109 results on '"Le Bouar, G."'
Search Results
2. Role of chromosomal imbalances in the pathogenesis of DSD: A retrospective analysis of 115 prenatal samples
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Mary, L., Fradin, M., Pasquier, L., Quelin, C., Loget, P., Le Lous, M., Le Bouar, G., Nivot-Adamiak, S., Lokchine, A., Dubourg, C., Jauffret, V., Nouyou, B., Henry, C., Launay, E., Odent, S., Jaillard, S., and Belaud-Rotureau, M.A.
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- 2023
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3. Modélisation de la ventilation au cours de l’exacerbation aiguë de pneumopathies interstitielles diffuses chroniques : de la physiologie au banc d’essai
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Artaud-Macari, E., primary, Fresnel, E., additional, Kerfourn, A., additional, Caillard, C., additional, Roussel, C., additional, Thévenin, R., additional, Debeaumont, D., additional, Melone, M.A., additional, Le Bouar, G., additional, Roger, P.A., additional, Molano, C., additional, Gravier, F.E., additional, Bonnevie, T., additional, Médrinal, C., additional, Salaün, M., additional, Cuvelier, A., additional, and Girault, C., additional
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- 2024
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4. L’interruption médicale de grossesse sans fœticide : une enquête nationale
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Chappé, H., Bétrémieux, P., Morel, V., Huillery, M.-L., and Le Bouar, G.
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- 2016
- Full Text
- View/download PDF
5. Projet palliatif anténatal après diagnostic de malformation fœtale létale : expérience du CHU de Rennes de 2006 à 2012
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Bétrémieux, P., Druyer, J., Bertorello, I., Huillery, M.-L., Brunet, C., and Le Bouar, G.
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- 2016
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6. Diagnostic Yield of Chromosomal Microarray Analysis in Fetuses With Isolated Increased Nuchal Translucency: A French Multicenter Study
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Egloff, M., Hervé, B., Quibel, T., Jaillard, S., Le Bouar, G., Uguen, K., Saliou, A.-H., Valduga, M., Perdriolle, E., Coutton, C., Coston, A.-L., Coussement, A., Anselem, O., Missirian, C., Bretelle, F., Prieur, F., Fanget, C., Muti, C., Jacquemot, M.-C., Beneteau, C., Le Vaillant, C., Vekemans, M., Salomon, L. J., Vialard, F., and Malan, V.
- Published
- 2019
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7. Rôle de l’interniste dans la démarche diagnostique et la prise en charge des morts fœtales in utero : l’expérience d’un registre multicentrique de MFIU entre 2010 et 2019
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Caillault, L., primary, Garlantézec, R., additional, Le Lous, M., additional, Le Bouar, G., additional, Loget, P., additional, Cauchois, A., additional, Quelin, C., additional, Plesse, C., additional, Lescoat, A., additional, Beranger, R., additional, and Belhomme, N., additional
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- 2022
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8. Définition des morts fœtales in utero vasculaires et caractérisation selon la positivité des anticorps antiphospholipides
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Caillault, L., primary, Garlantézec, R., additional, Le Lous, M., additional, Le Bouar, G., additional, Loget, P., additional, Cauchois, A., additional, Quelin, C., additional, Plesse, C., additional, Lescoat, A., additional, Beranger, R., additional, and Belhomme, N., additional
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- 2022
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9. Naissances très prématurées (22 à 26 SA) : de la décision à la mise en œuvre des soins palliatifs en salle de naissance. Expérience du CHU de Rennes (France)
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Cabaret, A.-S., Charlot, F., Le Bouar, G., Poulain, P., and Bétrémieux, P.
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- 2012
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10. Hypoplasies sévères du ventricule gauche : soins palliatifs après un diagnostic prénatal
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Noseda, C., Mialet-Marty, T., Basquin, A., Letourneur, I., Bertorello, I., Charlot, F., Le Bouar, G., and Bétrémieux, P.
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- 2012
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11. Grossesse multiple, malformation létale et soins palliatifs périnatals
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Bétrémieux, P., Druyer, J., Bertorello, I., and Le Bouar, G.
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- 2015
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12. Integration of the human factor into the design and construction of fishing vessels
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Chauvin, C., Le Bouar, G., and Renault, C.
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- 2008
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13. Diagnosis of fetal urinary tract malformations: prenatal management and postnatal outcome
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Ryckewaert-DʼHalluin, A., Le Bouar, G., Odent, S., Milon, J., DʼHervé, D., Lucas, J., Rouget, F., Loget, P., Poulain, P., Le Gall, E., and Taque, S.
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- 2011
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14. Perinatal grief following neonatal comfort care for lethal fetal condition
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Depoers-Béal, C., primary, Le Baccon, F.A., additional, Le Bouar, G., additional, Proisy, M., additional, Arnaud, A., additional, Legendre, G., additional, Dayan, J., additional, Bétrémieux, P., additional, and Le Lous, M., additional
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- 2020
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15. Prenatal diagnosis of isolated Congenital Heart Defects: results of a prospective study genome-wide high resolution array-CGH versus karyotyping and 22q11 FISH
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Pasquier, L., Roblot, F., Launay, E., Fradin, M., Quelin, C., Demurger, F., Loget, P., Le Bouar, G., Combescure, C., Leborgne, A., Basquin, A., Belaud-Rotureau, M., Odent, S., Oger, E., Jaillard, S., Centre de référence Maladies Rares CLAD-Ouest [Rennes], CHU Pontchaillou [Rennes], Institut de recherche en santé, environnement et travail (Irset), Université d'Angers (UA)-Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Institut de Recherche pour le Développement (IRD [France-Ouest]), Clinique mutualiste La Sagesse, Recherche en Pharmaco-épidémiologie et Recours aux Soins (REPERES), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-École des Hautes Études en Santé Publique [EHESP] (EHESP), Université d'Angers (UA)-Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), and Université de Rennes (UR)-École des Hautes Études en Santé Publique [EHESP] (EHESP)
- Subjects
[SDV]Life Sciences [q-bio] ,ComputingMilieux_MISCELLANEOUS - Abstract
International audience
- Published
- 2019
16. L’interruption médicale de grossesse sans fœticide : une enquête nationale
- Author
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Morel, H. Chappé, Le Bouar G, Bétrémieux P, and Huillery Ml
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medicine.medical_specialty ,Pregnancy ,030219 obstetrics & reproductive medicine ,Palliative care ,business.industry ,Obstetrics and Gynecology ,Prenatal diagnosis ,General Medicine ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Reproductive Medicine ,Multidisciplinary approach ,Feticide ,030225 pediatrics ,Family medicine ,Medicine ,Term Birth ,Confidentiality ,Medical team ,business - Abstract
PURPOSE Termination of pregnancy without feticide (TOPWF) is poorly known in France and far less practiced than palliative care after term birth of a child having a lethal pathology. Few teams consider it and its practice remains confidential. This survey tries to describe it. MATERIAL AND METHODS A national survey was realized in 2014 using a questionnaire sent to 50 centers of prenatal diagnosis depending on a perinatal diagnosis center in France. RESULTS Thirty-one centers answered the questionnaire. Seven teams shared their experience of TOPWF after 22-24 weeks gestation (WG). This practice concerned fetuses affected by "lethal" pathologies. The absence of feticide followed a parental request or a proposal of the medical team, after individual discussion in a multidisciplinary meeting. All the children born alive after TOPWF benefited of palliative care. The 24 other centers having answered our investigation performed systematically the feticide beyond 22-24 WG. They so wished "to protect" the fetus, the parents and the nursing team. A majority of these teams faced parental demands of abstention of feticide but few of them answered it favorably. CONCLUSION A robust "palliative culture" seems essential to allow the nursing team to consider the development of TOPWF.
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- 2016
17. OR02: A New Prognostic Indicator in Septic Shock: Muscle Mass Measured by the Thickness of Quadriceps in Ultrasound
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Lemaitre, C., primary, Selim, M., additional, Lagache, L., additional, Le Bouar, G., additional, Boyer, D., additional, Grall, M., additional, Clavier, T., additional, Demarest-Durand, E., additional, Surlemont, E., additional, Grange, S., additional, Carpentier, D., additional, Beduneau, G., additional, Girault, C., additional, Savoye, G., additional, Michel, P., additional, Savoye-Collet, C., additional, Dechelotte, P., additional, Coeffier, M., additional, and Tamion, F., additional
- Published
- 2019
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18. Diagnostic yield of chromosomal microarray analysis in fetuses with isolated increased nuchal translucency: a French multicenter study
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Egloff, M., primary, Hervé, B., additional, Quibel, T., additional, Jaillard, S., additional, Le Bouar, G., additional, Uguen, K., additional, Saliou, A.‐H., additional, Valduga, M., additional, Perdriolle, E., additional, Coutton, C., additional, Coston, A.‐L., additional, Coussement, A., additional, Anselem, O., additional, Missirian, C., additional, Bretelle, F., additional, Prieur, F., additional, Fanget, C., additional, Muti, C., additional, Jacquemot, M.‐C., additional, Beneteau, C., additional, Le Vaillant, C., additional, Vekemans, M., additional, Salomon, L. J., additional, Vialard, F., additional, and Malan, V., additional
- Published
- 2018
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19. Perinatal grief following neonatal comfort care for lethal fetal condition.
