A Descazeaud

University of Limoges, Limages, Limousin, France

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Publications (123)215.66 Total impact

  • Progrès en Urologie 01/2015; · 0.77 Impact Factor
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    ABSTRACT: Lower urinary tract symptoms (LUTS) represent one of the most common clinical complaints in adult men and have multifactorial aetiology. To develop European Association of Urology (EAU) guidelines on the assessment of men with non-neurogenic LUTS. A structured literature search on the assessment of non-neurogenic male LUTS was conducted. Articles with the highest available level of evidence were selected. The Delphi technique consensus approach was used to develop the recommendations. As a routine part of the initial assessment of male LUTS, a medical history must be taken, a validated symptom score questionnaire with quality-of-life question(s) should be completed, a physical examination including digital rectal examination should be performed, urinalysis must be ordered, post-void residual urine (PVR) should be measured, and uroflowmetry may be performed. Micturition frequency-volume charts or bladder diaries should be used to assess male LUTS with a prominent storage component or nocturia. Prostate-specific antigen (PSA) should be measured only if a diagnosis of prostate cancer will change the management or if PSA can assist in decision-making for patients at risk of symptom progression and complications. Renal function must be assessed if renal impairment is suspected from the history and clinical examination, if the patient has hydronephrosis, or when considering surgical treatment for male LUTS. Uroflowmetry should be performed before any treatment. Imaging of the upper urinary tract in men with LUTS should be performed in patients with large PVR, haematuria, or a history of urolithiasis. Imaging of the prostate should be performed if this assists in choosing the appropriate drug and when considering surgical treatment. Urethrocystoscopy should only be performed in men with LUTS to exclude suspected bladder or urethral pathology and/or before minimally invasive/surgical therapies if the findings may change treatment. Pressure-flow studies should be performed only in individual patients for specific indications before surgery or when evaluation of the pathophysiology underlying LUTS is warranted. These guidelines provide evidence-based practical guidance for assessment of non-neurogenic male LUTS. An extended version is available online (www.uroweb.org/guidelines). This article presents a short version of European Association of Urology guidelines for non-neurogenic male lower urinary tract symptoms (LUTS). The recommended tests should be able to distinguish between uncomplicated male LUTS and possible differential diagnoses and to evaluate baseline parameters for treatment. The guidelines also define the clinical profile of patients to provide the best evidence-based care. An algorithm was developed to guide physicians in using appropriate diagnostic tests. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.
    European urology. 01/2015;
  • Progrès en Urologie. 01/2015;
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    ABSTRACT: The French guidelines on the management of benign prostatic hyperplasia (BPH) have been published in 2012 by the LUTS committee of the French Urological Association. The aim of this study was to evaluate the impact of these guidelines on the BPH management by French urologists. A questionnaire has been distributed by email to 1141 urologists members of the French Association of Urologists in November 2013. We collected 222 responses (response rate: 19%). The guidelines have been read by 73% of the urologists. The guidelines were followed most of the time by 76% of them, 11% followed them systematically and 4.5% did not follow them. The new terminology was used by 28 to 52% according to the items. The symptoms were evaluated by the IPSS score (33%), by interrogatory alone (64%) or by neither of them (3%). Prostate volume was not systematically taken for account in the treatment strategy by 57% of the urologists. Sexual function was assessed systematically by 28% of the urologists, 11% used a questionnaire (IIEF: 92%). PSA was tested respectively by 70 and 51% of the urologists at the initial evaluation and the follow-up. After introduction of a monotherapy, 56% of the urologists evaluated the efficacy at 3 months. The French guidelines for the management of benign prostatic hyperplasia (BPH) by the LUTS committee of the French Urological Association were well known and used by French urologists. Some improvements can be expected for the use of the IPSS score, the evaluation of the sexual function, and the use of the new terminology. 4. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 12/2014;
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    ABSTRACT: Valider, à grande échelle, en médecine générale, l’utilisation d’une EVA dans la détermination et le suivi de la sévérité des SBAU associés à une HBP ; cette échelle comporte comme le score IPSS 35 points, et a fait l’objet d’une validation dans une étude pilote pauci-centrique en 2004 auprès d’urologues (Teillac P et al., 2004).
