Hopitaux Universitaires Of Lest Parisien

Saint-Antoine-du-Rocher, France

Hopitaux Universitaires Of Lest Parisien

Saint-Antoine-du-Rocher, France
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PubMed | Besancon University Hospital Center, LASER, Hopitaux Universitaires Of Lest Parisien, University of Bordeaux Segalen and 9 more.
Type: Journal Article | Journal: Haematologica | Year: 2016

This prospective observational cohort study aimed to explore the clinical features of incident immune thrombocytopenia in adults and predictors of outcome, while determining if a family history of autoimmune disorder is a risk factor for immune thrombocytopenia. All adults, 18 years of age or older, recently diagnosed with immune thrombocytopenia were consecutively recruited across 21 hospital centers in France. Data were collected at diagnosis and after 12 months. Predictors of chronicity at 12 months were explored using logistic regression models. The association between family history of autoimmune disorder and the risk of developing immune thrombocytopenia was explored using a conditional logistic regression model after matching each case to 10 controls. One hundred and forty-three patients were included: 63% female, mean age 48 years old (Standard Deviation=19), and 84% presented with bleeding symptoms. Median platelet count was 1010(9)/L. Initial treatment was required in 82% of patients. After 12 months, only 37% of patients not subject to disease-modifying interventions achieved cure. The sole possible predictor of chronicity at 12 months was a higher platelet count at baseline [Odds Ratio 1.03; 95%CI: 1.00, 1.06]. No association was found between outcome and any of the following features: age, sex, presence of either bleeding symptoms or antinuclear antibodies at diagnosis. Likewise, family history of autoimmune disorder was not associated with incident immune thrombocytopenia. Immune thrombocytopenia in adults has been shown to progress to a chronic form in the majority of patients. A lower platelet count could be indicative of a more favorable outcome.

Pilon A.,University Paris - Sud | Pilon A.,Hopitaux Universitaires Of Lest Parisien | Pous C.,University Paris - Sud | Pous C.,Hopitaux Universitaires Paris Sud
Medecine/Sciences | Year: 2013

Cytoplasm organization greatly depends on the cytoskeleton and especially on microtubules. Their multiple roles comprise for instance long-distance vesicular traffic or the organization of several signalling pathways. A variety of cellular functions require highly dynamic microtubules, which alternate between growing and shrinking phases. Meanwhile, other functions use stable microtubules, in which tubulin often bears multiple post-translational modifications like acetylation. Recent progress has been made in understanding some molecular mechanisms that control microtubule dynamics or tubulin acetylation. These mechanisms reveal the high plasticity of microtubules and point out the importance of their compartmentalization at structural and functional levels.

Lepretre A.,Institut Universitaire de France | Ba I.,Hopital Psychiatrique de Thiaroye | Lacombe K.,University of Paris Pantheon Sorbonne | Lacombe K.,Hopitaux Universitaires Of Lest Parisien | And 13 more authors.
Journal of the International AIDS Society | Year: 2015

Objectives: Data on the extent of drug use and associated HIV, hepatitis C and hepatitis B infection in West Africa are lacking. The objectives of ANRS12244 UDSEN study were to estimate the size of the heroin and/or cocaine drug user (DU) population living in the Dakar area (Senegal), and assess the prevalence and risk factors of HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV), including behavioural determinants in this population, in order to set up an integrated prevention and treatment programme for DUs. Design and methods: A capture-recapture method was applied for population size estimation, whereas the respondentdriven sampling (RDS) method was used to recruit a sample of DUs living in the Dakar area and determine HIV, HBV and HCV prevalence. Behavioural data were gathered during face-to-face interviews, and blood samples were collected on dried blood spots for analysis in a central laboratory. Data analysis was performed using the RDS analysis tool, and risk factors were determined by logistic regression. Access to laboratory results was organized for the participants. Results: The size of the DU population in the Dakar area was estimated to reach 1324 (95% confidence interval (95% CI: 1281-1367)). Based on the 506 DUs included in the study, the HIV, HCV and HBV prevalence were 5.2% (95% CI: 3.8-6.3), 23.3% (95% CI: 21.2-25.2) and 7.9% (95% CI: 5.2-11.1), respectively. In people who inject drugs (PWID), prevalence levels increased to 9.4% for HIV and 38.9% for HCV (p=0.001 when compared to those who never injected). Women were more at risk of being HIV infected (prevalence: 13.04% versus 2.97% in males, p=0.001). Being PWID was a risk factor for HCV and HIV infection (odds ratio, OR: 2.7, 95% CI: 1.7-4.3, and OR: 4.3, 95% CI: 1.7-10.7, respectively), whereas older age and female sex were additional risk factors for HIV infection (10% increase per year of age, p=0.03 and OR: 4.9, 95% CI: 1.6-156, respectively). No specific determinant was associated with the risk of HBV infection. Conclusions: High HIV and HCV prevalence were estimated in this population of DUs (including non-injectors) living in the Dakar area, Senegal, whereas HBV prevalence was close to that of the global Senegalese population, reflecting a risk of infection independent of drug use. Women seem to be highly vulnerable and deserve targeted interventions for decreasing exposure to HIV, while behavioural risk factors for HIV and HCV include the use of unsafe injections, reflecting the urgent need for developing harm reduction interventions and access to opioid substitution therapy services. © 2015 Leprêtre A et al.

