Date de création : 1898-01-01

Éditeur(s) : Paris : Nilsson-Per Lamm
Siècle(s) traité(s) : 19
Droits : Domaine public
Provenance : Collectivité territoriale de Guyane. Bibliothèque Alexandre-Franconie
Permalien : http://www.manioc.org/patrimon/FRA11008
FRA11008

Éditeur(s) : Paris : Union coloniale française
Siècle(s) traité(s) : 20
Droits : Domaine public
Provenance : Communauté d'agglomération de La Rochelle. Médiathèque Michel-Crépeau
Permalien : http://www.manioc.org/patrimon/MMC16032
MMC16032

Éditeur(s) : HAL CCSD Ferrata Storti Foundation
Résumé : International audience
The aim of the study was to determine the factors associated with resting and exercise-induced hemoglobin oxygen desaturation. The well-established six-minute walk test was conducted in 107 sickle cell children (50 with sickle hemoglobin C disease and 57 with sickle cell anemia) at steady state. Hemoglobin oxygen saturation was measured before and immediately after the six-minute walk test. Blood samples were obtained on the same day to measure hematologic and hemorheological parameters. Exercise-induced hemoglobin oxygen desaturation was defined as a drop in hemoglobin oxygen saturation of 3% or more at the end of the six-minute walk test compared to resting levels. No children with sickle hemoglobin C disease, but approximately 50% of children with sickle cell anemia showed mild or moderate oxygen desaturation at rest, which was independently associated with the percentage of reticulocytes. Exercise-induced hemoglobin oxygen desaturation was observed in 18% of children with sickle hemoglobin C disease and 34% of children with sickle cell anemia, and was independently associated with the six-minute walk test, acute chest syndrome rate and the strength of red blood cell aggregates in children with sickle cell anemia. No association was found in children with sickle hemoglobin C disease between exercise-induced hemoglobin oxygen desaturation and the measured parameters. Hemoglobin oxygen desaturation at rest was common in children with sickle cell anemia but not in children with sickle hemoglobin C disease, and was mainly associated with greater hemolysis. Physiological strain during exercise and red blood cell aggregation properties may predict the occurrence of exercise-induced hemoglobin oxygen desaturation in children with sickle cell anemia.
ISSN: 0390-6078

inserm-00838989
http://www.hal.inserm.fr/inserm-00838989
http://www.hal.inserm.fr/inserm-00838989/document
http://www.hal.inserm.fr/inserm-00838989/file/Waltz_et_al._Ferrata_Storti_Foundation.pdf
DOI : 10.3324/haematol.2013.083576

Éditeur(s) : HAL CCSD Wiley
Résumé : International audience
MR and MDHD contributed equally to this work. Summary Painful vaso-occlusive crisis, a hallmark of sickle cell anaemia, results from complex, incompletely understood mechanisms. Red blood cell (RBC) damage caused by continuous endogenous and exogenous oxidative stress may precipitate the occurrence of vaso-occlusive crises. In order to gain insight into the relevance of oxidative stress in vaso-occlusive crisis occurrence , we prospectively compared the expression levels of various oxidative markers in 32 adults with sickle cell anaemia during vaso-occlusive crisis and steady-state conditions. Compared to steady-state condition, plasma levels of free haem, advanced oxidation protein products and myeloperoxi-dase, RBC caspase-3 activity, as well as the concentrations of total, neutrophil-and RBC-derived microparticles were increased during vaso-occlusive crises, whereas the reduced glutathione content was decreased in RBCs. In addition, natural anti-band 3 autoantibodies levels decreased during crisis and were negatively correlated with the rise in plasma advanced oxidation protein products and RBC caspase-3 activity. These data showed an exacerbation of the oxidative stress during vaso-occlusive crises in sickle cell anaemia patients and strongly suggest that the higher concentration of harmful circulating RBC-derived microparticles and the reduced anti-band 3 autoantibodies levels may be both related to the recruitment of oxidized band 3 into membrane aggregates.
ISSN: 0007-1048

inserm-01476067
http://www.hal.inserm.fr/inserm-01476067
http://www.hal.inserm.fr/inserm-01476067/document
http://www.hal.inserm.fr/inserm-01476067/file/2016%2C%20Hierso%20-%20Exacerbation%20of%20oxidative%20stress%20during%20sickle%20vaso-occlusive%20crisis.pdf
DOI : 10.1111/bjh.14476