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Depoers-Béal, C., Le Baccon, F.A., Le Bouar, G., Proisy, M., Arnaud, A., Legendre, G., Dayan, J., Bétrémieux, P., and Le Lous, M.
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BIRTHING centers ,GRIEF ,ABORTION ,PRENATAL diagnosis ,PREGNANCY ,FETAL diseases ,PRENATAL care - Abstract
BACKGROUND: The objective of the study was to assess perinatal grief experienced after continuing pregnancy and comfort care in women diagnosed with lethal fetal condition compared with termination of pregnancy for fetal anomaly (TOPFA). METHODS: This was a retrospective observational study which included women who chose to continue their pregnancy after the diagnosis of lethal fetal condition with comfort care support at birth at the Prenatal Diagnosis Center of Rennes Hospital from January 2007 to January 2017. Women were matched with controls who underwent TOPFA for the same type of fetal anomaly, gestational age at diagnosis and year. Women were evaluated by a questionnaire including the Perinatal Grief Scale. RESULTS: There were 28 patients in the continuing pregnancy group matched with 56 patients in the TOPFA group. Interval between fetal loss and completion of questionnaire was 6±3 years. Perinatal grief score was similar at 61±22 vs 58±18 (p = 0.729) in the continuing pregnancy and TOPFA groups, respectively. Women in the TOPFA group expressed more guilt. The cesarean-section rate in the continuing pregnancy group was 25%. CONCLUSION: Perinatal grief experienced by women opting for continuing pregnancy and comfort care after diagnosis of a potentially lethal fetal anomaly is not more severe than for those choosing TOPFA. [ABSTRACT FROM AUTHOR]
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- 2019
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20. L’interruption médicale de grossesse sans fœticide : une enquête nationale
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Chappé, H., primary, Bétrémieux, P., additional, Morel, V., additional, Huillery, M.-L., additional, and Le Bouar, G., additional
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- 2016
- Full Text
- View/download PDF
21. Projet palliatif anténatal après diagnostic de malformation fœtale létale : expérience du CHU de Rennes de 2006 à 2012
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Bétrémieux, P., primary, Druyer, J., additional, Bertorello, I., additional, Huillery, M.-L., additional, Brunet, C., additional, and Le Bouar, G., additional
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- 2016
- Full Text
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22. Malformation adénomatoïde kystique pulmonaire de l’adulte opérée par voie robotique
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Le Bouar, G., primary, Salaun, M., additional, Thiberville, L., additional, and Baste, J.M., additional
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- 2015
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23. Naissances très prématurées (22 à 26 SA) : de la décision à la mise en œuvre des soins palliatifs en salle de naissance. Expérience du CHU de Rennes (France)
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Cabaret, A.-S., primary, Charlot, F., additional, Le Bouar, G., additional, Poulain, P., additional, and Bétrémieux, P., additional
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- 2012
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24. Pancréatite aiguë secondaire à une hypertriglycéridémie majeure au cours de la grossesse. À propos d’un cas
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Vandenbroucke, L., primary, Seconda, S., additional, Lassel, L., additional, Le Bouar, G., additional, and Poulain, P., additional
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- 2009
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25. Integration of the human factor into the design and construction of fishing vessels
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Chauvin, C., primary, Le Bouar, G., additional, and Renault, C., additional
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- 2007
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26. Numerical simulations of unsteady aerodynamics of helicopter rotor in manoeuvring flight conditions
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Le Bouar, G., primary, Costes, M., additional, Leroy-Chesneau, A., additional, and Devinant, P., additional
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- 2004
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27. Les accidents du travail dans la pêche maritime - Partie I - Analyse des données sur les accidents du travail à la pêche maritime dans les pays de la Communauté Economique Européenne de 1977 à 1980
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Andro, M., Dorval, Philippe, Le Bouar, G., and Le Pluart, C.
- Abstract
La littérature concernant les accidents du travail est nombreuse et disparate : statistique, recherche en laboratoire, étude clinique, compte rendu d'expériences de prévention, etc ... Cette abondance et cette disparité rendent l'approche de l'accident peu commode : il est bien difficile de dégager des orientations, des conceptions qui permettent de rendre compte de façon satisfaisante du phénomène accident. Le problème majeur que pose son étude tient au fait que celle-ci se situe au carrefour d'un grand nombre de disciplines : sciences fondamentales, sciences de l'ingénieur, sciences humaines, juridiques, de gestion... Là où il devrait y avoir synthèse, on trouve fréquemment une vision morcelée, répartie dans un cadre préétabli, selon que le chercheur est médecin du travail, ingénieur, psychologue,... Il en découle encore trop souvent une conception limitée -et donc limitative au niveau de la prévention- du phénomène accident. C'est ainsi que beaucoup trop d'études sur les accidents du travail ne prennent en compte qu'une seule variable -parfois deux ou trois- ignorant totalement d'autres dimensions du phénomène et excluant toute idée d'interdépendance entre l'ensemble des variables.
- Published
- 1983
28. Les accidents de travail dans la pêche maritime - Partie II - L'analyse des situations de travail dans la pêche maritime
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Andro, M., Dorval, Philippe, Le Bouar, G., and Le Pluart, C.
- Abstract
En introduction à la partie 1 de ce rapport portant sur les accidents du travail à la pêche maritime, nous avons précisé que dans le cadre des théories modernes de la sécurité, l'accident du travail devait être considéré comme un dysfonctionnement dans un système. le contexte dans lequel se manifeste ce dysfonctionnement, définissant l'activité du travailleur est, rappelons-le, formé de quatre composantes : l'individu, la tâche, le matériel et le milieu. L'analyse épidémiologique développée dans la partie 1, si elle nous permet d'obtenir un grand nombre de renseignements sur l'accidentabilité des marins-pêcheurs, n'est cependant pas suffisante en soi, pour décrire l'ensemble des moyens à mettre en oeuvre dans le cadre d'une politique globale de prévention recherchant une meilleure sécurité au travail des marins-pêcheurs. La connaissance de l'environnement de travail est un élément tout aussi essentiel à la réalisation de cet objectif : c'est l'objet de cette seconde partie. - Nous avons toujours dans la première partie, souligné l'hétérogénéité caractérisant la pêche maritime dans son ensemble. Il ne peut dès lors ici être question d'envisager les caractéristiques de l'environnement de travail, de chaque flottille de pêche, de chaque métier pratiqué, et ceci pour chaque pays. Aussi est-ce au travers d'un exemple, la flottille de chalutiers industriels de pêche fraîche du port de LORIENT, que nous insisterons sur un certain nombre de facteurs caractéristiques de l'environnement du marin au travail, facteurs dont la prise en compte est nécessaire a une bonne appréhension des problèmes posés par l'étude des accidents du travail à la pêche maritime. - Ajoutons qu'un certain nombre de facteurs socio-êconomiques (systèmes de rémunération, lois sociales, droit du travail... ) doivent être intégrés dans une analyse qui se veut globale, et l'importance de ces facteurs ne saurait être sous estimée dans l'élaboration d'une politique de prévention à l'intention des marins-pêcheurs. Que nous n'en parlions pas ici, ne signifie en rien, que nous n'accordions pas à ces facteurs l'importance qui est la leur ; disons simplement qu'il s'agit d'un travail qui reste à mener, complémentaire de celui effectué ici.
