Éditeur(s) : HAL CCSD Wiley
Résumé : International audience
Clin Microbiol Infect ABSTRACT: Atypical Toxoplasma gondii strains, unrelated to archetypal clonal lineages (I, II, III), have been reported more frequently over the last decade in areas other than Europe and North America. A newly described form of toxoplasmosis, 'Amazonian toxoplasmosis' (AT), has been reported since 2002 in French Guiana. It is characterized by severe cases and atypical strains linked to a neotropical forest-based cycle. We report on the cases of AT that required intensive care management. We performed a prospective observational study on hospitalized adults in the Intensive Care Unit (ICU) from 2002 to 2008. Clinical and laboratory data, microbiological findings and outcomes were recorded. Data, including the ICU simplified acute physiology score and the pneumonia severity index, were calculated. Epidemiological risk factors for AT were assessed through questionnaires. Eleven non-immunodeficient patients were admitted to the ICU in Cayenne for life-threatening pneumonia associated with disseminated toxoplasmosis. Mechanical ventilation was necessary in seven patients, four of whom required immediate orotracheal intubation. Cardiac and ophthalmological abnormalities were found in five and four patients, respectively. One patient died from multiple organ failure. The genetic characterization of Toxoplasma DNA using six microsatellite markers revealed unique and atypical genotypes in eight patients. All patients presented epidemiological risk factors for AT. In French Guiana, significant T. gondii-related infectious syndrome associated with the lungs, a high level of LDH activity and the reported risk factors for AT was strongly suggestive of disseminated toxoplasmosis with a possible trend toward life-threatening pneumonia.
ISSN: 1198-743X

hal-00678752
https://hal-unilim.archives-ouvertes.fr/hal-00678752
DOI : 10.1111/j.1469-0691.2011.03648.x
PUBMED : 21958195

Éditeur(s) : HAL CCSD Oxford University Press (OUP)
Résumé : International audience
BACKGROUND: HIV cohort collaborations, which pool data from diverse patient cohorts, have provided key insights into outcomes of antiretroviral therapy (ART). However, the extent of, and reasons for, between-cohort heterogeneity in rates of AIDS and mortality are unclear. METHODS: We obtained data on adult HIV-positive patients who started ART from 1998 without a previous AIDS diagnosis from 17 cohorts in North America and Europe. Patients were followed up from 1 month to 2 years after starting ART. We examined between-cohort heterogeneity in crude and adjusted (age, sex, HIV transmission risk, year, CD4 count and HIV-1 RNA at start of ART) rates of AIDS and mortality using random-effects meta-analysis and meta-regression. RESULTS: During 61 520 person-years, 754/38 706 (1.9%) patients died and 1890 (4.9%) progressed to AIDS. Between-cohort variance in mortality rates was reduced from 0.84 to 0.24 (0.73 to 0.28 for AIDS rates) after adjustment for patient characteristics. Adjusted mortality rates were inversely associated with cohorts' estimated completeness of death ascertainment [excellent: 96-100%, good: 90-95%, average: 75-89%; mortality rate ratio 0.66 (95% confidence interval 0.46-0.94) per category]. Mortality rate ratios comparing Europe with North America were 0.42 (0.31-0.57) before and 0.47 (0.30-0.73) after adjusting for completeness of ascertainment. CONCLUSIONS: Heterogeneity between settings in outcomes of HIV treatment has implications for collaborative analyses, policy and clinical care. Estimated mortality rates may require adjustment for completeness of ascertainment. Higher mortality rate in North American, compared with European, cohorts was not fully explained by completeness of ascertainment and may be because of the inclusion of more socially marginalized patients with higher mortality risk.
ISSN: 0300-5771

hal-00875138
https://hal.archives-ouvertes.fr/hal-00875138
DOI : 10.1093/ije/dys164
PUBMED : 23148105