Éditeur(s) : Fort-de-France : Imprimerie antillaise

Droits : Domaine public
Provenance : Université de Nantes. Service commun de la documentation
Permalien : http://www.manioc.org/patrimon/NAN13033
NAN13033

Éditeur(s) : HAL CCSD
Résumé : National audience
Introduction La leptospirose est une zoonose de répartition mondiale avec une incidence en augmentation. Elle représente un problème de santé publique en zone tropicale. L’objectif de notre étude était de faire un état des lieux de la leptospirose en Guyane Française afin d’en améliorer la prise en charge.
17es Journées Nationales d’Infectiologie
Lille, France

Droits : info:eu-repo/semantics/OpenAccess
inserm-01410984
http://www.hal.inserm.fr/inserm-01410984
http://www.hal.inserm.fr/inserm-01410984/document
http://www.hal.inserm.fr/inserm-01410984/file/2016%2C%20Le%20Turnier%20-%20PADS%202-07.pdf
PUBMED : 27495624

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : National audience
Objectif Analyser les caractéristiques virologiques et les complications des syndromes grippaux chez les diabétiques en période hivernale. Patients et Méthodes Étude conduite dans 6 hôpitaux (Montpellier, Lyon, Cochin, Bichat, Limoges, Rennes) au cours de 3 saisons grippales (2012-2013, 2013-2014 et 2014-2015), sur 1 451 adultes hospitalisés avec syndrome grippal récent (début ≤ 7 jours), associant un signe respiratoire (toux, dys-pnée) et un signe systémique (fièvre, céphalées, malaise, myalgies). Les virus respiratoires étaient recherchés par RT-PCR sur prélèvement naso-pharyngé ou LBA (Centre National de Référence, Lyon). La vaccination anti-grippale, la présence d'un diabète, les comorbidités, les complications en cours d'hospitalisation (insuffisance rénale, cardiaque, respiratoire, pneumonie, décès) et la durée moyenne de séjour (DMS) étaient enregistrées. Les facteurs de risque de complications ont été étudiés par régression logistique multivariée ajustée sur âge, sexe, infection grippale, vaccination, diabète et antécédents de pathologies rénale, cardiaque ou respiratoire. Résultats Les hospitalisations ont eu lieu dans des services de maladies respiratoires, médecine interne, MIT et réanimation. Un diabète était présent chez 368 sujets (non traités : 15 %, ADO : 41 %, insuline : 27 %, mixte : 17 %). Les diabétiques étaient plus âgés (71 ± 15 vs 65 ± 20 ans, P < 0,001) et présentaient plus souvent un antécédent de pathologie rénale (18 % vs 8 %, P < 0,00001) ou cardiaque (19 % vs 11 %, P < 0,001). Leur couverture vaccinale était meilleure (60 % vs 46 %). Les données virologiques étaient comparables : grippe 38,9 % (76,1 % type A) vs 39,2 % ; (74,1 % type A) ; autres virus respiratoires : 17,0 % vs 19,9 %. La DMS était un peu plus élevée chez les diabétiques (9,1 ± 9 vs 8,9 ± 11, P = 0,015), avec une tendance à un risque de décès plus élevé (6,25 % vs 3,97 %, P 0,07). En analyse multivariée, le diabète était un facteur de risque de complications à type d'insuffisance rénale (OR : 1,66, IC 95 % : 1,10-2,52) mais pas d'insuffisance cardiaque, respiratoire ou de décès. Les complications n'étaient pas modi-fiées par les résultats virologiques. Conclusions Le diabète est un facteur de risque de complications rénales chez les patients hospitalisés avec syndrome grippal
ISSN: 1262-3636

hal-01300779
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01300779
DOI : 10.1016/S1262-3636(16)30020-9