- Published
- 1983
29. Sécurité et conditions de travail à la pêche artisanale et semi-industrielle
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Andro, M, Dorval, P, Le Bouar, G, Le Roy, Y, Roullot, C, Prado, J, Meillat, Marc, and Le Pluart, C
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Ifremer is honoured to publish this study, conducted under the supervision of Prof Dorval. Not only are the issues addressed in this study important and timely, but the methods employed are exceptionally pertinent and original. Two major issues dominate the current affairs in professional fishing: safety and competitiveness. Recent, dramatic events have brought fishing vessel safety and working conditions back to the forefront of national preoccupations. Once again, all those-administrative bodies, sector professionals, fishers, boat builders and fishing gear designers, researchers-confronted with the difficulty of finding satisfactory solutions to this distressing problem wonder what actions should be taken...., L'étude menée sous la conduite du professeur DORVAL, que l'IFREMER s'honore de publier aujourd'hui, se distingue tant par l'importance et l'actualité du sujet traité que par la pertinence et la nouveauté de la méthode utilisée. Deux préoccupations majeures dominent l'actualité dans les activités de pêche professionnelle: la sécurité, la compétitivité. Des événements récents et dramatiques ont mis à nouveau au premier plan de l'actualité nationale la question de la sécurité du navire et, en même temps, des conditions de travail à la pêche. Une fois encore, l'administration, les professionnels, les marins, les constructeurs de navires et d'équipements, les chercheurs eux-mêmes, confrontés à la difficulté de trouver des solutions satisfaisantes à ce douloureux problème, s'interrogent sur les voies à suivre. Dans le même temps, la rentabilité de l'exploitation de certains navires devient insuffisante ; des secteurs importants de la filière pêche sont menacés. Tous comprennent que la survie des branches professionnelles et des régions concernées passe par une amélioration de la commercialisation des produits de la mer. Dans les deux domaines clés de la sécurité et de la compétitivité, essentiels pour l'évolution de la filière pêche, l'étude de l'équipe dirigée par le professeur DORVAL apporte à tous les responsables une base scientifique de données d'observation, dans un domaine où "l'expérience individuelle" et "la tradition orale" ne suffisent plus pour poser correctement les problèmes. Elle comble ainsi une importante lacune des connaissances mises à la disposition des responsables de la filière. Dans la production moderne à la pêche, il est frappant de constater à quel point les éléments sont liés les uns aux autres: le navire de pêche, - instrument de récolte, atelier de transformation, lieu de vie; l'équipage, - dont les possibilités physiques, intellectuelles et même culturelles ne sont pas extensibles; les conditions imposées par l'environnement marin; "armement enfin, confronté à une compétition économique sévère et permanente, constituent des facteurs fortement liés et interdépendants. C'est-à-dire qu'une approche "globale" et "pluridisciplinaire" est indispensable pour analyser le "système de production" qu'est l'entreprise-pêche. Or cette approche a été souvent méconnue, peut-être par manque de dialogue entre les différents responsables de la filière, peut-être aussi par manque d'équipes pluridisciplinaires convenablement coordonnées. Là également, l'étude menée sous la direction du professeur DORVAL innove en utilisant une méthode de type "analyse de systèmes", particulièrement, adaptée au problème posé; elle constitue un bon exemple concret de la voie à suivre dans les démarches d'étude des processus de production à la pêche. Pour toutes ces raisons, le présent livre devrait devenir une référence pour les responsables de l'administration, de la profession et de la recherche dans le domaine de la Pêche professionnelle, et devrait engendrer des réflexions constructives et dénuées de passion, ainsi que des actions efficaces. Que le professeur DORVAL et son équipe en soient remerciés, et qu'ils continuent sur leur lancée à produire des études d'un intérêt aussi fécond. [OCR NON CONTRÔLE]
- Published
- 1987
30. Analyse de l'organisation du travail, de la sécurité et des conditions de travail à la pêche artisanale
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Andro, M., Dorval, Philippe, Le Bouar, G., Le Pluart, C, Le Roy, Y, Roullot, C, Meillat, Marc, and Prado, J
- Abstract
Lorsque l'on étudie la flotte de pêche artisanale française, on ne peut qu'être frappé par la grande diversité des navires existants. L'examen des unités, soit construites ces dernières années, soit mises en chantier, soit projetées, dans le cadre de la politique de renouvellement de la flotte artisanale ne laisse apparaître aucune évolution significative dans ce domaine. On peut certes expliquer la très grande variété de navires proposés par différents facteurs : . Le coût des unités de pêche doit s'adapter aux budgets disponibles, très divers, les équipements intervenant de façon non négligeables dans ces coûts. . Chaque patron cherche à acquérir l'unité qu'il croit le mieux adapté au métier qu'il désire pratiquer (les exigences seront très diverses selon les engins que l'on va mettre en oeuvre, les secteurs fréquentés, les habitudes locales... ) . Le patron-pêcheur est souvent un indépendant fonCièrement individualiste, qui préferera une unité de 20,50 metres, plutôt que le 20,40 mètres de son collègue, avec un moteur de 20 à 30 chevaux de plus... Il n'en reste pas moins vrai qu'une telle situation se traduit : - D'une part par un manque de rationalisation évident des activités tant des chantiers de construction navale artisanale, que de celles des fabricants d'équipements. - D'autre part par le retard pris dans le domaine de la standardisation des navires qui devrait permettre aux chantiers artisanaux de s'orienter vers l'adoption de méthodes de construction de type industriel.
- Published
- 1985
31. The ANTENATAL multicentre study to predict postnatal renal outcome in fetuses with posterior urethral valves: objectives and design
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Buffin-Meyer, Bénédicte, Klein, Julie, van der Zanden, Loes F M, Levtchenko, Elena, Moulos, Panogiotis, Lounis, Nadia, Conte-Auriol, Françoise, Hindryckx, An, Wühl, Elke, Persico, Nicola, Oepkes, Dick, Schreuder, Michiel F, Tkaczyk, Marcin, Ariceta, Gema, Fossum, Magdalena, Parvex, Paloma, Feitz, Wout, Olsen, Henning, Montini, Giovanni, Decramer, Stéphane, Schanstra, Joost P, De Catte, Luc, Vayssieres, Christophe, Sartor, Agnès, Groussolles, Marion, Plard, Christelle, Guerby, Paul, Connan, Laure, Morin, Mathieu, Simon, Elizabeth, Breaud, Jean, Saliou, Anne-Hélène, De Parscau, Loic, Jay, Nadine, Germouty, Isabelle, Le Bouar, Gwenaelle, Ryckewaert, Amelie, Manca-Pellissier, Marie-Christine, Merrot, Thierry, Laurichesse, Helene, Gallot, Denis, Bessenay, Lucie, Bidat, Laurent, Boize, Philippe, Winer, Norbert, Allain-Launey, Emma, Le Vaillant, Claudine, Prieur, Fabienne, Lavocat, Marie-Pierre, Coatleven, Frederic, Debromez, Eric, Harembat, Jérôme, Llanas, Brigitte, Favre, Romain, Moog, Raphael, Zaloszyc, Ariane, Massardier, Jérôme, Demede, Delphine, Perrotin, Franck, Cloarec, Sylvie, Vequeau-Goua, Valérie, Descombes, Emmanuelle, Boulot, Pierre, Morin, Denis, Fuchs, Florent, Tenenbaum, Julie, Ville, Yves, Blanc, Thomas, Heidet, Laurence, Paris, Anne, Dobremez, Eric, Froute, Marie-Françoise, Gondry, Jean, Muszynski, Charles, Haraux, Elodie, Lobelle, Fabienne, Chevreau, Julien, Rosenblatt, Jonathan, Baudoin, Véronique, Deschenes, Georges, Guigue, Virginie, Amblard, Florence, Bourdat-Michel, Guylhène, Schaefer, Franz, Elsässer, Michael, Rossi, Federica, Manzoni, Gianantonio, De Marco, Erika A, Capone, Valentina, Caforio, Leonardo, Zaccara, Antonio, Innocenzi, Michele, Bagolan, Pietro, Capozza, Nicola, Castagnetti, Marco, Mancini, Mariangela, van Scheltema, Phebe Adama, Kortmann, Barbara, Schreuder, Michiel, Stańczyk, Małgorzata, Szaflik, Krzysztof, Wojtera, Justyna, Krzeszowski, Waldemar, Talar, Tomasz, Pawłowska, Barbara, Fortecka-Piestrzeniewicz, Katarzyna, Olejniczak, Dariusz, Arevalo, Silvia, Rodo, Carlota, Lindgren, Peter, Chehade, Hassib, ANTENATAL Consortium, Hindryckx, A., De Catte, L., Vayssieres, C., Sartor, A., Groussolles, M., Plard, C., Guerby, P., Connan, L., Morin, M., Simon, E., Breaud, J., Saliou, A.H., De Parscau, L., Jay, N., Germouty, I., Le Bouar, G., Ryckewaert, A., Manca-Pellissier, M.C., Merrot, T., Laurichesse, H., Gallot, D., Bessenay, L., Bidat, L., Boize, P., Winer, N., Allain-Launey, E., Le Vaillant, C., Prieur, F., Lavocat, M.P., Coatleven, F., Debromez, E., Harembat, J., Llanas, B., Favre, R., Moog, R., Zaloszyc, A., Massardier, J., Demede, D., Perrotin, F., Cloarec, S., Vequeau-Goua, V., Descombes, E., Boulot, P., Morin, D., Fuchs, F., Tenenbaum, J., Ville, Y., Blanc, T., Heidet, L., Paris, A., Dobremez, E., Froute, M.F., Gondry, J., Muszynski, C., Haraux, E., Lobelle, F., Chevreau, J., Rosenblatt, J., Baudoin, V., Deschenes, G., Guigue, V., Amblard, F., Bourdat-Michel, G., Wühl, E., Schaefer, F., Elsässer, M., Persico, N., Rossi, F., Manzoni, G., De Marco, E.A., Montini, G., Capone, V., Caforio, L., Zaccara, A., Innocenzi, M., Bagolan, P., Capozza, N., Castagnetti, M., Mancini, M., Oepkes, D., van Scheltema, P.A., Feitz, W., Kortmann, B., Schreuder, M., Tkaczyk, M., Stańczyk, M., Szaflik, K., Wojtera, J., Krzeszowski, W., Talar, T., Pawłowska, B., Fortecka-Piestrzeniewicz, K., Olejniczak, D., Ariceta, G., Arevalo, S., Rodo, C., Fossum, M., Lindgren, P., Parvex, P., Chehade, H., Institut des Maladies Métaboliques et Cardiovasculaires (I2MC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées, Radboud University Medical Center [Nijmegen], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), HybridStat Predictive Analytics [Athens, Greece], Centre d'investigation clinique de Toulouse (CIC 1436), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Institut National de la Santé et de la Recherche Médicale (INSERM), University Hospitals