Résumé : Nous avons étudié les marqueurs hémorhéologiques, hématologiques et biochimiques chez des sujets drépanocytaires homozygotes SS (HbS/HbS) et hétérozygotes composites SC (HbS/HbC) dans deux cohortes, pédiatriques et adultes, de patients drépanocytaires, et ce, à travers 7 complications récurrentes de la drépanocytose : 2 appartenant au profil hémolytique (l’ulcère de jambes et la glomérulopathie) et 5 appartenant au phénotype visqueux/vaso-occlusif (l’hypertension artérielle, le syndrome thoracique aigu (STA), la crise vaso-occlusive (CVO), la rétinopathie et l’ostéonécrose). Nous avons montré que : 1) une viscosité sanguine et une déformabilité érythrocytaire élevées sont des facteurs de risques de CVO chez les enfants homozygotes ; 2) Une viscosité sanguine élevée est associée à une hypertension artérielle systémique relative chez des adultes SS ; 3) les enfants SC présente une fonction vasculaire mieux préservée que les enfants SS pour faire face à une augmentation de la viscosité sanguine ; 4) les patients adultes SS avec une ostéonécrose présentent une déformabilité érythrocytaire plus élevée que les patients sans ostéonécrose ; 5) une viscosité sanguine élevée est associée à la présence d’une rétinopathie chez les adultes SC mais pas chez les SS ; 6) les patients adultes SS présentant une glomérulopathie ont un taux d’hémolyse élevé, une déformabilité érythrocytaire réduite et des agrégats érythrocytaires très robustes ; 7) les patients adultes SS avec des ulcères de jambes récurrents ont un taux d’hémolyse accru et une déformabilité érythrocytaire réduite. De plus, nos travaux confirment que l’-thalassémie module les propriétés de déformabilité érythrocytaire, mais montrent pour la première fois qu’elle module aussi les propriétés d’agrégation érythrocytaire, et notamment la force des agrégats érythrocytaires. En conclusion, ces travaux permettent de préciser le rôle de la rhéologie sanguine dans un certain nombre de complications de la drépanocytose et d’enrichir le modèle préexistant divisant les complications de la drépanocytose selon 2 phénotypes : hémolytique versus visqueux/vaso-occlusif. Nous montrons pour la première fois que le phénotype hémolytique est caractérisé aussi par des anomalies de la rhéologie du globule rouge : rigidité accrue et agrégats érythrocytaire robustes.
Hemorheological, hemathological, and biochemical marquers of patients with sickle cell anemia (SS) and patients with sickle cell SC disease (SC) were studied in 2 cohorts: children and adults. We focused on 7 recurrent complications: 5 belonging to the viscosity/vaso-occlusion phenotype (systemic hypertension, acute chest syndrome (ACS), vaso-occlusive crisis (VOC), retinopathy and osteonecrosis) and 2 belonging to the hemolytic phenotype (leg ulcer and glomerulopathy). Our results show that 1) high viscosity is associated with increased risk for VOC in SS children; 2) blood viscosity is increased in SS adults with systemic relative hypertension; 3) SC children have preserved vascular function compared to SS children; 4) SS adults with osteonecrosis are characterized by higher red blood cell (RBC) deformability than SS adults without osteonecrosis; 5) high blood viscosity is associated with retinopathy in SC adults but not in SS adults; 6) SS adults affected by glomerulopathy have high hemolytic rate, low RBC deformability and increased RBC aggregates strenght; 7) SS adults with recurrent leg ulcers have high hemolytic rate and reduced RBC deformability. Moreover, our studies shows that alpha-thalassemia modulate RBC deformability and RBC aggregation properties. In conclusion, this work shows for the first time that the hemolytic phenotype is characterized by an abnormal RBC rheology which may play a role in several sickle cell complications.

http://www.theses.fr/2013AGUY0684/document

Éditeur(s) : HAL CCSD MDPI
Résumé : International audience
The decline in children's Blood Lead Levels (BLL) raises questions about the ability of current lead poisoning screening criteria to identify those children most exposed. The objectives of the study were to evaluate the performance of current screening criteria in identifying children with blood lead levels higher than 50 µg/L in France, and to propose new criteria. Data from a national French survey, conducted among 3831 children aged 6 months to 6 years in 2008-2009 were used. The sensitivity and specificity of the current criteria in predicting blood lead levels higher than or equal to 50 µg/L were evaluated. Two predictive models of BLL above 44 µg/L (for lack of sufficient sample size at 50 µg/L) were built: the first using current criteria, and the second using newly identified risk factors. For each model, performance was studied by calculating the area under the ROC (Receiver Operating Characteristic) curve. The sensitivity of current criteria for detecting BLL higher than or equal to 50 µg/L was 0.51 (0.26; 0.75) and specificity was 0.66 (0.62; 0.70). The new model included the following criteria: foreign child newly arrived in France, mother born abroad, consumption of tap water in the presence of lead pipes, pre-1949 housing, period of construction of housing unknown, presence of peeling paint, parental smoking at home, occupancy rates for housing and child's address in a cadastral municipality or census block comprising more than 6% of housing that is potentially unfit and built pre-1949. The area under the ROC curve was 0.86 for the new model, versus 0.76 for the current one. The lead poisoning screening criteria should be updated. The risk of industrial, occupational and hobby-related exposure could not be assessed in this study, but should be kept as screening criteria
ISSN: 1660-4601

hal-01239804
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01239804
DOI : 10.3390/ijerph121214989
PUBMED : 26633457

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
The nine countries sharing the Amazon forest accounted for 89% of all malaria cases reported in the Americas in 2008. Remote sensing can help identify the environmental determinants of malaria transmission and their temporo-spatial evolution. Seventeen studies characterizing land cover or land use features, and relating them to malaria in the Amazon subregion, were identified. These were reviewed in order to improve the understanding of the land cover/use class roles in malaria transmission. The indicators affecting the transmission risk were summarized in terms of temporal components, landscape fragmentation and anthropic pressure. This review helps to define a framework for future studies aiming to characterize and monitor malaria.
ISSN: 1475-2875

inserm-00834790
http://www.hal.inserm.fr/inserm-00834790
http://www.hal.inserm.fr/inserm-00834790/document
http://www.hal.inserm.fr/inserm-00834790/file/1475-2875-12-192.pdf
DOI : 10.1186/1475-2875-12-192