Éditeur(s) : HAL CCSD
Résumé : International audience
Background: Guadeloupe is the region of France with the second highest prevalence of HIV. Methods: To determine the risk factors for being lost to follow-up (LFU), a retrospective cohort study of 2,732 patients followed between 1988 and 2009 was conducted, and determined which variables were related to being LFU, i.e. permanently disappearing from HIV clinics or coming back after more than one year of missed appointments. Results: The incidence rate for permanent follow-up interruption was 9 per 100 person-years (8.3-9.7 personyears). The median time of LFU was 6.4 years (interquartile range 3-16.9 years). Cox modelling showed that the younger age groups (HR: 1.60[1.30-2.10], p=0.000) and patients diagnosed before 1997 (HR: 4.80[3.50-6.50], p=0.000) were significantly more likely to be permanently LFU. However, patients treated with HAART had a lower risk of being LFU (HR: 0.63[0.51-0.80], p=0.000). Conclusion: These results suggest that some patients may have died. They also allow to quantify the magnitude of a major yet often under-recognized problem and to identify its predictors in the context of Guadeloupe. This could help clinicians improve patient retention.
J AIDS Clin Res

inserm-00915235
http://www.hal.inserm.fr/inserm-00915235
http://www.hal.inserm.fr/inserm-00915235/document
http://www.hal.inserm.fr/inserm-00915235/file/2013_Elenga_-_Incidence_and_Risk_Factors_for_Follow-Up_Interruptionsur HIV-Infected_patients_guadeloupe.pdf
DOI : 10.4172/2155-6113.1000238

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
ISSN: 0020-7292

inserm-01065103
http://www.hal.inserm.fr/inserm-01065103
http://www.hal.inserm.fr/inserm-01065103/document
http://www.hal.inserm.fr/inserm-01065103/file/Figure.pdf
http://www.hal.inserm.fr/inserm-01065103/file/2013_Douine_-_Survival_cervical.pdf

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Meconium is the first fecal excretion of newborns. This complex accumulative matrix allows assessing the exposure of the fetus to xenobiotics during the last 6 months of pregnancy. To determine the eventual effect of fetal exposure to micropollutants in this matrix, robust and sensitive analytical methods must be developed. This article describes the method development of liquid chromatography methods coupled to triple quadrupole mass spectrometry for relevant pollutants. The 28 selected target compounds had different physico-chemical properties from very polar (glyphosate) to non-polar molecules (pyrethroids). Tests were performed with three different types of columns: reversed phase, ion exchange and HILIC. As a unique method could not be determined for the simultaneous analysis of all compounds, three columns were selected and suitable chromatographic methods were optimized. Similar results were noticed for the separation of the target compounds dissolved in either meconium extract or solvent for reversed phase and ion exchange columns. However, for HILIC, the matrix had a significant influence on the peak shape and robustness of the method. Finally, the analytical methods were applied to “real” meconium samples.
ISSN: 0039-9140

hal-01141722
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01141722
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01141722/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01141722/file/Development%20of%20liquid%20chromatography%20%281%29.pdf
PUBMED : 25863396

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
Diagnosis of toxoplasmic encephalitis (TE) in patients with AIDS is not straightforward because clinicians rely initially on an empiric diagnosis based on clinical and radiographic improvement to specific anti-Toxoplasma gondii therapy. There is therefore a need for biological tools to improve the diagnosis of TE, especially in tropical areas where this diagnosis is likely to be underestimated. The use of PCR testing in blood samples for the diagnosis of TE has been limited by its poor sensitivity in the studies conducted in Europe. In tropical South America, the results of PCR sensitivity in blood samples were controversial. Considering that T. gondii strains from tropical South America have substantial genetic and pathogenic differences with those from USA and Europe, it is therefore important to re-evaluate the performance of the PCR assay in blood samples for the diagnosis of TE in AIDS patients from this region. Our results showed that the only interest of PCR would be in the most severe forms of TE with altered consciousness because PCR is more likely to be positive. We also provided important genotyping data on T. gondii strains isolated in human cases of toxoplasmosis in the Caribbean and in South America.
ISSN: 1935-2727

hal-01503761
https://hal-unilim.archives-ouvertes.fr/hal-01503761
https://hal-unilim.archives-ouvertes.fr/hal-01503761/document
https://hal-unilim.archives-ouvertes.fr/hal-01503761/file/journal.pntd.0004790.pdf
DOI : 10.1371/journal.pntd.0004790

Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
A retrospective cohort study was conducted on 1541 HIV-infected patients to determine variables associated with the incidence of herpes zoster. A single failure Cox model showed that herpes zoster incidence increased following the first 6 months of antiretroviral treatment adjusted hazard ratio (AHR)=5 (95%CI=2.6-9.2), P<0.001; in the >60 years age group AHR=2 (95%CI=1-4), P=0.04; in patients in the top CD8 quartile AHR=2.1 (95%CI=1.3-3.6), P<0.001; and in patients previously reported to use crack cocaine AHR=5.9, (95%CI=1.4-25), P=0.02. Herpes zoster incidence increased in patients with CD4 counts<500 per mm(3) and gradually declined since 1992-1996, with AHR=0.3 (95%CI=0.2-0.5), P<0.001 for the 1997-2002 period and AHR=0.24 (95%CI=0.14-0.4), P<0.001 for the 2002-2008 period. Contrary to what has been described elsewhere, there was no specific effect of protease inhibitors on herpes zoster incidence. The present study is the first to suggest that crack cocaine is associated with an increased incidence of herpes zoster. The neurological or immunological effects of crack are discussed.
ISSN: 1932-6203

inserm-00921158
http://www.hal.inserm.fr/inserm-00921158
http://www.hal.inserm.fr/inserm-00921158/document
http://www.hal.inserm.fr/inserm-00921158/file/2013_Nacher_-_Predictive_factorssur herpes_zoster.pdf
DOI : 10.1371/journal.pone.0080187

Éditeur(s) : HAL CCSD American Society for Microbiology
Résumé : International audience
A rapid and specific high-performance liquid chromatography method with UV detection (HPLC-UV) for the simultaneous determination of 12 beta-lactam antibiotics (amoxicillin, cefepime, cefotaxime, ceftazidime, ceftriaxone, cloxacillin, imipenem, meropenem, oxacillin, penicillin G, piperacillin, and ticarcillin) in small samples of human plasma is described. Extraction consisted of protein precipitation by acetonitrile. An Atlantis T3 analytical column with a linear gradient of acetonitrile and a pH 2 phosphoric acid solution was used for separation. Wavelength photodiode array detection was set either at 210 nm, 230 nm, or 298 nm according to the compound. This method is accurate and reproducible (coefficient of variation [CV] < 8%), allowing quantification of beta-lactam plasma levels from 5 to 250 μg/ml without interference with other common drugs. This technique is easy to use in routine therapeutic drug monitoring of beta-lactam antibiotics.
ISSN: 0066-4804

hal-00875271
https://hal.archives-ouvertes.fr/hal-00875271
https://hal.archives-ouvertes.fr/hal-00875271/document
https://hal.archives-ouvertes.fr/hal-00875271/file/Simultaneous_Determination-accepted.pdf
PUBMED : 21788467

Éditeur(s) : HAL CCSD Springer Verlag
Résumé : International audience
The purpose of this investigation was to characterize the management and prognosis of severe Pneumocystis jirovecii pneumonia (PJP) in human immunodeficiency virus (HIV)-negative patients. An observational cohort study of HIV-negative adults with PJP documented by bronchoalveolar lavage (BAL) through Gomori-Grocott staining or immunofluorescence, admitted to one intensive care unit (ICU) for acute respiratory failure, was undertaken. From 1990 to 2010, 70 patients (24 females, 46 males) were included, with a mean age of 58.6 ± 18.3 years. The mean Simplified Acute Physiology Score (SAPS)-II was 36.9 ± 20.4. Underlying conditions included hematologic malignancies (n = 21), vasculitis (n = 13), and solid tumors (n = 13). Most patients were receiving systemic corticosteroids (n = 63) and cytotoxic drugs (n = 51). Not a single patient received trimethoprim-sulfamethoxazole as PJP prophylaxis. Endotracheal intubation (ETI) was required in 42 patients (60.0 %), including 38 with acute respiratory distress syndrome (ARDS). In-ICU mortality was 52.9 % overall, reaching 80.9 % and 86.8 %, respectively, for patients who required ETI and for patients with ARDS. In the univariate analysis, in-ICU mortality was associated with SAPS-II (p = 0.0131), ARDS (p < 0.0001), shock (p < 0.0001), and herpes simplex virus (HSV) or cytomegalovirus (CMV) on BAL (p = 0.0031). In the multivariate analysis, only ARDS was associated with in-ICU mortality (odds ratio [OR] 23.4 [4.5-121.9], p < 0.0001). PJP in non-HIV patients remains a serious disease with high in-hospital mortality. Pulmonary co-infection with HSV or CMV may contribute to fatal outcome.
ISSN: 0934-9723

inserm-00872789
http://www.hal.inserm.fr/inserm-00872789
DOI : 10.1007/s10096-012-1730-7
PUBMED : 22930407