    Progrès en Urologie 11/2014; 24. · 0.77 Impact Factor
  • S. Lebdai, A. Descazeaud
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    ABSTRACT: Benign prostatic hyperplasia is a frequent pathology in men after 50 years old. It is responsible for lower urinary tract symptoms (LUTS). These LUTS might have an important impact on quality of life and might induce complications that might require medical or surgical treatments. The aim of this study was to explain the management of LUTS due to BPH.
    Progrès en Urologie 11/2014; · 0.77 Impact Factor
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    ABSTRACT: Valider, en médecine générale, l’utilisation d’un SVPI dans la détermination et le suivi de la sévérité des SBAU associés à une HBP. Ce score, échelonné de 0 à 24 points, comporte cinq questions illustrées par des pictogrammes (Fig. 1)
    Progrès en Urologie 11/2014; 24. · 0.77 Impact Factor
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    ABSTRACT: Évaluer le risque hémorragique des patients sous AVK pour valve cardiaque mécanique opérés d’une hypertrophie bénigne de prostate, en fonction de la technique chirurgicale employée.
    Progrès en Urologie 11/2014; 24. · 0.77 Impact Factor
  • S Lebdai, A Descazeaud
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    ABSTRACT: Benign prostatic hyperplasia is a frequent pathology in men after 50years old. It is responsible for lower urinary tract symptoms (LUTS). These LUTS might have an important impact on quality of life and might induce complications that might require medical or surgical treatments. The aim of this study was to explain the management of LUTS due to BPH.
    Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 09/2014;
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    ABSTRACT: To perform an update on the conservative treatment of male non-neurologic urinary incontinence.
    Progrès en urologie : journal de l'Association française d'urologie et de la Société française d'urologie. 09/2014; 24(10):610-5.
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    ABSTRACT: Purpose To perform an update on the treatment of masculine urinary incontinence due to idiopathic overactive bladder. Method A systematic review was conducted using PubMed/MEDLINE with the following keywords: “overactive bladder”, “male urinary incontinence”, “urgency”, “antimuscarinic”, “onabotulinumtoxinA”, “neurostimulation”, “cystoplasty”. Results Antimuscarinic treatments were the first line option for overactive bladder incontinence (decreased incontinence under tolterodine versus placebo respectively −71% vs. −40%, P < 0.05). Their main side effects were dry mouth (16–29.6%) and constipation (4%), which might decrease the observance. In case of failure, neuromostimulation could be prosed with a 67% efficacy rate. Intra-detrusorian injections of onabotulinumtoxinA were an option, however there were still not validated for this indication and their efficacy decreases with time and after repeated injections. The ultimate option in case of refractory major over-activity was cystoplasty, which involves major morbidity for inconstant efficacy. Conclusions The same treatments are available for non-neurologic urinary incontinence by bladder over-activity for men and women: antimuscarinic drugs, neurostimulation, onabotulinumtoxinA. However, only few data is available for masculine population exclusively.
    Progrès en Urologie 07/2014; · 0.77 Impact Factor
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    ABSTRACT: Intravesical prostatic protrusion (IPP) is a protrusion of the lateral and/or median prostatic lobes into the bladder lumen. IPP can be estimated by suprapubic ultrasound. A literature search was conducted in Pubmed/MEDLINE database using the following keywords: intravesical prostatic protrusion; benign prostatic enlargement; treatment outcome; ultrasonography. There are 3 grades of IPP: grade 1, 2 and 3 respectively if IPP≤5mm, if 5-10mm, and if >10mm. IPP was a better prognosis factor than PSA and prostate volume for bladder outlet obstruction (BOO) with a sensibility of 80% and a sensitivity of 68% for grade 3. The progression risk of BOO increased with IPP (grade 1: OR=5.1 [95%CI: 1.6-16.2] and grade≥2 OR=10.4 [95%CI: 3.3-33.4]). IPP was a predictive marker of failure of trial off catheter in patients with acute urinary retention with a 6 folds higher risk for grades ≥2. IPP was a prognosis factor for tamsulosine efficacy: 78% of patients with grade≤2 had an improvement >35% of the IPSS-score versus 58% for grade >3 (P<0.01). Patients with grade >3 and a PV<40cc had a poorer response to tamsulosine. After TURP, IPSS was more improved for grade≥1 with an OR=3.43 (95%CI: 1.03-11.44, P=0.045). IPP can be a useful marker for the management of LUTS/BPH.