Éditeur(s) : HAL CCSD Springer Verlag
Résumé : International audience
In France, reducing social health inequalities has become an explicit goal of health policies over the past few years, one of its objectives is specifically the reduction of the perinatal mortality rate. This study investigates the association between infant mortality and social deprivation categories at a small area level in the Lille metropolitan area, in the north of France, to identify census blocks where public authorities should prioritize appropriate preventive actions. We used census data to establish a neighbourhood deprivation index whose multiple dimensions encompass socioeconomic characteristics. Infant mortality data were obtained from the Lille metropolitan area municipalities to estimate a death rate at the census tract level. We used Bayesian hierarchical models in order to reduce the extra variability when computing relative risks (RR) and to assess the associations between infant mortality and deprivation. Between 2000 and 2009, 668 cases of infant death occurred in the Lille metropolitan area (4.2 per 1,000 live births). The socioeconomic status is associated with infant mortality, with a clear gradient of risk from the most privileged census blocks to the most deprived ones (RR = 2.62, 95 % confidence interval [1.87; 3.70]). The latter have 24.6 % of families who were single parents and 29.9 % of unemployed people in the labor force versus 8.5 % and 7.7 % in the former. Our study reveals socio-spatial disparities in infant mortality in the Lille metropolitan area and highlights the census blocks most affected by the inequalities. Fine spatial analysis may help inform the design of preventive policies tailored to the characteristics of the local communities.
ISSN: 1092-7875

hal-00876255
https://hal.archives-ouvertes.fr/hal-00876255
DOI : 10.1007/s10995-013-1251-8
PUBMED : 23479336

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
BACKGROUND: Hepatocellular carcinoma (HCC) is a particularly severe disease characterized by a high rate of recurrence and death even after surgical resection. Molecular characterization of HCC helps refine prognosis and may facilitate the development of improved therapy. Phosphatidylinositol 4-kinases have recently been identified as cellular factors associated with cancer. Also, phosphatidylinositol 4-kinase type IIIα (PI4KA) is necessary for the propagation of the hepatitis C virus, a major etiological factor for HCC. METHODS: Reverse transcription, quantitative real-time PCR was used to assay PI4KA mRNA. The expression levels were investigated both in a collection of molecularly and clinically characterized hepatic tissues from 344 patients with diverse liver diseases and in human hepatocyte cell lines whose proliferative and differentiation status was controlled by specific culture conditions. Analytical microarray data for 60 HCC and six normal liver tissue samples were exploited to study correlations between PI4KA mRNA levels and cell proliferation markers in vivo. Postoperative disease-specific survival and time to recurrence in a set of 214 patients with HCC were studied by univariate and multivariate analyses. RESULTS: PI4KA mRNA was more abundant in HCC than normal healthy tissues. This upregulation correlated significantly with both poor differentiation and the active proliferation rate in HCC. These associations were confirmed with in vitro models. Moreover, patients with HCC who had been treated by surgical resection and had higher PI4KA mRNA concentrations in their tumor tissue exhibited a higher risk of tumor recurrence (median time: 20 months versus 49 months, P = 0.0012) and shorter disease-specific survival (first quartile time: 16 months versus 48 months, P = 0.0004). Finally, the abundance of PI4KA mRNA proved to be an independent prognostic marker of survival for cases of HCC (hazard ratio = 2.36, P = 0.0064). CONCLUSIONS: PI4KA mRNA could be used as a new molecular marker to improve established prognostic models for HCC. These findings also indicate possible new lines of research for the development of innovative therapeutic approaches targeting PI4KA.
ISSN: 1471-2407

inserm-00934294
http://www.hal.inserm.fr/inserm-00934294
http://www.hal.inserm.fr/inserm-00934294/document
http://www.hal.inserm.fr/inserm-00934294/file/1471-2407-14-7.pdf
DOI : 10.1186/1471-2407-14-7