Éditeur(s) : HAL CCSD Lippincott, Williams & Wilkins
Résumé : International audience
The aim of the study was to investigate the impact of first-line combined antiretroviral therapy (cART) regimen on the course of CD8 + T-cell counts in human immunodeficiency virus (HIV)-infected patients. A retrospective observational study conducted on the French DAT'AIDS Cohort of HIV-infected patients. We selected 605 patients initiating a first-line cART between 2002 and 2009, and which achieved a sustained undetectable HIV plasma viral load (pVL) for at least 12 months without cART modification. The evolution of CD8 + T-cell counts according to cART regimen was assessed. CD8 + T-cell counts were assessed in 572 patients treated with 2NRTIs+1PI/r (n= 297), 2NRTIs+1NNRTI (n= 207) and 3NRTIs (n= 68). In multivariate analysis, after 12 months of follow-up, the 3NRTIs regimen was associated with a significantly smaller decrease of CD8 + T-cell count compared with NNRTI-containing regimens (–10.2 cells/mL in 3NRTIs vs –105.1 cells/mL; P=0.02) but not compared with PI-containing regimens (10.2 vs –60.9 cells/mL; P=0.21). After 24 months, the 3NRTIs regimen was associated with a smaller decrease of CD8 + T-cell count and % compared with PI/r-and NNRTI-containing regimens (0.2 in 3NRTIs vs –9.9 with PI/r-regimens, P=0.001, and vs –11.1 with NNRTI-regimens, p < 0.0001). A focus analysis on 11 patients treated with an INSTI-containing cART regimen during the study period showed after 12 months of follow-up, a median decrease of CD8 + T-cell count of –155 [inter quartile range: –302; –22] cells/mL. Our data highlight the fact that cART regimens have differential effects on CD8 pool down regulation. Abbreviations: cART = combined antiretroviral therapy, HIV = human immunodeficiency virus, INSTI = integrase strand transfer inhibitor, NNRTI = non-nucleotide reverse transcriptase inhibitor, NRTI = nucleotide reverse transcriptase inhibitor, PI/r = Ritonavir-boosted protease inhibitor, pVL = plasma viral load.
ISSN: 0025-7974

inserm-01408002
http://www.hal.inserm.fr/inserm-01408002
http://www.hal.inserm.fr/inserm-01408002/document
http://www.hal.inserm.fr/inserm-01408002/file/2016%2C%20Poizot-Martin%20-%20First-line%20cART%20regimen%20impacts%20the%20course%20of%20CD8%2B%20T-cell%20counts%20in%20HIV-infected%20patients.pdf
DOI : 10.1097/MD.0000000000005087

Éditeur(s) : HAL CCSD Springer Verlag
Résumé : International audience
Meconium is the earliest stool of newborns, and is a complex matrix that reflects the degree of exposure of the fetus to xenobiotics. To investigate fetal exposure to volatile organic compounds, an analytical method was developed to identify and quantify BTEX (benzene, toluene, ethylbenzene, and o,m,p-xylene) and two chlorinated solvents (trichloroethylene and tetrachloroethylene) in meconium. Headspace-solid-phase microextraction coupled with gas chromatography-mass spectrometry was selected because it is simple, sensitive, can be automated, and requires no extensive sample preparation. Several extraction variables were optimized (fiber type, incubation time, temperature of fiber, and use of salt). Because meconium is a complex matrix, quantification by SPME was considered carefully because of potential interference, for example competitive adsorption. Calibration in water was compared with calibration in meconium using external and internal methods (with isotope-labeled compounds). In meconium, limits of quantification were determined to be in the range 0.064-0.096 ng g(-1) for the investigated compounds. All target compounds were determined in "real-case" meconium samples.
ISSN: 1618-2642

hal-01064967
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01064967
DOI : 10.1007/s00216-014-7836-2
PUBMED : 24838489

