always keep in mind the various implications of exposure to silica compounds in a wide range of diseases. © 2015 Wiley Periodicals, Inc.

Mourad J.-J.,Hopital Avicenne | O'Brien E.,Conway Institute of Biomolecular and Biomedical Research
Current Hypertension Reports | Year: 2010

Ambulatory blood pressure (BP) monitoring is increasingly used in the evaluation of hypertensive patients. The ability to monitor BP throughout the day and night allows the detection of abnormal nocturnal BP patterns, the most common being a "nondipping" pattern, which is associated with increased cardiovascular risk; its correction appears to have a positive impact on cardiovascular outcome. Antihypertensive treatment should be individually adjusted to control BP during both daytime and nighttime. However, drug-induced lowering of nocturnal BP, if excessive, could amplify the morning BP surge in patients with daytime BP elevation, increasing the risk of developing a cardiovascular event. Ambulatory BP monitoring therefore represents a unique tool to establish the most appropriate antihypertensive drug regimen for the individual patient. © 2010 Springer Science+Business Media, LLC.

From the organisation of nursing care to the quality of care and the management of human resources, the healthcare manager is the linchpin uniting the different players close to the patient. To ensure this continuity, the healthcare manager relies on a value common to caregivers: the professional conscience. ©2014 Elsevier Masson SAS. All rights reserved.

Ades L.,Hopital Avicenne
Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program | Year: 2011

Based on immune mechanisms that appear to play an important role in the pathophysiology of at least part of the lower-risk myelodysplastic syndrome (MDS), the immunomodulating drug (IMID) thalidomide and its derivative lenalidomide (LEN) have been used in MDS, principally in lower-risk MDS. LEN has become the first-line US Food and Drug Administration (FDA)-approved treatment for lower-risk MDS with 5q deletion (del5q), in which its main mechanism of action is probably a direct cytotoxic activity on the del5q clone. This possibly specific effect is currently being investigated in higher-risk MDS-and even acute myeloid leukemia (AML)-with del5q, but LEN has also demonstrated some efficacy in MDS and AML without del5q. Thalidomide also has some activity in lower-risk MDS without del5q, but its side effects limit its practical use in these patients.

Mourad J.-J.,Hopital Avicenne
Journal of Hypertension | Year: 2011

Fixed-dose combinations have been strongly endorsed by European guidelines for first-line and second-line treatment of hypertension. Among recommended combinations, that of an angiotensin-converting enzyme inhibitor and a calcium channel blocker stands out because the mechanisms of action of these two therapeutic classes are complementary, leading to enhanced efficacy. In the large multicentre ASCOT-BPLA trial, treatment based on the combination of amlodipine and perindopril significantly reduced the risk of cardiovascular and all-cause death, stroke, coronary events and procedures, new-onset diabetes, and new-onset renal impairment in a wide range of patients with hypertension and other cardiovascular risk factors, when compared with atenolol/thiazide-based therapy. The perindopril/amlodipine single-pill combination was developed based on guideline recommendations for combination treatment, the indications of each component, and ASCOT-BPLA trial data. Several studies in real-life settings show that a wide range of hypertensive patients, including everyday hypertensives with common risk factors, would benefit from the perindopril/amlodipine combination. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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