    Progrès en Urologie 04/2014; 24(5):313-8. · 0.77 Impact Factor
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    ABSTRACT: The objective of this study was to analyze the efficacy and safety of silodosin in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in current urologic practice. This was a prospective observational study conducted by 272 urologists on patients treated by silodosin for BPH. The parameters evaluated were the weighted IPSS score, the IPSS question 8 related to quality of life, the USP score and the Athens Insomnia Scale (AIS) measured at treatment initiation and after 3months. Nine hundred and fourteen patients whose average age was 66 years with LUTS for 3.3 years were analyzed. After 3 months of treatment, a significant decrease in IPSS (from 16.2±6.1 to 9.7±5.5, P<0.0001) and USP score (from 10.6±5.1 to 6 0±4.6, P<0.0001) were observed, quality of life (from 67.1% to 14.4% of unsatisfied patients, P<0.0001) and sleep were significantly improved (from 49.2% to 28.9% patients with insomnia, P<0.0001). Among the patients, 21.2% experienced at least one adverse event. The most frequent were abnormal ejaculation (17.2%). And 7.1% discontinued the treatment for this reason. After 3months of treatment silodosin was continued in 86.9% of patients. This large study confirmed the efficacy of silodosin in LUTS associated with BPH with a safety profile that does not affect patient satisfaction.
    Progrès en Urologie 03/2014; 24(3):196-202. · 0.77 Impact Factor
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    ABSTRACT: Purpose To perform an update on the conservative treatment of male non-neurologic urinary incontinence. Method A systematic review was conducted using PubMed/MEDLINE with the following keywords: “incontinence”, “male stress urinary incontinence”, “pelvic floor training”, “biofeedback”, “absorbant products”, “life style”, “penile clamp”. Results Palliative devices like penile clamps, penile sheaths and absorbent products were transitory options that were poorly evaluated. Life style modifications (scheduled voiding, controlled hydric absorption, decreased caffeine and spice intake) were useful in complement of other treatments especially in case of overactive bladder. Pelvic floor training (PFT) was useful after radical prostatectomy but remained optional for other types of incontinence. It accelerated the continence recovery postoperatively but it results at 1 year were uncertain. These results were maintained 1 year. Conservative treatments were useful postoperatively especially early supervised PFT. The benefit of biofeedback and perineal stimulation was controversial. Balder catheterization was a last resort option. Penile sheaths were better than urethral catheterization if there were no post-voiding residual urines. Conclusions Palliative options have a limited efficacy but are mini-invasive and might be helpful complementary options.
    Progrès en Urologie. 01/2014;
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    ABSTRACT: Introduction Intravesical prostatic protrusion (IPP) is a protrusion of the lateral and/or median prostatic lobes into the bladder lumen. IPP can be estimated by suprapubic ultrasound. Methods A literature search was conducted in Pubmed/MEDLINE database using the following keywords: intravesical prostatic protrusion; benign prostatic enlargement; treatment outcome; ultrasonography. Results There are 3 grades of IPP: grade 1, 2 and 3 respectively if IPP ≤ 5 mm, if 5–10 mm, and if > 10 mm. IPP was a better prognosis factor than PSA and prostate volume for bladder outlet obstruction (BOO) with a sensibility of 80% and a sensitivity of 68% for grade 3. The progression risk of BOO increased with IPP (grade 1: OR = 5.1 [95%CI: 1.6–16.2] and grade ≥ 2 OR = 10.4 [95%CI: 3.3–33.4]). IPP was a predictive marker of failure of trial off catheter in patients with acute urinary retention with a 6 folds higher risk for grades ≥ 2. IPP was a prognosis factor for tamsulosine efficacy: 78% of patients with grade ≤ 2 had an improvement > 35% of the IPSS-score versus 58% for grade > 3 (P < 0.01). Patients with grade > 3 and a PV < 40 cc had a poorer response to tamsulosine. After TURP, IPSS was more improved for grade ≥ 1 with an OR = 3.43 (95%CI: 1.03–11.44, P = 0.045). Conclusion IPP can be a useful marker for the management of LUTS/BPH.
    Progrès en Urologie. 01/2014; 24(5):313–318.