Éditeur(s) : HAL CCSD IOS Press
Résumé : International audience
The hematocrit-to-viscosity ratio (HVR) has been widely used has an estimate of red blood cell (RBC) oxygen transport effectiveness into the microvasculature or as an oxygen delivery index. However, no study investigated the possibility of HVR to truly reflect RBC oxygen transport effectiveness or to be an oxygen delivery index. We measured blood viscosity at high shear rate (225 s-1), hematocrit, HVR, as well as the microvascular oxyhemoglobin saturation (TOI; tissue oxygen index) by spatial resolved near-infrared spectroscopy (NIRS) at cerebral and muscle levels in three population known to have various degrees of hemorheological abnormalities: healthy subjects (AA), patients with sickle cell SC disease (SC) characterized by moderate anemia and patients with sickle cell anemia (SS) marked by severe anemia. At both the cerebral and muscle level, HVR was positively correlated with TOI (r = 0.28; p = 0.03 and r = 0.38; p = 0.003, at the cerebral and muscle level, respectively). These findings suggest that HVR probably play a key role in blood flow and hemodynamic regulation in the microvasculature, hence modulating the amount of oxygen available for tissues. Nevertheless, the strengths of the associations are weak (R2 < 0.50), suggesting that other determinants modulate microvascular blood flow and oxygenation, such as vascular geometry and vasomotor reserve.
ISSN: 1386-0291

inserm-01081701
http://www.hal.inserm.fr/inserm-01081701
http://www.hal.inserm.fr/inserm-01081701/document
http://www.hal.inserm.fr/inserm-01081701/file/2013%2C%20Waltz%20-%20Is%20there%20a%20relationship%20between%20the%20hematocrit-to-viscosity%20ratio%20and%20microvascular%20oxygenation%20in%20brain%20and%20muscle.pdf
PUBMED : 23719422

Éditeur(s) : HAL CCSD Oxford University Press (OUP): Policy B
Résumé : International audience
AIMS: Indications for surgery in acute infective endocarditis (IE) are detailed in guidelines, but their application is not well known. We analysed the agreement between the patient's attending physicians and European Society of Cardiology guidelines regarding indications for surgery. We also assessed whether surgery was performed in patients who had an indication. METHODS AND RESULTS: From the 2008 prospective population-based French survey on IE, 303 patients with definite left-sided native IE were identified. For each case, we prospectively recorded (i) indication for surgery according to the attending physicians and (ii) indication for surgery according to guidelines. Surgery was indicated in 194 (65%) patients according to attending physicians and in 221 (73%) according to guidelines, while 139 (46%) underwent surgery. Agreement was moderate between attending physicians and guidelines (kappa 0.41-0.59) and between indication according to guidelines and the performance of surgery (kappa 0.38). Of the 90 (30%) patients not operated despite indication, contraindication to surgery was reported by the attending physicians in 42 (47%), and indication was not identified in 48 (53%). One-year survival was 76% in patients with indication and surgery performed (n = 131), 69% in patients without indication and no surgery (n = 74), 56% in patients with identified indication and contraindication to surgery (n = 42), and 60% in patients with no identified indication (n = 48; P = 0.059). CONCLUSION: Cardiac surgery during acute IE was recommended in almost three out of four patients, although fewer than half were actually operated. Indication was not acknowledged by the attending physicians in one out of six patients
ISSN: 0195-668X

hal-01255874
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01255874
DOI : 10.1093/eurheartj/ehv650
PUBMED : 26685134