Renet S.,Groupe Hospitalier la Pitie Salpetriere | Renet S.,University Paris - Sud | Maritaz C.,Groupe Hospitalier la Pitie Salpetriere | Maritaz C.,Groupe Hospitalier Paris Saint Joseph | And 5 more authors.
Bulletin du Cancer | Year: 2016

Summary The care pathway of cancer patients is complex and therefore difficult to define. The oral anticancers (AKPO) have shown their benefits to patients and health professionals, however, the risks induced on the care pathway remain unknown. The objective of the study is to define, quantify the risks from AKPO and their effects on the care pathway (breakdown [Ds], rupture [Rt]). From the proposed care pathway model, FMEA method is used to analyze risks. For the 3 identified processes (1 monotherapy, 2 bitherapies: 2 AKPO or 1 AKPO/1 AKIV), analysis revealed an average of 91 risks, 173 Ds, 147 Rt, increased for 1 AKPO/1 AKIV therapy. The administration and delivery are the most risky steps. The lack of training and information of patients and healthcare professionals generates 80% of Ds and Rt. This model confirms the complexity, variability of the care pathway. The development of actions to improve town-hospital coordination and exchange of information is required to optimize and secure the route, confirming the objectives of "Plan Cancer 3". © 2015 Société Française du Cancer.

Fotiou D.,National and Kapodistrian University of Athens | Gerotziafas G.,French Institute of Health and Medical Research | Gerotziafas G.,Hopitaux Universitaires Of Lest Parisien | Kastritis E.,National and Kapodistrian University of Athens | And 2 more authors.
Expert Review of Hematology | Year: 2016

Introduction: Patients with multiple myeloma (MM) have an increased risk of venous thromboembolic (VTE) complications. The first reports of high VTE rates date back to 1999 but became more apparent with the introduction of novel agents in the treatment of MM and mostly with immunomodulatory drugs (IMiDs; thalidomide, lenalidomide and pomalidomide). Areas covered: Currently thromboprophylaxis is recommended for patients who receive IMiDs-based regimens and the type of thrombophrophylaxis is based on patient-, disease- and treatment-related risk factors. Making the distinction between the intrinsic risk of thrombosis in MM and the effect of therapy is crucial. The use of aspirin, low molecular weight heparins and warfarin are the recommended drugs but despite their appropriate use the rates of VTE are not completely eliminated. Expert commentary: Research into biomarkers of increased coagulability and their incorporation in risk assessment models could identify patients most likely to benefit from thromboprophylaxis but such models are not widely used in myeloma. © 2016 Informa UK Limited, trading as Taylor & Francis Group.

Lacombe K.,University Pierre and Marie Curie | Lacombe K.,Hopitaux Universitaires Of Lest Parisien | Lacombe K.,French Institute of Health and Medical Research | Valin N.,Hopitaux Universitaires Of Lest Parisien | And 14 more authors.
AIDS | Year: 2013

The efficacy and tolerance of telaprevir (TVR) was examined in 20 mostly cirrhotic HIV-hepatitis C genotype 1 (HCV-G1)-infected patients failing previous treatment with pegylated-interferon and ribavirin (PR). HCV-RNA less than 12IU/ml was observed in 35.3% of patients at W2, 55.0% at W4, 65.0% at W12 and 55.0% at W24. All patients with virological failure (n=9) exhibited V36M/R155K mutations. Early virological response was a determinant of HCV-RNA less than 12IU/ml at W24 (P<0.001). No grade 3-4 dermatological side-effects were reported. TVR-PR tritherapy appeared to be rather effective and well tolerated among difficult-to-treat HIV-HCV-G1 patients. © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Launay-Vacher V.,Service ICAR | Scotte F.,Service doncologie medicale | Scotte F.,University of Paris Descartes | Antoine E.-C.,Service doncologie medicale | And 2 more authors.
Journal de Pharmacie Clinique | Year: 2015