Éditeur(s) : Communication, ICES Conference and Meeting (CM), 2010, Nantes
Résumé : Chlordecone is a very persistent insecticide used in banana plantations of the French West Indies between 1972 and 1993. Chlordecone residues were found in inland water, in agricultural and freshwater products, and in marine organisms. This pollution has become of great concern in 2007. Therefore, a governmental action Plan was launched to better assess the pollution and to improve the consumer’s protection. Within this plan, 1048 samples from 69 different species of marine fishes and crustaceans were collected all around both the Guadeloupe and the Martinique Islands and analyzed. The results confirm the presence of chlordecone in marine organisms, with highly variable concentrations (from the detection limit to 1000 μg.kg-1). In 17.9 % of the samples, concentrations exceeded 20 μg.kg-1, the maximum acceptable level in fish according to the French regulation (Anon, 2008). Two main features of this contamination were characterized. 1) Because of the sedimentation of contaminated suspended soil particles, the sheltered bays are more exposed to chlordecone than the open coast where terrigenous flux are dispersed. 2) Species biology, particularly their lifestyle and diet, appear to influence contamination levels. Thus, the more contaminated species live in relation with sediment or are at high trophic level. These results have directly supported political decisions in order to prevent too high exposure of consumers to chlordecone. Fishing activities in sheltered bays have been forbidden for potentially highly contaminated species like benthic crustaceans and top predators. Further studies are under way to assess the importance of the trophic transport of chlordecone within the foodweb, and to evaluate the historical deposition of this insecticide in sediment and its further bioavailability.

Droits : 2010 ICES/CIEM ; Ifremer
http://archimer.ifremer.fr/doc/00014/12511/9361.pdf
http://archimer.ifremer.fr/doc/00014/12511/

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Big storm events represent a major risk for populations and infrastructures settled on coastal lowlands. In the Western Mediterranean, where human societies colonized and occupied the coastal areas since the Ancient times, the variability of storm activity for the past three millennia was investigated with a multi-proxy sedimentological and geochemical study from a lagoonal sequence. Mappings of the geochemistry and magnetic susceptibility of detrital sources in the watershed of the lagoon and from the coastal barriers were undertaken in order to track the terrestrial or coastal/marine origin of sediments deposited into the lagoon. The multi-proxy analysis shows that coarser material, low magnetic susceptibility, and high strontium content characterize the sedimentological signature of the paleostorm levels identified in the lagoonal sequence. A comparison with North Atlantic and Western Mediterranean paleoclimate proxies shows that the phases of high storm activity occurred during cold periods, suggesting a climatically-controlled mechanism for the occurrence of these storm periods. Besides, an in-phase storm activity pattern is found between the Western Mediterranean and Northern Europe. Spectral analyses performed on the Sr content revealed a new 270-year solar-driven pattern of storm cyclicity. For the last 3000 years, this 270-year cycle defines a succession of ten major storm periods (SP) with a mean duration of 96 ± 54 yr. Periods of higher storm activity are recorded from >680 to 560 cal yr BC (SP10, end of the Iron Age Cold Period), from 140 to 820 cal yr AD (SP7 to SP5) with a climax of storminess between 400 and 800 cal yr AD (Dark Ages Cold Period), and from 1230 to >1800 cal yr AD (SP3 to SP1, Little Ice Age). Periods of low storm activity occurred from 560 cal yr BC to 140 cal yr AD (SP9 and SP8, Roman Warm Period) and from 820 to 1230 cal yr AD (SP4, Medieval Warm Period).
ISSN: 0277-3791

hal-01277796
https://hal.archives-ouvertes.fr/hal-01277796
DOI : 10.1016/j.quascirev.2015.10.009