Éditeur(s) : HAL CCSD Oxford University Press (OUP)
Résumé : International audience
STUDY QUESTION: Is prenatal exposure to persistent organic pollutants (POPs) associated with variations of sex hormone levels in cord blood? SUMMARY ANSWER: Prenatal exposure to a number of POPs is associated with a disruption of hormone levels in cord blood, with sex specificities. WHAT IS KNOWN ALREADY: Epidemiological studies have reported disorders of reproductive health, in relation with POPs exposure during early life and the endocrine disruption properties of these chemicals have been suggested as possible mechanisms. STUDY DESIGN, SIZE, DURATION: A subset of 282 mother-child pairs was selected from the prospective population-based PELAGIE birth cohort (n = 3421, 2002-2006, Brittany, France). Pregnant women were recruited before 19 weeks of gestation and followed until delivery. PARTICIPANTS/MATERIALS, SETTING, METHODS: Sex hormone levels including sex hormone-binding globulin (SHBG), estradiol (E2), total testosterone (T), free testosterone (fT = T/SHBG) and the aromatase index (AI = T/E2) were measured in 282 cord blood samples. Anti-Müllerian hormone (AMH) was measured in male newborns only. Pesticide concentrations of α-endosulfan, β-hexachlorocyclohexane (β-HCH), γ-HCH, dieldrin, pp'-dichlorodiphenyldichloroethylene (p,p'-DDE), hexachlorobenzene (HCB), heptachlor epoxide (HCE), as well as PCBs (congeners 153, 187 and the sum of anti-estrogenic PCBs 118, 138, and 170) and decabrominated diphenyl ether (BDE209) were also measured in cord blood. Associations between sex hormones and POPs exposure were explored using multiple linear regressions adjusted for potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE: High PCB levels were associated with an increase of SHBG (P-trend extless 0.01) and AMH (P-trend extless 0.05) and a decrease of fT (P-trend extless 0.05) and AI (P-trend extless 0.01). High pesticide levels, particularly α-endosulfan and HCE, were associated with an increase of SHBG (P extless 0.05) and E2 (P extless 0.01) and a decrease of fT (P extless 0.05) and AI (P extless 0.01). Several of these associations were stronger, or specific, among male or female newborns. The associations were not altered in the sensitivity analyses. LIMITATIONS, REASONS FOR CAUTION: The study population was of relatively small sample size, and some compounds rarely detected in cord blood. The high level of correlation between POPs makes it difficult to identify the most contributing POPs. Hormone measurements were performed at birth (in cord blood) and may not adequately represent the infant endocrine system. Multiple statistical testing may have led to false-positive associations. WIDER IMPLICATIONS OF THE FINDINGS: Our results are in discordance with those reported in the only published study of the kind but in accordance with studies about prenatal exposure to other endocrine disruptors such as phthalates. These findings may help understanding the pathways involved in adverse reproductive outcomes associated with POPs exposure. STUDY FUNDING/COMPETING INTERESTS: The PELAGIE cohort is funded by Inserm, French Ministry of Health, French Ministry of Labor, InVS, ANR, ANSES, and French Ministry of Ecology. None of the authors has any competing interest to declare
ISSN: 0268-1161

hal-01220641
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01220641
DOI : 10.1093/humrep/dev260
PUBMED : 26493407

Éditeur(s) : HAL CCSD
Résumé : National audience
Objectives To define the different stages of spontaneous labour. To determine the indications, modalities of use and the effects of administering synthetic oxytocin. And to describe undesirable maternal and perinatal outcomes associated with the use of synthetic oxytocin. Method A systematic review was carried out by searching Medline database and websites of obstetrics learned societies until March 2016. Results The 1st stage of labor is divided in a latence phase and an active phase, which switch at 5 cm of cervical dilatation. Rate of cervical dilatation is considered as abnormal below 1 cm per 4 hour during the first part of the active phase, and blow 1 cm per 2 hours above 7 cm of dilatation. During the latent phase of the first stage of labor, i.e. before 5 cm of cervical dilatation, it is recommended that an amniotomy not be performed routinely and not to use oxytocin systematically. It is not recommended to expect the active phase of labor to start the epidural analgesia if patient requires it. If early epidural analgesia was performed, the administration of oxytocin must not be systematic. If dystocia during the active phase, an amniotomy is recommended in first-line treatment. In the absence of an improvement within an hour, oxytocin should be administrating. However, in the case of an extension of the second stage beyond 2 hours, it is recommended to administer oxytocin to correct a lack of progress of the presentation. If dynamic dystocia, it is recommended to start initial doses of oxytocin at 2 mUI/min, to respect at least 30 min intervals between increases in oxytocin doses delivered, and to increase oxytocin doses by 2 mUI/min intervals without surpassing a maximum IV flow rate of 20 mUI/min. The reported maternal adverse effects concern uterine hyper-stimulation, uterine rupture and postpartum haemorrhage, and those of neonatal adverse effects concern foetal heart rate anomalies associated with uterine hyper-stimulation, neonatal morbidity and mortality, neonatal jaundice, weak suck/poor breastfeeding latch and autism. Conclusion The widespread use of oxytocin during spontaneous labour must not be considered as simply another inoffensive prescription without any possible deleterious consequences for mother or foetus. Conditions for administering the oxytocin must therefore respect medical protocols. Indications and patient consent have to be report in the medical file. © 2016 Elsevier Masson SAS
Revue Sage - Femme

hal-01467543
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01467543
DOI : 10.1016/j.sagf.2016.11.006