Leuven [Leuven], Heidelberg University Hospital [Heidelberg], University of Milan, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico [Milan, Italy], Leiden University Medical Center (LUMC), Radboud Institute for Molecular Life Sciences [Nijmegen, the Netherlands], Polish Mother’s Memorial Hospital Research Institute [Lodz] (ICZMP), Pediatric Nephrology [Barcelona, Spain] (Vall d’Hebron Hospital), Universitat Autònoma de Barcelona (UAB)-Vall d'Hebron University Hospital [Barcelona], Karolinska University Hospital [Stockholm], Karolinska Institutet [Stockholm], Geneva University Hospital (HUG), Aarhus University Hospital, Aarhus University [Aarhus], Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, ANTENATAL Consortium: An Hindryckx, Luc De Catte, Christophe Vayssieres, Agnès Sartor, Marion Groussolles, Christelle Plard, Paul Guerby, Laure Connan, Mathieu Morin, Elizabeth Simon, Jean Breaud, Anne-Hélène Saliou, Loic De Parscau, Nadine Jay, Isabelle Germouty, Gwenaelle Le Bouar, Amelie Ryckewaert, Marie-Christine Manca-Pellissier, Thierry Merrot, Helene Laurichesse, Denis Gallot, Lucie Bessenay, Laurent Bidat, Philippe Boize, Norbert Winer, Emma Allain-Launey, Claudine Le Vaillant, Fabienne Prieur, Marie-Pierre Lavocat, Frederic Coatleven, Eric Debromez, Jérôme Harembat, Brigitte Llanas, Romain Favre, Raphael Moog, Ariane Zaloszyc, Jérôme Massardier, Delphine Demede, Franck Perrotin, Sylvie Cloarec, Valérie Vequeau-Goua, Emmanuelle Descombes, Pierre Boulot, Denis Morin, Florent Fuchs, Julie Tenenbaum, Yves Ville, Thomas Blanc, Laurence Heidet, Anne Paris, Eric Dobremez, Marie-Françoise Froute, Jean Gondry, Charles Muszynski, Elodie Haraux, Fabienne Lobelle, Julien Chevreau, Jonathan Rosenblatt, Véronique Baudoin, Georges Deschenes, Virginie Guigue, Florence Amblard, Guylhène Bourdat-Michel, Elke Wühl, Franz Schaefer, Michael Elsässer, Nicola Persico, Federica Rossi, Gianantonio Manzoni, Erika A De Marco, Giovanni Montini, Valentina Capone, Leonardo Caforio, Antonio Zaccara, Michele Innocenzi, Pietro Bagolan, Nicola Capozza, Marco Castagnetti, Mariangela Mancini, Dick Oepkes, Phebe Adama van Scheltema, Wout Feitz, Barbara Kortmann, Michiel Schreuder, Marcin Tkaczyk, Małgorzata Stańczyk, Krzysztof Szaflik, Justyna Wojtera, Waldemar Krzeszowski, Tomasz Talar, Barbara Pawłowska, Katarzyna Fortecka-Piestrzeniewicz, Dariusz Olejniczak, Gema Ariceta, Silvia Arevalo, Carlota Rodo, Magdalena Fossum, Peter Lindgren, Paloma Parvex, Hassib Chehade., Schanstra, Joost, Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Pôle Santé publique et médecine publique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), and Università degli Studi di Milano = University of Milan (UNIMI)
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Posterior urethral valve ,medicine.medical_specialty ,Urinary system ,[SDV]Life Sciences [q-bio] ,kidney disease ,prenatal biomarkers ,Renal function ,Prenatal care ,030204 cardiovascular system & hematology ,DIAGNOSIS ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,0302 clinical medicine ,Medicine ,obstructive uropathy ,Obstructive uropathy ,development ,030304 developmental biology ,RISK ,0303 health sciences ,Transplantation ,Kidney ,ddc:618 ,Science & Technology ,business.industry ,Obstetrics ,Original Articles ,prediction ,Urology & Nephrology ,Omics ,medicine.disease ,6. Clean water ,3. Good health ,[SDV] Life Sciences [q-bio] ,Reconstructive and regenerative medicine Radboud Institute for Molecular Life Sciences [Radboudumc 10] ,Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11] ,medicine.anatomical_structure ,Nephrology ,embryonic structures ,Settore MED/20 ,URINARY-TRACT OBSTRUCTION ,Renal disorders Radboud Institute for Health Sciences [Radboudumc 11] ,business ,Life Sciences & Biomedicine ,Kidney disease - Abstract
Altres ajuts: The study is partially made possible by support of the 'Programme Hospitalier de Recherche Clinique and 'La Foundation de la Recherche Médicale (grant number DEQ20170336759, France). M.T. was supported by the Polish Mothers Memorial Hospital Research Institute (internal grant number 2016/IV/54-GW. LvdZ is supported by a Kolff grant from the Dutch Kidney Foundation (13OKJ36) and a ZonMW-VENI grant from the Netherlands Organisation for Scientific Research (91618036). This project has been supported by ERN ERKNet and ERN eUROGEN, which are partly co-funded by the European Union within the framework of the Third Health Programme 'ERN-2016-Framework Partnership Agreement 2017-2021'. Posterior urethral valves (PUV) account for 17% of paediatric end-stage renal disease. A major issue in the management of PUV is prenatal prediction of postnatal renal function. Fetal ultrasound and fetal urine biochemistry are currently employed for this prediction, but clearly lack precision. We previously developed a fetal urine peptide signature that predicted in utero with high precision postnatal renal function in fetuses with PUV. We describe here the objectives and design of the prospective international multicentre ANTENATAL (multicentre validation of a fetal urine peptidome-based classifier to predict postnatal renal function in posterior urethral valves) study, set up to validate this fetal urine peptide signature. Participants will be PUV pregnancies enrolled from 2017 to 2021 and followed up until 2023 in >30 European centres endorsed and supported by European reference networks for rare urological disorders (ERN eUROGEN) and rare kidney diseases (ERN ERKNet). The endpoint will be renal/patient survival at 2 years postnatally. Assuming α = 0.05, 1-β = 0.8 and a mean prevalence of severe renal outcome in PUV individuals of 0.35, 400 patients need to be enrolled to validate the previously reported sensitivity and specificity of the peptide signature. In this largest multicentre study of antenatally detected PUV, we anticipate bringing a novel tool to the clinic. Based on urinary peptides and potentially amended in the future with additional omics traits, this tool will be able to precisely quantify postnatal renal survival in PUV pregnancies. The main limitation of the employed approach is the need for specialized equipment. Accurate risk assessment in the prenatal period should strongly improve the management of fetuses with PUV.
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- 2020
32. Beta2-adrenergic agonists to tocolytic therapy in pre-eclampsia: two cases of pulmonary oedema
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Eliat, C., Lassel, L., Guillou, Y.-M., and Le Bouar, G.
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EDEMA , *BODY fluid disorders , *LUNG diseases , *PREECLAMPSIA - Abstract
Two cases of pulmonary oedema during beta2-adrenergic agonist therapy in pre-eclampsia pregnant patients are reported. In our first case, the pulmonary oedema was exceptionally severe, because the patient (twins at 26 SA) had to be intubated and ventilated, but the caesarean section was performed only 6 weeks later. These two clinical observations underline the fact that B2 adrenergic agonist are not indicated for the treatment of preeclampsy. Furthermore they suggest that such patients should be rapidly admitted to intensive care units. [Copyright &y& Elsevier]
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- 2002
33. Extending the clinical spectrum of X-linked Tonne-Kalscheuer syndrome (TOKAS): new insights from the fetal perspective.
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Cuinat S, Quélin C, Effray C, Dubourg C, Le Bouar G, Cabaret-Dufour AS, Loget P, Proisy M, Sauvestre F, Sarreau M, Martin-Berenguer S, Beneteau C, Naudion S, Michaud V, Arveiler B, Trimouille A, Macé P, Sigaudy S, Glazunova O, Torrents J, Raymond L, Saint-Frison MH, Attié-Bitach T, Lefebvre M, Capri Y, Bourgon N, Thauvin-Robinet C, Tran Mau-Them F, Bruel AL, Vitobello A, Denommé-Pichon AS, Faivre L, Brehin AC, Goldenberg A, Patrier-Sallebert S, Perani A, Dauriat B, Bourthoumieu S, Yardin C, Marquet V, Barnique M, Fiorenza-Gasq M, Marey I, Tournadre D, Doumit R, Nugues F, Barakat TS, Bustos F, Jaillard S, Launay E, Pasquier L, and Odent S
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- Humans, Male, Female, Fetus pathology, Mutation, Phenotype, Prenatal Diagnosis, Exome Sequencing, Genetic Association Studies methods, Abnormalities, Multiple genetics, Abnormalities, Multiple pathology, Abnormalities, Multiple diagnosis, Pedigree, Pregnancy, Genetic Diseases, X-Linked genetics, Genetic Diseases, X-Linked pathology, Genetic Diseases, X-Linked diagnosis
- Abstract
Introduction: Tonne-Kalscheuer syndrome (TOKAS) is a recessive X-linked multiple congenital anomaly disorder caused by RLIM variations. Of the 41 patients reported, only 7 antenatal cases were described., Method: After the antenatal diagnosis of TOKAS by exome analysis in a family followed for over 35 years because of multiple congenital anomalies in five male fetuses, a call for collaboration was made, resulting in a cohort of 11 previously unpublished cases., Results: We present a TOKAS antenatal cohort, describing 11 new cases in 6 French families. We report a high frequency of diaphragmatic hernia (9 of 11), differences in sex development (10 of 11) and various visceral malformations. We report some recurrent dysmorphic features, but also pontocerebellar hypoplasia, pre-auricular skin tags and olfactory bulb abnormalities previously unreported in the literature. Although no clear genotype-phenotype correlation has yet emerged, we show that a recurrent p.(Arg611Cys) variant accounts for 66% of fetal TOKAS cases. We also report two new likely pathogenic variants in RLIM , outside of the two previously known mutational hotspots., Conclusion: Overall, we present the first fetal cohort of TOKAS, describe the clinical features that made it a recognisable syndrome at fetopathological examination, and extend the phenotypical spectrum and the known genotype of this rare disorder., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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- 2024
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34. [Ventilatory management of SARS-CoV-2 acute respiratory failure].