Résumé : En Guyane comme dans l'ensemble de la région amazonienne, le risque de maladie de Chagas pour l'homme a longtemps été sous estimé du fait de l'absence de vecteur domestique et de l'existence d'un réservoir animal exclusivement sauvage. Le travail présenté répond aux besoins de compléter et d'actualiser les connaissances épidémiologiques disponibles sur la maladie de Chagas dans ce département , en précisant les modalités de circulation de Trypanosoma cruzi et les facteurs impliqués dans le cycle à l'origine des cas humains. Les données cumilées entre 2001 et 2023 représentent 971 spécimens de triatomes. Nous avons choisi de différencier les triatomes provenant des zones non habitées (forêts primaire ou secondaire) de ceux provenant de zones habitées, collectées dans les maisons à la faveur d'intrusion. Une espère, Panstrongylus geniculatus, s'est distinguée par son abondance (61,1%) et son omniprésence dans les différents types de milieux explorés. Au total, neuf espèces ont été retrouvées. En zone non habitée, avec une prédominance de P. geniculatus, P. lignarius, Rhodnius pictipes et R. robustus. L'infection des triatomes par T. cruzi a été étudiée, avec une mise en évidence d'un taux d'infection plus élevé chez les triatomes collectés à l'intérieur des habitations (53.9%) que chez ceux provenant des zones non habitées (46%). L'étude sur les mammifères sauvages a montré des taux d'infection élevés pour T. cruzi chez deux espèces : didelphis marsupialis (62.5%) et Philander opossum (35%). Cette étude a été complétée par l'analyse de la variabilité génétique de T. cruzi identifié par des techniques de génotypage réalisées sur du matériel obtenu à partir de triatomes, de mammifères sauvages et domestiques et des hommes. En zone non habitée trois groupes, TcI, TcII-TcV-TcVI et TcIII-TcIV, ont été caractérisés, avec une prédominance de TcI. Parmi les acteurs du cycle parasite, les chiens et P. geniculatus hébergent le groupe TcIII-TcIV à la différence du genre Rhodnius et des marsupiaux qui hébergent le groupe TcI. Nos résultats ont permis d'émettre un certain nombre d'hypothèses sur la circulation des génotypes de T. cruzi en Guyane
In French Guiana, as in the whole of Amazon region, the risk of Chagas disease to humans has long been underestimated due to the presence of non-domiciled triatomines and wild animal reservoir. Overall, this thesis aims at reactualizing and improving epidemiological knowledge about Chagas disease in French Guiana, by specific modalities of circulation of Trypanosoma cruzi and the factorsinvolved in the transmission cycle of the origin of human cases. Accumulated data, between 2001 and 2013, represent 971 triatomine specimens collected. We chose to differentiate triatomine collected in uninhabited areas (primary or secondary forests) and those frominhabited areas, collected in homes by intrusion. One species, Panstrongylus geniculatus, was distinguished by its abundance (61.1%) and its presence in different types of habitats investigated. A total of nine species were found in uninhabited area, with the predominance of four species: P. geniculatus, P. lignarius, Rhodnius pictipes and Eratyrus mucronatus. In inhabited area, five species of triatomine were collected, with the predominance of P. geniculatus, R. pictipes and R. robustus. The triatomine infection rate with T. cruzi has been studied, with a highlighting of higher rate of infection in triatomine collected inside houses (53.9%) than those from uninhabited area (46%). The study on wild mammals showed high T. cruzi infection rates for two species: Didelphis marsupialis (62.5%) and Philander opossum (35%).This study was completed by the analysis of the genetic variability of T. cruzi identified by genotyping techniques performed on material obtained from triatomine, wild and domestic mammals and humans. In uninhabited area, three groups$ TcI, TcII-TcV-TcVI and TcIII-TcIV have been characterized, with a predominance of TcIII-TcIV group. In inhabited area, only two groups were characterized (TcI andTcIII-TcIV), with a predominance of TcI. Among the actor’s transmission cycle of parasite, dogs and P. geniculatus were characterized by TcIII-TcIV group. Contrary to Rhodnius genus and marsupials were characterized by the TcI group. Our results have allowed issuing a number of assumptions about the circulation of T. cruzi genotypes in French Guiana

http://www.theses.fr/2013AGUY0734/document

Éditeur(s) : HAL CCSD BioMed Central
Résumé : International audience
UNLABELLED: ABSTRACT: BACKGROUND: Malaria remains a major health problem in French Guiana, with a mean of 3800 cases each year. A previous study in Camopi, an Amerindian village on the Oyapock River, highlighted the major contribution of environmental features to the incidence of malaria attacks. We propose a method for the objective selection of the best multivariate peridomestic landscape characterisation that maximises the chances of identifying relationships between environmental features and malaria incidence, statistically significant and meaningful from an epidemiological point of view. METHODS: A land-cover map, the hydrological network and the geolocalised inhabited houses were used to characterise the peridomestic landscape in eleven discoid buffers with radii of 50, 100, 200, 300, 400, 500, 600, 700, 800, 900 and 1000 metres. Buffer-based landscape characterisations were first compared in terms of their capacity to discriminate between sites within the geographic space and of their effective multidimensionality in variable space. The Akaike information criterion (AIC) was then used to select the landscape model best explaining the incidences of P. vivax and P. falciparum malaria. Finally, we calculated Pearson correlation coefficients for the relationships between environmental variables and malaria incidence, by species, for the more relevant buffers. RESULTS: The optimal buffers for environmental characterisation had radii of 100 m around houses for P. vivax and 400 m around houses for P. falciparum. The incidence of P. falciparum malaria seemed to be more strongly linked to environmental features than that of P. vivax malaria, within these buffers. The incidence of P. falciparum malaria in children was strongly correlated with proportions of bare soil (r = -0.69), land under high vegetation (r = 0.68) and primary forest (r = 0.54), landscape division (r = 0.48) and the number of inhabited houses (r = -0.60). The incidence of P. vivax malaria was associated only with landscape division (r = 0.49). CONCLUSIONS: The proposed methodology provides a simple and general framework for objective characterisation of the landscape to account for field observations. The use of this method enabled us to identify different optimal observation horizons around houses, depending on the Plasmodium species considered, and to demonstrate significant correlations between environmental features and the incidence of malaria.
ISSN: 1476-072X

inserm-00674075
http://www.hal.inserm.fr/inserm-00674075
http://www.hal.inserm.fr/inserm-00674075/document
http://www.hal.inserm.fr/inserm-00674075/file/1476-072X-10-65.pdf
DOI : 10.1186/1476-072X-10-65