Among solid tumors, breast cancer has been a model of the benefit of targeted therapies, particularly with trastuzumab which reversed the prognosis of patients with HER-2 positive tumor, opening the way to the development of other anti-HER2 targeted therapies and a antibody-drug conjugate. The past two years have seen the arrival of a specific pharmaceutical form of trastuzumab, allowing subcutaneously and fixed-dose administration. Attention has also been paid to a second targeted biotherapy in breast cancer: bevacizumab. Data from IMELDA and TANIA studies pose questions, and provide answers, on the administration sequence as compared to chemotherapy and the maintenance of antiangiogenic pressure using bevacizumab in this type of tumor. We propose here a review of data from the past two years on these two drugs in this indication.

PubMed | University of Monastir, University Pierre and Marie Curie, Hopitaux Universitaires Henri Mondor and Hopitaux Universitaires Of Lest Parisien
Type: Journal Article | Journal: Intensive care medicine | Year: 2015

Previous clinical trials suggested that inhaled nitric oxide (iNO) could have beneficial effects in sickle cell disease (SCD) patients with acute chest syndrome (ACS).To determine whether iNO reduces treatment failure rate in adult patients with ACS, we conducted a prospective, double-blind, randomized, placebo-controlled clinical trial. iNO (80 ppm, N = 50) gas or inhaled nitrogen placebo (N = 50) was delivered for 3 days. The primary end point was the number of patients with treatment failure at day 3, defined as any one of the following: (1) death from any cause, (2) need for endotracheal intubation, (3) decrease of PaO2/FiO2 15 mmHg between days 1 and 3, (4) augmented therapy defined as new transfusion or phlebotomy.The two groups did not differ in age, gender, genotype, or baseline characteristics and biological parameters. iNO was well tolerated, although a transient decrease in nitric oxide concentration was mandated in one patient. There was no significant difference in the primary end point between the iNO and placebo groups [23 (46 %) and 29 (58 %); odds ratio (OR), 0.8; 95 % CI, 0.54-1.16; p = 0.23]. A post hoc analysis of the 45 patients with hypoxemia showed that those in the iNO group were less likely to experience treatment failure at day 3 [7 (33.3 %) vs 18 (72 %); OR = 0.19; 95 % CI, 0.06-0.68; p = 0.009].iNO did not reduce the rate of treatment failure in adult SCD patients with mild to moderate ACS. Future trials should target more severely ill ACS patients with hypoxemia.NCT00748423.

Aubard Y.,Limoges University Hospital Center | Poirot C.,Hopitaux Universitaires Of Lest Parisien
Journal de Gynecologie Obstetrique et Biologie de la Reproduction | Year: 2013

We reviewed the studies about fertility-sparing in young patient presenting a benign ovarian tumor. It appears that more than the histologic nature of the ovarian cysts, it is the surgical treatment of the cyst which may decrease fertility. Some good practice of surgical procedures must be kept in mind when one manages a benign ovarian tumor in a young patient wishing to preserve her fertility: surgery should be avoided as much as possible; kystectomy is better than oophorectomy; no radical surgery should be done without pathological certitudes; electrocoagulation must be avoided on the cyst walls. In some situations, fertility is specially endangered: bilateral ovarian cysts, recurrence or strong probability of recurrence (endometriomas), poor ovarian reserve (previous chemo- or radiotherapy, age > 35, premature ovarian failure). In these situations, a pre-operative assessment of the ovarian reserve could be useful. Beside the surgical 'good procedures', gamete cryopreservation procedures could be used. Cryopreservation of mature oocytes (after ovarian hyperstimulation) or in vitro mature oocytes (after antral follicle retrieval) can be proposed. Ovarian tissue cryopreservation is another option. Oocyte (or embryos) cryopreservation can be proposed before or after the surgery. The global management of benign ovarian tumors in young patients should be decided between surgeons and specialists in reproductive biology. © 2013 Elsevier Masson SAS. All rights reserved.

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