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Artaud-Macari E, Le Bouar G, Maris J, Dantoing E, Vatignez T, and Girault C
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- Humans, SARS-CoV-2, Lung, COVID-19 complications, COVID-19 therapy, Respiratory Distress Syndrome etiology, Respiratory Distress Syndrome therapy, Respiratory Insufficiency etiology, Respiratory Insufficiency therapy
- Abstract
COVID-19 pneumonia presents several particularities in its clinical presentation (cytokine storm, silent hypoxemia, thrombo-embolic risk) and may lead to a number of acute respiratory distress syndrome (ARDS) phenotypes. While the optimal oxygenation strategy in cases of hypoxemic acute respiratory failure (ARF) is still under debate, ventilatory management of COVID-19-related ARF has confirmed the efficacy of high-flow oxygen therapy and restored interest in other ventilatory approaches such as continuous positive airway pressure (CPAP) and noninvasive ventilation involving a helmet, which due to patient overflow are sometimes implemented outside of critical care units. However, further studies are still needed to determine which patients should be given which oxygenation technique, and under which conditions they require invasive mechanical ventilation, given that delayed initiation potentially burdens prognosis. During invasive mechanical ventilation, ventral decubitus and extracorporeal membrane oxygenation have become increasingly prevalent. While innovative therapies such as awake prone position or lung transplantation have likewise been developed, their indications, modalities and efficacy remain to be determined., (Copyright © 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.)
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- 2023
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35. Correction: Influence of socio-economic status on functional recovery after ARDS caused by SARS-CoV-2: the multicentre, observational RECOVIDS study.
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Declercq PL, Fournel I, Demeyere M, Berraies A, Ksiazek E, Nyunga M, Daubin C, Ampere A, Sauneuf B, Badie J, Delbove A, Nseir S, Artaud-Macari E, Bironneau V, Ramakers M, Maizel J, Miailhe AF, Lacombe B, Delberghe N, Oulehri W, Georges H, Tchenio X, Clarot C, Redureau E, Bourdin G, Federici L, Adda M, Schnell D, Bousta M, Salmon-Gandonnière C, Vanderlinden T, Plantefeve G, Delacour D, Delpierre C, Le Bouar G, Sedillot N, Beduneau G, Rivière A, Meunier-Beillard N, Gélinotte S, Rigaud JP, Labruyère M, Georges M, Binquet C, and Quenot JP
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- 2023
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36. Influence of socio-economic status on functional recovery after ARDS caused by SARS-CoV-2: the multicentre, observational RECOVIDS study.
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Declercq PL, Fournel I, Demeyere M, Berraies A, Ksiazek E, Nyunga M, Daubin C, Ampere A, Sauneuf B, Badie J, Delbove A, Nseir S, Artaud-Macari E, Bironneau V, Ramakers M, Maizel J, Miailhe AF, Lacombe B, Delberghe N, Oulehri W, Georges H, Tchenio X, Clarot C, Redureau E, Bourdin G, Federici L, Adda M, Schnell D, Bousta M, Salmon-Gandonnière C, Vanderlinden T, Plantefeve G, Delacour D, Delpierre C, Le Bouar G, Sedillot N, Beduneau G, Rivière A, Meunier-Beillard N, Gélinotte S, Rigaud JP, Labruyère M, Georges M, Binquet C, and Quenot JP
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- Humans, SARS-CoV-2, Prospective Studies, Economic Status, Oxygen, COVID-19 complications, Respiratory Distress Syndrome etiology, Respiratory Distress Syndrome therapy
- Abstract
Purpose: Survivors after acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) are at high risk of developing respiratory sequelae and functional impairment. The healthcare crisis caused by the pandemic hit socially disadvantaged populations. We aimed to evaluate the influence of socio-economic status on respiratory sequelae after COVID-19 ARDS., Methods: We carried out a prospective multicenter study in 30 French intensive care units (ICUs), where ARDS survivors were pre-enrolled if they fulfilled the Berlin ARDS criteria. For patients receiving high flow oxygen therapy, a flow ≥ 50 l/min and an FiO
2 ≥ 50% were required for enrollment. Socio-economic deprivation was defined by an EPICES (Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé - Evaluation of Deprivation and Inequalities in Health Examination Centres) score ≥ 30.17 and patients were included if they performed the 6-month evaluation. The primary outcome was respiratory sequelae 6 months after ICU discharge, defined by at least one of the following criteria: forced vital capacity < 80% of theoretical value, diffusing capacity of the lung for carbon monoxide < 80% of theoretical value, oxygen desaturation during a 6-min walk test and fibrotic-like findings on chest computed tomography., Results: Among 401 analyzable patients, 160 (40%) were socio-economically deprived and 241 (60%) non-deprived; 319 (80%) patients had respiratory sequelae 6 months after ICU discharge (81% vs 78%, deprived vs non-deprived, respectively). No significant effect of socio-economic status was identified on lung sequelae (odds ratio (OR), 1.19 [95% confidence interval (CI), 0.72-1.97]), even after adjustment for age, sex, most invasive respiratory support, obesity, most severe P/F ratio (adjusted OR, 1.02 [95% CI 0.57-1.83])., Conclusions: In COVID-19 ARDS survivors, socio-economic status had no significant influence on respiratory sequelae 6 months after ICU discharge., (© 2023. The Author(s).)- Published
- 2023
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37. Influence of socioeconomic status on functional recovery after ARDS caused by SARS-CoV-2: a multicentre, observational study.
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Declercq PL, Fournel I, Demeyere M, Ksiazek E, Meunier-Beillard N, Rivière A, Clarot C, Maizel J, Schnell D, Plantefeve G, Ampere A, Daubin C, Sauneuf B, Kalfon P, Federici L, Redureau É, Bousta M, Lagache L, Vanderlinden T, Nseir S, La Combe B, Bourdin G, Monchi M, Nyunga M, Ramakers M, Oulehri W, Georges H, Salmon Gandonniere C, Badie J, Delbove A, Monnet X, Beduneau G, Artaud-Macari É, Abraham P, Delberghe N, Le Bouar G, Miailhe AF, Hraiech S, Bironneau V, Sedillot N, Hoppe MA, Barbar SD, Calcaianu GD, Dellamonica J, Terzi N, Delpierre C, Gélinotte S, Rigaud JP, Labruyère M, Georges M, Binquet C, and Quenot JP
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- Cohort Studies, Humans, Oxygen, Prospective Studies, Quality of Life, SARS-CoV-2, Social Class, Treatment Outcome, COVID-19 complications, Respiratory Distress Syndrome etiology, Respiratory Distress Syndrome therapy
- Abstract
Introduction: Prognosis of patients with COVID-19 depends on the severity of the pulmonary affection. The most severe cases may progress to acute respiratory distress syndrome (ARDS), which is associated with a risk of long-term repercussions on respiratory function and neuromuscular outcomes. The functional repercussions of severe forms of COVID-19 may have a major impact on quality of life, and impair the ability to return to work or exercise. Social inequalities in healthcare may influence prognosis, with socially vulnerable individuals more likely to develop severe forms of disease. We describe here the protocol for a prospective, multicentre study that aims to investigate the influence of social vulnerability on functional recovery in patients who were hospitalised in intensive care for ARDS caused by COVID-19. This study will also include an embedded qualitative study that aims to describe facilitators and barriers to compliance with rehabilitation, describe patients' health practices and identify social representations of health, disease and care., Methods and Analysis: The "Functional Recovery From Acute Respiratory Distress Syndrome (ARDS) Due to COVID-19: Influence of Socio-Economic Status" (RECOVIDS) study is a mixed-methods, observational, multicentre cohort study performed during the routine follow-up of post-intensive care unit (ICU) functional recovery after ARDS. All patients admitted to a participating ICU for PCR-proven SARS-CoV-2 infection and who underwent chest CT scan at the initial phase AND who received respiratory support (mechanical or not) or high-flow nasal oxygen, AND had ARDS diagnosed by the Berlin criteria will be eligible. The primary outcome is the presence of lung sequelae at 6 months after ICU discharge, defined either by alterations on pulmonary function tests, oxygen desaturation during a standardised 6 min walk test or fibrosis-like pulmonary findings on chest CT. Patients will be considered to be socially disadvantaged if they have an "Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examen de Santé" (EPICES) score ≥30.17 at inclusion., Ethics and Dissemination: The study protocol and the informed consent form were approved by an independent ethics committee (Comité de Protection des Personnes Sud Méditerranée II) on 10 July 2020 (2020-A02014-35). All patients will provide informed consent before participation. Findings will be published in peer-reviewed journals and presented at national and international congresses., Trial Registration Number: NCT04556513., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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38. Predicting the risk of respiratory distress in newborns with congenital pulmonary malformations.