Éditeur(s) : HAL CCSD John Libbey Eurotext
Résumé : International audience
The principal gynaecological cancers (breast, ovary, uterus, and cervix) account for over 40% of cancers found in women worldwide. However, large differences exist, in both their incidence and geographical distribution. The French West Indies, through their location, environment, socio-economic development, lifestyle, nutrition and the origins of their populations, constitute territories with a very particular character in the heart of the Caribbean. These characteristics have an impact on public health and can affect the incidence of tumours. We report for the first time the incidence of these major gynaecological cancers in Guadeloupe. Breast, ovary and uterine cancers have lower incidences in Guadeloupe than in mainland France. By contrast, cervical cancer is more frequent in Guadeloupe than in mainland France. The mortality rates associated with breast cancer, ovary and uterine cancer are also lower in Guadeloupe than in mainland France, whereas the opposite pattern is observed for cervical cancer. These observations may be accounted for in part by a difference in the prevalence of established or suspected risk factors for each of these types of cancer.
ISSN: 0007-4551

inserm-00504624
http://www.hal.inserm.fr/inserm-00504624
DOI : 10.1684/bdc.2008.0810
PUBMED : 19258222

Éditeur(s) : HAL CCSD International Medical Press
Résumé : International audience
Background: Although the role of clinical/biological factors associated with mortality has already been explored in HIV-infected patients on antiretroviral therapy (ART), to date little attention has been given to the potential role of social vulnerability. This study aimed to construct an appropriate measure of social vulnerability and to evaluate whether this measure is predictive of increased mortality risk in ART-treated patients followed up in the ANRS CO8 APROCO-COPILOTE cohort.Methods: The cohort enrolled 1,281 patients initiating a protease inhibitor-based regimen in 1997–1999. Clinical/laboratory data were collected every 4 months. Self-administered questionnaires collected psycho-social/behavioural characteristics at enrolment (month [M] 0), M4 and every 8–12 months thereafter. A multiple correspondence analysis using education, employment and housing indicators helped construct a composite indicator measuring social vulnerability. The outcome studied was all-cause deaths occurring after M4. The relationship between social vulnerability and mortality, after adjustment for other predictors, was studied using a shared-frailty Cox model, taking into account informative study dropout.Results: Over a median (IQR) follow-up of 7.9 (3.0–11.2) years, 121 deaths occurred among 1,057 eligible patients, corresponding to a mortality rate (95% CI) of 1.64 (1.37, 1.96)/100 person-years. Leading causes of death were non-AIDS defining cancers (n=26), AIDS (n=23) and cardiovascular diseases (n=12). Social vulnerability (HR [95% CI] =1.2 [1.0, 1.5]) was associated with increased mortality risk, after adjustment for other known behavioural and bio-medical predictors.Conclusions: Social vulnerability remains a major mortality predictor in ART-treated patients. A real need exists for innovative interventions targeting individuals cumulating several sources of social vulnerability, to ensure that social inequalities do not continue to lead to higher mortality.
ISSN: 1359-6535

hal-01299300
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01299300
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01299300/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01299300/file/Twelve-year%20mortality%20in%20HIV-infected%20patients_accepted.pdf
DOI : 10.3851/IMP2960

Éditeur(s) : HAL CCSD Endocrine Society
Résumé : International audience
The Developmental Origins of Health and Disease (DOHaD) paradigm is one of the most rapidly expanding areas of biomedical research. Environmental stressors that can impact on DOHaD encompass a variety of environmental and occupational hazards as well as deficiency and oversupply of nutrients and energy. They can disrupt early developmental processes and lead to increased susceptibility to disease/dysfunctions later in life. Presentations at the fourth Conference on Prenatal Programming and Toxicity in Boston, in October 2014, provided important insights and led to new recommendations for research and public health action. The conference highlighted vulnerable exposure windows that can occur as early as the preconception period and epigenetics as a major mechanism than can lead to disadvantageous "reprogramming" of the genome, thereby potentially resulting in transgenerational effects. Stem cells can also be targets of environmental stressors, thus paving another way for effects that may last a lifetime. Current testing paradigms do not allow proper characterization of risk factors and their interactions. Thus, relevant exposure levels and combinations for testing must be identified from human exposure situations and outcome assessments. Testing of potential underpinning mechanisms and biomarker development require laboratory animal models and in vitro approaches. Only few large-scale birth cohorts exist, and collaboration between birth cohorts on a global scale should be facilitated. DOHaD-based research has a crucial role in establishing factors leading to detrimental outcomes and developing early preventative/remediation strategies to combat these risks
ISSN: 0013-7227

hal-01187409
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01187409
DOI : 10.1210/EN.2015-1350
PUBMED : 26241067