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    ABSTRACT: To describe drugs targeting urethra and prostate to treat dysfunctions such LUTS related to BPH, primary bladder neck obstruction (PBNO), detrusor sphincter dyssynergia (DSD) or sphincter deficiency (SD). Pubmed search for efficacy, mode of action and side effects for each molecule. Additional data were searched from the French regulatory agencies web sites (HAS and ANSM). To treat LUTS related to BPH alpha-blockers (AB) and 5-alpha reductase inhibitors (5ARIs) have a clearer efficacy than plant extract. Daily Phospdiesterase 5 inhibitors (PDE5Is) alone or in association with AB also demonstrate efficacy in this indication. AB are an option in PBNO and DSD related to multiple sclerosis. Although Botulinum toxin A derived molecules decrease urethral pressure in patient with DSD related to spinal cord injury or multiple sclerosis, efficiency remains to be demonstrated. Duloxetine a serotonin reuptake inhibitor increases urethral sphincter pressure and reduce stress urinary incontinence in women and men. Nevertheless, moderate efficacy combine with frequent side effects lead French regulation agency to reject its agreement. Armamenterium to treat urethral dysfunctions has recently increases. Two new therapeutic classes emerge: PDE5Is to treat LUTS related to BPH and an SRIs (Duloxetine) to treat stress urinary incontinence. Efficacy and safety evaluation of all the possible associations between drugs targeting urethra and/or bladder is needed to a subtler and more efficient pharmacologic modulation of lower urinary tract dysfunction.
    Progrès en Urologie 11/2013; 23(15):1287-98. · 0.77 Impact Factor
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    ABSTRACT: The present study assessed the incidence and histopathological features of incidentally diagnosed prostate cancer (PCa) in specimens from radical cystoprostatectomy (RCP) for bladder cancer. The patient outcomes also were evaluated. We retrospectively reviewed the histopathological features and survival data of 4,299 male patients who underwent a RCP for bladder cancer at 25 French centers between January 1996 and June 2012. No patients had preoperative clinical or biological suspicion of PCa. Among the 4,299 RCP specimens, PCa was diagnosed in 931 patients (21.7 %). Most tumors (90.1 %) were organ-confined (pT2), whereas 9.9 % of them were diagnosed at a locally advanced stage (≥pT3). Gleason score was <6 in 129 cases (13.9 %), 6 in 575 cases (61.7 %), 7 (3 + 4) in 149 cases (16.0 %), 7 (4 + 3) in 38 cases (4.1 %), and >7 in 40 cases (4.3 %). After a median follow-up of 25.5 months (interquartile range 14.2-47.4), 35.4 % of patients had bladder cancer recurrence and 23.8 % died of bladder cancer. Only 16 patients (1.9 %) experienced PCa biochemical recurrence during follow-up, and no preoperative predictive factor was identified. No patients died from PCa. The rate of incidentally diagnosed PCa in RCP specimens was 21.7 %. The majority of these PCas were organ-confined. PCa recurrence occurred in only 1.9 % of cases during follow-up.
    Annals of Surgical Oncology 10/2013; · 3.94 Impact Factor
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    ABSTRACT: Despite the high prevalence of histological Benign Prostatic Hypeplasia (BPH) in elderly men, little is known regarding the molecular mechanisms and networks underlying the development and progression of the disease. Here, we explored the effects of a phytotherapeutic agent, Lipidosterolic extract of the dwarf palm plant Serenoa repens (LSESr), on the mRNA gene expression profiles of two representative models of BPH, BPH1 cell line and primary stromal cells derived from BPH. Treatment of these cells with LSESr significantly altered gene expression patterns as assessed by comparative gene expression profiling on gene chip arrays. The expression changes were manifested three hours following in vitro administration of LSESr, suggesting a rapid action for this compound. Among the genes most consistently affected by LSESr treatment, we found numerous genes that were categorized as part of proliferative, apoptotic, and inflammatory pathways. Validation studies using quantitative real-time PCR confirmed the deregulation of genes known to exhibit key roles in these biological processes including IL1B, IL1A, CXCL6, IL1R1, PTGS2, ALOX5, GAS1, PHLDA1, IL6, IL8, NFkBIZ, NFKB1, TFRC, JUN, CDKN1B, and ERBB3. Subsequent analyses also indicated that LSESr treatment can impede the stimulatory effects of certain proinflammatory cytokines such as IL6, IL17, and IL15 in these cells. These results suggest that LSESr may be useful to treat BPH that manifest inflammation characteristics. This also supports a role for inflammation in BPH presumably by mediating the balance between apoptosis and proliferation.