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Delacourt C, Bertille N, Salomon LJ, Rahshenas M, Benachi A, Bonnard A, Choupeaux L, Fouquet V, Goua V, Hameury F, Hervieux E, Jouannic JM, Khen-Dunlop N, Le Bouar G, Massardier J, Roditis L, Rosenblatt J, Sartor A, Thong-Vanh C, Lelong N, and Khoshnood B
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- Child, Female, Gestational Age, Humans, Infant, Infant, Newborn, Infant, Premature, Pregnancy, Prospective Studies, Risk Factors, Respiratory Distress Syndrome, Ultrasonography, Prenatal methods
- Abstract
Objectives: Most children with prenatally diagnosed congenital pulmonary malformations (CPMs) are asymptomatic at birth. We aimed to develop a parsimonious prognostic model for predicting the risk of neonatal respiratory distress (NRD) in preterm and term infants with CPM, based on the prenatal attributes of the malformation., Methods: MALFPULM is a prospective population-based nationally representative cohort including 436 pregnant women. The main predictive variable was the CPM volume ratio (CVR) measured at diagnosis (CVR first) and the highest CVR measured (CVR max). Separate models were estimated for preterm and term infants and were validated by bootstrapping., Results: In total, 67 of the 383 neonates studied (17%) had NRD. For infants born at term (>37 weeks, n=351), the most parsimonious model included CVR max as the only predictive variable (receiver operating characteristic (ROC) curve area: 0.70±0.04, negative predictive value: 0.91). The probability of NRD increased linearly with increasing CVR max and remained below 10% for CVR max <0.4. In preterm infants (n=32), both CVR max and gestational age were important predictors of the risk of NRD (ROC: 0.85±0.07). Models based on CVR first had a similar predictive ability., Conclusions: Predictive models based exclusively on CVR measurements had a high negative predictive value in infants born at term. Our study results could contribute to the individualised general risk assessment to guide decisions about the need for newborns with prenatally diagnosed CPM to be delivered at specialised centres., Competing Interests: Conflict of interest: C. Delacourt has nothing to disclose. Conflict of interest: N. Bertille has nothing to disclose. Conflict of interest: L.J. Salomon has nothing to disclose. Conflict of interest: M. Rahshenas has nothing to disclose. Conflict of interest: A. Benachi has nothing to disclose. Conflict of interest: A. Bonnard has nothing to disclose. Conflict of interest: L. Choupeaux has nothing to disclose. Conflict of interest: V. Fouquet has nothing to disclose. Conflict of interest: V. Goua has nothing to disclose. Conflict of interest: F. Hameury has nothing to disclose. Conflict of interest: E. Hervieux has nothing to disclose. Conflict of interest: J-M. Jouannic has nothing to disclose. Conflict of interest: N. Khen-Dunlop has nothing to disclose. Conflict of interest: G. Le Bouar has nothing to disclose. Conflict of interest: J. Massardier has nothing to disclose. Conflict of interest: L. Roditis has nothing to disclose. Conflict of interest: J. Rosenblatt has nothing to disclose. Conflict of interest: A. Sartor has nothing to disclose. Conflict of interest: C. Thong-Vanh has nothing to disclose. Conflict of interest: N. Lelong has nothing to disclose. Conflict of interest: B. Khoshnood has nothing to disclose., (Copyright ©The authors 2022. For reproduction rights and permissions contact permissions@ersnet.org.)
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- 2022
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39. Prenatal phenotype of 22q11 micro-duplications: A systematic review and report on 12 new cases.
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Mary L, Lavillaureix A, Perrot A, Loget P, Launay E, Leborgne AS, Demurger F, Fradin M, Le Bouar G, Quélin C, Dubourg C, Pasquier L, Odent S, Belaud-Rotureau MA, and Jaillard S
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- Abnormalities, Multiple pathology, Adaptor Proteins, Signal Transducing genetics, Chromosomes, Human, Pair 22 genetics, DiGeorge Syndrome pathology, Female, Humans, Infant, Newborn, Male, Phosphoproteins genetics, Abnormalities, Multiple genetics, Chromosome Duplication genetics, DiGeorge Syndrome genetics, Fetus pathology, Phenotype
- Abstract
The 22q11 region is prone to generating recurring Copy Number Variations (CNVs) as a result of the large numbers of Low Copy Repeats (LCRs). Typical duplications encompass the LCR-A-to-D region but atypical duplications of various sizes have also been reported. These duplications are responsible for highly variable phenotypes with incomplete penetrance and expressivity, which is challenging for adequate genetic counselling, especially in the prenatal period. To better delineate prenatal phenotypes associated with these CNVs, we report here a clinical and molecular description of twelve cases (9 foetuses and 3 deceased new-borns babies) carrying recurrent 22q11 duplications (diagnosed via aCGH), along with a review of the existing literature. 22q11 duplications were inherited from an apparently healthy parent in almost 60% of the cases. Other CNVs were diagnosed for 8% of the cases. Increased nuchal translucency and cardiac anomalies (CHD) were the most prominent phenotypes observed, along with mild renal and skeletal anomalies. Duplications encompassing the LCR-C-to-D region (and the CRKL gene) seemed more likely to generate CHDs and renal malformations. Cleft lip/palate were observed in foetuses with duplications encompassing the LCR-A-to-B region or the SPECC1L gene, as previously suggested. However, genotype-phenotype correlations remain difficult to ascertain. Second-hit point variants, epigenetic or environmental variations could play a role in the phenotypic variability of 22q11 duplications, but remain a challenge for assessment in the short period of pregnancy., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)
- Published
- 2022
- Full Text
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40. Virtual Bronchoscopy Planner and Radial-EBUS Guided Biopsy for Organizing Pneumonia Diagnosis.
- Author
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Lachkar S, Salaün M, Perrot L, Gervereau D, De Marchi M, Le Bouar G, Morisse-Pradier H, Dominique S, Piton N, Guisier F, and Thiberville L
- Abstract
Background: The diagnosis of organizing pneumonia (OP) often requires histological confirmation. The aim of this retrospective study was to evaluate the diagnostic yield and complication rate of radial endobronchial ultrasound (r-EBUS) for OP., Methods: All patients who had r-EBUS as a first diagnostic procedure for a peripheral pulmonary lesion at Rouen University Hospital, France, between April 2008 and December 2020 were included. Cases without a final diagnosis of OP or follow-up were excluded. Patients, lesions, and r-EBUS characteristics were retrospectively analyzed., Results: 2735 r-EBUS procedures were performed, and 33 cases with final OP could be analyzed. Procedures were performed under local anesthesia in 28/33 cases (85%). Among the 33 final OP cases, 17 were considered cryptogenic, and 16 secondary. The lesions were patchy alveolar opacities in 23 cases (70%), masses or pulmonary nodules in 8 cases (24%), and diffuse infiltrative opacities in 2 cases (6%). A bronchus sign on CT scan was found in all cases. In 22 cases (67%), a histopathological diagnosis was obtained from the r-EBUS samples. In 4 cases (12%), histopathological diagnosis was made by surgery, and in 7 cases (21%) the diagnosis was made based on clinical, radiological, and evolution features. An ultrasound image was found in 100% (22/22) of cases in the r-EBUS positive (r-EBUS+) group vs. 60% (6/10) in the r-EBUS negative (r-EBUS-) group, respectively ( p < 0.002). The diagnostic yield of r-EBUS for OP was 67% and increased to 79% (22/28) when an ultrasound image was obtained. The median time between CT scan and r-EBUS procedure was 14 days (3-94): 11.5 days in the r-EBUS+ group and 22 days in the r-EBUS- group ( p < 0.0001). No severe complications were reported., Conclusion: r-EBUS, when performed shortly after a CT scan showing a bronchus sign, is an efficient and safe technique for OP diagnosis.
- Published
- 2021
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41. High-flow oxygen therapy versus noninvasive ventilation: a randomised physiological crossover study of alveolar recruitment in acute respiratory failure.