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
BACKGROUND: Mutations in the telomerase complex (TERT and TR) are associated with pulmonary fibrosis and frequent hematologic manifestations. The aim of this study was to characterize the prognosis of lung transplantation in patients with TERT or TR mutations. METHODS: Patients with documented TERT or TR mutations who received a lung transplant between 2007 and 2013 in France were identified via an exhaustive search of the lung transplantation network, one expert genetic laboratory, and the clinical research network on rare pulmonary diseases. RESULTS: There were 9 patients (7 men) with TERT (n = 6) or TR (n = 3) mutations who received a single (n = 8) or a double (n = 1) lung transplant for pulmonary fibrosis. Median age was 50 years (range, 35-61 years) at diagnosis and 52 years (range, 37-62 years) at the time of lung transplantation. Thrombocytopenia was present in 7 patients before lung transplantation. After lung transplantation, 6 patients developed myelodysplasia and/or bone marrow failure, directly contributing to death in 4 cases. Anemia was observed in 9 patients, and neutropenia was observed in 3 patients. The median survival after lung transplantation was 214 days (range, 59-1,709 days). CONCLUSIONS: Patients with mutations of the telomerase complex are at high risk of severe hematologic complications after lung transplantation, in particular, bone marrow failure. Specific recommendations should be developed for appropriate guidance regarding hematologic risk assessment before transplantation and management of the post-transplantation immunosuppressive regimen.
ISSN: 1053-2498

hal-01146848
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01146848
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01146848/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01146848/file/Severe%20hematological%20complications%20after%20lung%20transplantation_accepted.pdf
DOI : 10.1016/j.healun.2014.11.010

Éditeur(s) : HAL CCSD Wiley
Résumé : The evolutionary potential of long-lived species, such as forest trees, is fundamental for their local persistence under climate change (CC). Genome–environment association (GEA) analyses reveal if species in heterogeneous environments at the regional scale are under differential selection resulting in populations with potential preadaptation to CC within this area. In 79 natural [i]Fagus sylvatica[/i] populations, neutral genetic patterns were characterized using 12 simple sequence repeat (SSR) markers, and genomic variation (144 single nucleotide polymorphisms (SNPs) out of 52 candidate genes) was related to 87 environmental predictors in the latent factor mixed model, logistic regressions and isolation by distance/environmental (IBD/IBE) tests. SSR diversity revealed relatedness at up to 150m intertree distance but an absence of large-scale spatial genetic structure and IBE. In the GEA analyses, 16 SNPs in 10 genes responded to one or several environmental predictors and IBE, corrected for IBD, was confirmed. The GEA often reflected the proposed gene functions, including indications for adaptation to water availability and temperature. Genomic divergence and the lack of large-scale neutral genetic patterns suggest that gene flow allows the spread of advantageous alleles in adaptive genes. Thereby, adaptation processes are likely to take place in species occurring in heterogeneous environments, which might reduce their regional extinction risk under CC
ISSN: 0028-646X

hal-01309135
https://hal.archives-ouvertes.fr/hal-01309135
PRODINRA : 343710
DOI : 10.1111/nph.13809

Éditeur(s) : Elsevier
Résumé : in this study we evaluated the effects of the probiotic Pediococcus acidilactici MA18/5M on shrimp, Litopenaeus stylirostris (also called Penaeus stylirostris), first on antioxidant defences and secondly on the oxidative stress status in the shrimps' haemolymph and digestive gland. We conducted two experiments with the same protocol in which shrimps were fed two diets for three weeks: a control diet and a probiotic diet containing 1 g of live P. acidilactici MA18/5M kg(-1). In the first experiment, the shrimps were found to be healthy over the trial period; no mortalities and non-detectable signs of infection were recorded. These resulted in high final survival rates (above 90% in both treatments). On the other hand, during the second trial, carried out at a period of increased risk for an outbreak of the summer syndrome, higher mortalities were recorded, associated with high V. nigripulchritudo prevalence and loads in the shrimp haemolymph. In healthy shrimps (trial 1), no detectable response of the antioxidant defence system and of oxidative stress bio-indicators were observed. However, feeding the probiotic significantly increased the total antioxidant status (TAS) and glutathione peroxidase activity, while all other parameters remained significantly unchanged. In the shrimps exposed to V nigripulchritudo (trial 2), the antioxidant response was characterized by higher antioxidant enzyme activities (superoxide dismutase and catalase) and higher oxidative stress level in the digestive gland (higher oxidized/reduced glutathione ratio, higher malonclialdehyde and carbonyl protein contents) compared to levels found in trial 1. However, shrimps fed the probiotic diet exhibited (i) significantly higher final survival rates (67 +/- 3%) compared to the control (47 +/- 4%) and (ii) a lower prevalence of V nigripulchritudo throughout the trial. Moreover, the antioxidant response and the oxidative stress level recorded in the digestive gland with shrimps submitted to the probiotic diet were lower. In the light of these results, we confirm that P acidilactici enrichment in shrimps' diet seems an effective way of reducing the susceptibility of shrimps to bacterial pathogens. (c) 2009 Elsevier B.V. All rights reserved.
Aquaculture (0044-8486) (Elsevier), 2009-09 , Vol. 294 , N. 3-4 , P. 306-313

Droits : 2009 Elsevier B.V. All rights reserved.
http://archimer.ifremer.fr/doc/2009/publication-6780.pdf
DOI:10.1016/j.aquaculture.2009.06.016
http://archimer.ifremer.fr/doc/00000/6780/

Éditeur(s) : HAL CCSD Springer Verlag
Résumé : International audience
We aimed to assess the impact of a postoperative drainage after RPN. A retrospective multicentric study included RPN performed at eight centers between 2010 and 2014. Three centers stopped using postoperative drainage early in their RPN experience, whereas other institutions systematically left a drain. Preoperative characteristics, complication rates, need for postoperative imaging or procedure (surgical or radiological) and length of hospital stay were compared between the two groups [drainage (D) and no drainage (ND)]. Among 636 RPNs, 140 were done without drainage (22 %). In the ND group, surgeons were more experienced (> 50 cases: 55.7 vs. 15.1 %; p < 0.0001), and tumors were more complex (RENAL score: 7.6 vs. 6.5; p < 0.0001). Complication rates were similar in both groups (21.9 vs. 20.2 %; p = 0.67). The omission of postoperative drainage did not increase requirement of CT scan (RR = 1.03; 95 % CI 0.64-1.67). Length of hospital stay was shorter in the ND group (4.5 vs. 5.5 days; p = 0.007). There were six urinary fistulas: four in the D group (0.8 %) and two in the ND group (1.4 %; p = 0.49). A CT scan was done to confirm the diagnosis of fistula in every case. In multivariate analysis, the omission of drainage was not associated with increased need of postoperative CT scan or major complications but was a predictor of decreased length of stay. The omission of postoperative drainage does not seem to increase the risk of postoperative complications and could safely be omitted after RPN.
ISSN: 0724-4983

hal-01361502
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01361502
DOI : 10.1007/s00345-015-1721-2
PUBMED : 26511751

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
Objective: To describe characteristics and outcomes of HIV-infected patients with Pneumocystis jirovecii pneumonia (PCP) over 2004–2011 in France, in particular in those previously enrolled (PE) in the French Hospital Database on HIV (FHDH). Methods: PE patients with an incident PCP were compared with patients with an inaugural PCP revealing HIV infection (reference). Adequate adherence to care was defined as a CD4 measurement at least every 6 months. Immune reconstitution (CD4$200/mm 3) and risk of death were studied using Kaplan-Meier estimates and multivariable Cox proportional hazards models. Results: In a context of a decreasing incidence of PCP, 1259 HIV-infected patients had a PCP diagnosis, and 593 (47%) were PE patients of whom 161 (27%) have had a prior history of AIDS-defining clinical illness (prior ADI). Median time since enrolment was 8 years for PE patients; 74% had received cART. Median proportion of time with adequate adherence to care was 85% (IQR, 66–96) for all FHDH enrollees, but only 45% (IQR, 1–81) for PE patients during the 2 years before PCP. Median CD4 cell count (38/mm 3) and HIV viral load (5.2 log10 copies/ml) at PCP diagnosis did not differ between PE patients and the reference group. Three year mortality rate of 25% was observed for PE prior ADI group, higher than in PE non-prior ADI group (8%) and the reference group (9%) (p,0.0001). In the PE prior ADI group, poor prognosis remained even after adjustment for virological control and immune reconstitution (HR, 2.4 [95%CI, 1.5–3.7]). Conclusion: Almost 50% of PCP diagnoses in HIV-infected patients occurred presently in patients already in care, mainly with a previous cART prescription but with waning adherence to care. Having repeated ADI is contributing to the risk of death beyond its impact on immune reconstitution and viral suppression: special efforts must be undertaken to maintain those patients in care.
ISSN: 1932-6203

Droits : http://creativecommons.org/licenses/by/
hal-01345090
http://hal.upmc.fr/hal-01345090
http://hal.upmc.fr/hal-01345090/document
http://hal.upmc.fr/hal-01345090/file/journal.pone.0094183.PDF
DOI : 10.1371/journal.pone.0094183

Éditeur(s) : HAL CCSD
Résumé : International audience
The identification and economic valuation of ecosystem services (ES) are becoming important components of coral reef management. In many contexts, protection of human assets against coastal floods is one of the most important ES provided by coral reefs. The methods utilized to characterize this ES should be able to accommodate situations with low data availability, without sacrificing robustness. In this paper, we suggest such an approach that utilizes expert opinion and does not require copious amounts of data. Our primary objective is to find a balance between simple and complex models that can be used in a data scarce environment, to produce an economic valuation of the coral reef ES of protection against coastal floods. The approach has three steps: (i) identify geographic zones and assets at risk, (ii) identify the contributing role of coral reefs in the protection of coasts and, (iii) value the annual repair costs of assets through the avoided damage cost approach. The proposed method seems appropriate for advocacy with policy makers, but appears to be less effective for small scale approaches, such as those required for Payment for ES negotiations or marine spatial planning.
Ecosystem Services

hal-01359394
https://hal-univ-perp.archives-ouvertes.fr/hal-01359394
DOI : 10.1016/j.ecoser.2016.07.005