- Author
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Artaud-Macari E, Bubenheim M, Le Bouar G, Carpentier D, Grangé S, Boyer D, Béduneau G, Misset B, Cuvelier A, Tamion F, and Girault C
- Abstract
High-flow nasal cannula (HFNC) oxygen therapy has recently shown clinical benefits in hypoxaemic acute respiratory failure (ARF) patients, while the value of noninvasive ventilation (NIV) remains debated. The primary end-point was to compare alveolar recruitment using global end-expiratory electrical lung impedance (EELI) between HFNC and NIV. Secondary end-points compared regional EELI, lung volumes (global and regional tidal volume variation ( V
T )), respiratory parameters, haemodynamic tolerance, dyspnoea and patient comfort between HFNC and NIV, relative to face mask (FM). A prospective randomised crossover physiological study was conducted in patients with hypoxaemic ARF due to pneumonia. They received alternately HFNC, NIV and FM. 16 patients were included. Global EELI was 4083 with NIV and 2921 with HFNC (p=0.4). Compared to FM, NIV and HFNC significantly increased global EELI by 1810.5 (95% CI 857-2646) and 826 (95% CI 399.5-2361), respectively. Global and regional VT increased significantly with NIV compared to HFNC or FM, but not between HFNC and FM. NIV yielded a significantly higher pulse oxygen saturation/inspired oxygen fraction ratio compared to HFNC (p=0.03). No significant difference was observed between HFNC, NIV and FM for dyspnoea. Patient comfort score with FM was not significantly different than with HFNC (p=0.1), but was lower with NIV (p=0.001). This study suggests a potential benefit of HFNC and NIV on alveolar recruitment in patients with hypoxaemic ARF. In contrast with HFNC, NIV increased lung volumes, which may contribute to overdistension and its potentially deleterious effect in these patients., Competing Interests: Conflict of interest: E. Artaud-Macari has nothing to disclose. Conflict of interest: M. Bubenheim has nothing to disclose. Conflict of interest: G. Le Bouar has nothing to disclose. Conflict of interest: D. Carpentier has nothing to disclose. Conflict of interest: S. Grangé has nothing to disclose. Conflict of interest: D. Boyer has nothing to disclose. Conflict of interest: G. Béduneau has nothing to disclose. Conflict of interest: B. Misset has nothing to disclose. Conflict of interest: A. Cuvelier has nothing to disclose. Conflict of interest: F. Tamion has nothing to disclose. Conflict of interest: C. Girault reports grants and nonfinancial support from Fischer & Paykel Healthcare and Resmed Ltd during the conduct of the study., (Copyright ©The authors 2021.)- Published
- 2021
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42. Performance of diagnostic ultrasound to identify causes of hydramnios.
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Adam MJ, Enderle I, Le Bouar G, Cabaret-Dufour AS, Tardif C, Contin L, Arnaud A, Proisy M, Jaillard S, Pasquier L, and Le Lous M
- Subjects
- Adult, Amniocentesis statistics & numerical data, Diabetes, Gestational diagnostic imaging, Female, Humans, Pregnancy, Pregnancy in Diabetics diagnostic imaging, Retrospective Studies, Polyhydramnios diagnostic imaging, Polyhydramnios etiology, Ultrasonography, Prenatal statistics & numerical data
- Abstract
Introduction: We aimed to assess the diagnostic yield of ultrasonography in the identification of the etiology of hydramnios, and the added value of MRI or amniocentesis., Methods: We conducted a single-center retrospective study including pregnancies with confirmed hydramnios (defined as deepest pocket ≥8 cm) between January 2013 and May 2017. Twin pregnancies, secondary hydramnios discovered after the diagnosis of a causal pathology, and pregnancies of unknown outcome were excluded. All pregnancies underwent a targeted scan, and selected cases underwent MRI or amniocentesis., Results: A total of 158 patients with confirmed hydramnios were included. Hydramnios was associated with a fetal pathology in 37 cases (23.4%), with diabetes in 39 (24.6%), isolated macrosomia in 16 (10.1%), and considered idiopathic in 66 (41.7%). Ultrasonography established a diagnosis of the underlying pathology in 73% of cases. Amniocentesis was done in 31 cases (20%) and it allowed diagnosis of chromosome anomalies, esophageal atresia, myotonic dystrophy congenital type, Prader-Willi syndrome, and Bartter syndrome. MRI was done in 15 cases (10%) and it allowed one additional diagnosis of esophageal atresia. The diagnostic yields of MRI and amniocentesis were 91.7% and 95.2%, respectively. There were five false positive diagnoses at ultrasonography, and one false positive diagnosis at MRI., Conclusion: Hydramnios can be associated with a wide variety of underlying pathologies. Diagnostic ultrasound can attain a diagnosis in the majority of cases. Amniocentesis offers a valuable complementary assessment., (© 2020 John Wiley & Sons Ltd.)
- Published
- 2021
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43. Antenatal Management of Bronchopulmonary Sequestration by Intrafetal Vascular Laser Ablation under Ultrasound Control: Narrative Review of the Literature and Report of Three Cases.
- Author
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Grozdeva L, Senat MV, Vandewynckele N, Fouquet V, Castaigne V, Le Bouar G, Benachi A, and Bouchghoul H
- Subjects
- Female, Gestational Age, Humans, Infant, Infant, Newborn, Pregnancy, Ultrasonography, Prenatal, Bronchopulmonary Sequestration diagnostic imaging, Bronchopulmonary Sequestration surgery, Fetal Diseases diagnostic imaging, Fetal Diseases surgery, Laser Therapy
- Abstract
Objective: The objective of this study is to assess the effectiveness and safety of intrafetal vascular laser ablation (VLA) for fetuses with bronchopulmonary sequestration (BPS) with hydrops., Methods: First, we present 3 cases of fetuses with BPS and hydrops treated by VLA. Second, we aimed to conduct a narrative review to identify all reported cases of fetuses with BPS treated by intrafetal VLA., Results: The review of the literature identified 41 fetuses treated by VLA for BPS with hydrops. The median gestational age of the VLA was 27+0 weeks' gestation [25+0-31+0] with an associated procedure at the same time in 43% of the cases (pleuroamniotic shunt, thoracentesis, and amniodrainage). A second procedure was required in 25% of cases for residual flow in the feeding vessel. No stillbirth or neonatal death was reported. The complications reported were a fetal thoracic hematoma complicated by fetal anemia and 4 preterm deliveries with a rate of 9%., Conclusion: VLA of the feeding vessel can be an effective treatment but is not without complications. In cases demonstrating cardiac output failure, intrafetal VLA should be considered as a treatment for BPS., (© 2021 S. Karger AG, Basel.)
- Published
- 2021
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44. Multicolor-FISH Characterization of a Prenatal Mosaicism for a Chromosomal Rearrangement Undetected by Molecular Cytogenetics.
- Author
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Mary L, Loget P, Odent S, Aussel D, Le Bouar G, Launay E, Henry C, Belaud-Rotureau MA, and Jaillard S
- Subjects
- Adult, Chromosomes, Human, Pair 17 genetics, Chromosomes, Human, Pair 4 genetics, Comparative Genomic Hybridization, Female, Humans, Karyotyping, Maternal Age, Pregnancy, Chromosome Painting methods, Cytogenetics methods, Fetus metabolism, Mosaicism, Prenatal Diagnosis methods, Translocation, Genetic genetics
- Abstract
Fetal mosaicism for chromosomal rearrangements remains a challenge to diagnose, even in the era of whole-genome sequencing. We present here a case of fetal mosaicism for a chromosomal rearrangement explored in amniocytes and fetal muscle, consisting of a major cell population (95%) with partial monosomy 4q and a minor population (5%) with additional material replacing the 4qter deleted segment. Molecular techniques (MLPA, array-CGH) failed to assess the origin of this material. Only multicolor-FISH identified the additional segment on chromosome 4 as derived from chromosome 17. Due to the poor prognosis, the couple chose to terminate the pregnancy. Because of low-level mosaicism, chromosomal microarray analysis (CMA), now considered as first-tier prenatal genetic analysis, did not allow the identification of the minor cell line. In case of large CNVs (>5 Mb) detected by CMA, karyotyping may be considered to elucidate the mechanism of the underlying rearrangement and eliminate mosaicism., (© 2021 S. Karger AG, Basel.)
- Published
- 2021
- Full Text
- View/download PDF
45. Elucidating in utero fetal demise: time to reassemble the pieces of the puzzle?
- Author
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Belhomme N, Lescoat A, Ballerie A, Rouget F, Le Bouar G, Loget P, Caillault L, and Jego P
- Subjects
- Humans, Fetal Death
- Published
- 2020
- Full Text
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46. Is laterality of congenital diaphragmatic hernia a reliable prognostic factor? French national cohort study.
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Pinton A, Boubnova J, Becmeur F, Kuhn P, Senat MV, Stirnemann J, Capelle M, Rosenblatt J, Massardier J, Vaast P, Le Bouar G, Desrumaux A, Connant L, Begue L, Parmentier B, Perrotin F, Diguet A, Benoist G, Muszynski C, Scalabre A, Winer N, Michel JL, Casagrandre-Magne F, Jouannic JM, Gallot D, Coste Mazeau P, Sapin E, Maatouk A, Saliou AH, Sentilhes L, Biquard F, Mottet N, Favre R, Benachi A, and Sananès N
- Subjects
- Adult, Cohort Studies, Female, France epidemiology, Hernias, Diaphragmatic, Congenital mortality, Humans, Infant, Infant Mortality, Infant, Newborn, Lung diagnostic imaging, Male, Pregnancy, Prenatal Diagnosis, Prognosis, Reproducibility of Results, Retrospective Studies, Hernias, Diaphragmatic, Congenital diagnosis, Hernias, Diaphragmatic, Congenital pathology, Lung pathology
- Abstract
Objectives: The objective of this study was to assess whether the laterality of congenital diaphragmatic hernia (CDH) was a prognostic factor for neonatal survival., Methods: This was a cohort study using the French national database of the Reference Center for Diaphragmatic Hernias. The principal endpoint was survival after hospitalization in intensive care. We made a comparative study between right CDH and left CDH by univariate and multivariate analysis. Terminations and stillbirths were excluded from analyses of neonatal outcomes., Results: A total of 506 CDH were included with 67 (13%) right CDH and 439 left CDH (87%). Rate of survival was 49% for right CDH and 74% for left CDH (P < .01). Multivariate analysis showed two factors significantly associated with mortality: thoracic herniation of liver (OR 2.27; IC 95% [1.07-4.76]; P = .03) and lung-to-head-ratio over under expected (OR 2.99; IC 95% [1.41-6.36]; P < .01). Side of CDH was not significantly associated with mortality (OR 1.87; IC 95% [0.61-5.51], P = .26)., Conclusion: Rate of right CDH mortality is more important than left CDH. Nevertheless after adjusting for lung-to-head-ratio and thoracic herniation of liver, right CDH does not have a higher risk of mortality than left CDH., (© 2020 John Wiley & Sons, Ltd.)
- Published
- 2020
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47. Perinatal grief following neonatal comfort care for lethal fetal condition.
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Depoers-Béal C, Le Baccon FA, Le Bouar G, Proisy M, Arnaud A, Legendre G, Dayan J, Bétrémieux P, and Le Lous M
- Subjects
- Abortion, Induced psychology, Adult, Female, Fetal Diseases psychology, Gestational Age, Humans, Infant, Newborn, Patient Comfort, Pregnancy, Psychiatric Status Rating Scales, Retrospective Studies, Abortion, Induced statistics & numerical data, Choice Behavior, Fetal Diseases diagnosis, Grief, Palliative Care methods, Prenatal Diagnosis psychology
- Abstract
Background: The objective of the study was to assess perinatal grief experienced after continuing pregnancy and comfort care in women diagnosed with lethal fetal condition compared with termination of pregnancy for fetal anomaly (TOPFA)., Methods: This was a retrospective observational study which included women who chose to continue their pregnancy after the diagnosis of lethal fetal condition with comfort care support at birth at the Prenatal Diagnosis Center of Rennes Hospital from January 2007 to January 2017. Women were matched with controls who underwent TOPFA for the same type of fetal anomaly, gestational age at diagnosis and year. Women were evaluated by a questionnaire including the Perinatal Grief Scale., Results: There were 28 patients in the continuing pregnancy group matched with 56 patients in the TOPFA group. Interval between fetal loss and completion of questionnaire was 6±3 years. Perinatal grief score was similar at 61±22 vs 58±18 (p = 0.729) in the continuing pregnancy and TOPFA groups, respectively. Women in the TOPFA group expressed more guilt. The cesarean-section rate in the continuing pregnancy group was 25%., Conclusion: Perinatal grief experienced by women opting for continuing pregnancy and comfort care after diagnosis of a potentially lethal fetal anomaly is not more severe than for those choosing TOPFA.
- Published
- 2019
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48. Prenatal therapy with pyrimethamine + sulfadiazine vs spiramycin to reduce placental transmission of toxoplasmosis: a multicenter, randomized trial.
- Author
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Mandelbrot L, Kieffer F, Sitta R, Laurichesse-Delmas H, Winer N, Mesnard L, Berrebi A, Le Bouar G, Bory JP, Cordier AG, Ville Y, Perrotin F, Jouannic JM, Biquard F, d'Ercole C, Houfflin-Debarge V, Villena I, and Thiébaut R
- Subjects
- Adult, Antiprotozoal Agents administration & dosage, Drug Therapy, Combination, Female, France, Humans, Infectious Disease Transmission, Vertical prevention & control, Pregnancy, Prenatal Care, Pyrimethamine administration & dosage, Pyrimethamine therapeutic use, Sulfadiazine administration & dosage, Sulfadiazine therapeutic use, Toxoplasmosis transmission, Toxoplasmosis, Congenital prevention & control, Treatment Outcome, Antiprotozoal Agents therapeutic use, Pregnancy Complications, Infectious drug therapy, Toxoplasmosis drug therapy
- Abstract
Background: The efficacy of prophylaxis to prevent prenatal toxoplasmosis transmission is controversial, without any previous randomized clinical trial. In France, spiramycin is usually prescribed for maternal seroconversions. A more potent pyrimethamine + sulfadiazine regimen is used to treat congenital toxoplasmosis and is offered in some countries as prophylaxis., Objective: We sought to compare the efficacy and tolerance of pyrimethamine + sulfadiazine vs spiramycin to reduce placental transmission., Study Design: This was a randomized, open-label trial in 36 French centers, comparing pyrimethamine (50 mg qd) + sulfadiazine (1 g tid) with folinic acid vs spiramycin (1 g tid) following toxoplasmosis seroconversion., Results: In all, 143 women were randomized from November 2010 through January 2014. An amniocentesis was later performed in 131 cases, with a positive Toxoplasma gondii polymerase chain reaction in 7/67 (10.4%) in the pyrimethamine + sulfadiazine group vs 13/64 (20.3%) in the spiramycin group. Cerebral ultrasound anomalies appeared in 0/73 fetuses in the pyrimethamine + sulfadiazine group, vs 6/70 in the spiramycin group (P = .01). Two of these pregnancies were terminated. Transmission rates, excluding 18 children with undefined status, were 12/65 in the pyrimethamine + sulfadiazine group (18.5%), vs 18/60 in the spiramycin group (30%, P = .147), equivalent to an odds ratio of 0.53 (95% confidence interval, 0.23-1.22) and which after adjustment tended to be stronger (P = .03 for interaction) when treatment started within 3 weeks of seroconversion (95% confidence interval, 0.00-1.63). Two women had severe rashes, both with pyrimethamine + sulfadiazine., Conclusion: There was a trend toward lower transmission with pyrimethamine + sulfadiazine, but it did not reach statistical significance, possibly for lack of statistical power because enrollment was discontinued. There were also no fetal cerebral toxoplasmosis lesions in the pyrimethamine + sulfadiazine group. These promising results encourage further research on chemoprophylaxis to prevent congenital toxoplasmosis., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2018
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49. Analysis of occupational injuries in the sea fishing industry according to the type of fishery and the fishing activity.
- Author
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Chauvin C, Le Bouar G, and Lardjane S
- Subjects
- France epidemiology, Humans, Incidence, Male, Naval Medicine, Risk Factors, Ships, Accidents, Occupational statistics & numerical data, Fisheries statistics & numerical data, Occupational Injuries epidemiology
- Abstract
Background: Sea fishing is one of the most dangerous occupations. Numerous studies have already sought to evaluate the risk level of this occupation through the analysis of the frequency and seriousness of occupational injuries. The purpose of the present study is to analyse these accidents in terms of two main characteristics of the vessels involved: the fishery type (high seas, offshore, coastal, or inshore fishery) and the fishing activity (use of passive or active gears)., Materials and Methods: Injury rates were calculated for the Brittany region and for the year 2012. A second analysis was carried out on 8,286 reported injuries that occurred in France from 2002 to 2012, while vessels were in the process of fishing., Results: This first analysis shows that the incidence rate is very high (103 per 1,000 full-time equivalent fishermen) and that it depends more on the fishery type than on the fishing activity; the highest rates concern the offshore and the coastal fleets. Results of the second analysis show that the nature of accidents depends more on the fishing activity than on the type of fishery., Conclusions: These findings lead to a discussion of the causes of the highest incidence rate values and the causes of the observed variations. The discussion also involves the methodological difficulties related to the incidence rate calculations.
- Published
- 2017
- Full Text
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50. [Termination of pregnancy without feticide: A French national survey].
- Author
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Chappé H, Bétrémieux P, Morel V, Huillery ML, and Le Bouar G
- Subjects
- Adult, Female, France, Humans, Pregnancy, Abortion, Therapeutic statistics & numerical data, Fetal Diseases, Health Care Surveys statistics & numerical data, Palliative Care statistics & numerical data, Pregnancy Trimester, Third
- Abstract
Purpose: Termination of pregnancy without feticide (TOPWF) is poorly known in France and far less practiced than palliative care after term birth of a child having a lethal pathology. Few teams consider it and its practice remains confidential. This survey tries to describe it., Material and Methods: A national survey was realized in 2014 using a questionnaire sent to 50 centers of prenatal diagnosis depending on a perinatal diagnosis center in France., Results: Thirty-one centers answered the questionnaire. Seven teams shared their experience of TOPWF after 22-24 weeks gestation (WG). This practice concerned fetuses affected by "lethal" pathologies. The absence of feticide followed a parental request or a proposal of the medical team, after individual discussion in a multidisciplinary meeting. All the children born alive after TOPWF benefited of palliative care. The 24 other centers having answered our investigation performed systematically the feticide beyond 22-24 WG. They so wished "to protect" the fetus, the parents and the nursing team. A majority of these teams faced parental demands of abstention of feticide but few of them answered it favorably., Conclusion: A robust "palliative culture" seems essential to allow the nursing team to consider the development of TOPWF., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
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