    International Journal of Molecular Sciences 07/2013; 14(7):14301-14320. · 2.34 Impact Factor
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    ABSTRACT: OBJECTIVE: To present a summary of the 2013 version of the European Association of Urology guidelines on the treatment and follow-up of male lower urinary tract symptoms (LUTS). EVIDENCE ACQUISITION: We conducted a literature search in computer databases for relevant articles published between 1966 and 31 October 2012. The Oxford classification system (2001) was used to determine the level of evidence for each article and to assign the grade of recommendation for each treatment modality. EVIDENCE SYNTHESIS: Men with mild symptoms are suitable for watchful waiting. All men with bothersome LUTS should be offered lifestyle advice prior to or concurrent with any treatment. Men with bothersome moderate-to-severe LUTS quickly benefit from α1-blockers. Men with enlarged prostates, especially those >40ml, profit from 5α-reductase inhibitors (5-ARIs) that slowly reduce LUTS and the probability of urinary retention or the need for surgery. Antimuscarinics might be considered for patients who have predominant bladder storage symptoms. The phosphodiesterase type 5 inhibitor tadalafil can quickly reduce LUTS to a similar extent as α1-blockers, and it also improves erectile dysfunction. Desmopressin can be used in men with nocturia due to nocturnal polyuria. Treatment with an α1-blocker and 5-ARI (in men with enlarged prostates) or antimuscarinics (with persistent storage symptoms) combines the positive effects of either drug class to achieve greater efficacy. Prostate surgery is indicated in men with absolute indications or drug treatment-resistant LUTS due to benign prostatic obstruction. Transurethral resection of the prostate (TURP) is the current standard operation for men with prostates 30-80ml, whereas open surgery or transurethral holmium laser enucleation is appropriate for men with prostates >80ml. Alternatives for monopolar TURP include bipolar TURP and transurethral incision of the prostate (for glands <30ml) and laser treatments. Transurethral microwave therapy and transurethral needle ablation are effective minimally invasive treatments with higher retreatment rates compared with TURP. Prostate stents are an alternative to catheterisation for men unfit for surgery. Ethanol or botulinum toxin injections into the prostate are still experimental. CONCLUSIONS: These symptom-oriented guidelines provide practical guidance for the management of men experiencing LUTS. The full version is available online (www.uroweb.org/gls/pdf/12_Male_LUTS.pdf).
    European Urology 03/2013; · 10.48 Impact Factor
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    ABSTRACT: Background. There are no validated markers that predict outcome in metastatic renal cell cancer (mRCC) patients treated with sunitinib. Recently, single nucleotide polymorphism (SNP) rs9582036 in VEGFR1 has been proposed as a predictor of progression-free survival (PFS) and overall survival (OS) to bevacizumab in patients with pancreatic cancer and rs7993418 in VEGFR1 as predictor for PFS in mRCC-patients treated with bevacizumab. Here, we aim to study the impact of these SNPs in mRCC patients treated with sunitinib. Methods. We included patients with mRCC treated in 15 institutions in France and Belgium. Patients received sunitinib as first-line targeted therapy. We assessed response, time-to-tumor progression (TTP), OS, and clinical and biochemical parameters associated with outcome. We genotyped rs9582036 and rs7993418 as well as three other surrounding SNPs in VEGFR1: rs9554320, rs9554316 and rs9513070. Association between SNPs and treatment outcome were studied by univariate analysis and by multivariate Cox regression using relevant clinical factors associated with TTP and OS as covariates. Findings. Ninety-one patients were included. We found that mRCC patients with the CC-variant in rs9582036 in VEGFR1 have a poorer response rate (RR) (0% vs. 46%, p = 0.028), a poorer PFS (10 vs. 18 months, p = 0.033 on univariate and 0.06 on multivariate analysis) and a poorer OS (14 vs. 31 months, p = 0.019 on univariate and 0.008 on multivariate analysis) compared to patients with the AC- and AA-genotypes. mRCC patients with the AA-variant in rs9554320 in VEGFR1 have a poorer PFS (12 vs. 21 months, p = 0.0066 on univariate and 0.005 on multivariate analysis) and a poorer OS (22 vs. 34 months, p = 0.019 on univariate and 0.067 on multivariate analysis) compared to patients with the AC- and CC-genotypes. Interpretation. mRCC patients with the CC-genotype in VEGFR1 SNP rs9582036 have a poorer response rate, PFS and OS when treated with sunitinib. These findings are in agreement with the association of rs9582036 and outcome observed in bevacizumab treated pancreatic cancer patients. Prospective validation of this SNP is warranted.
    Acta oncologica (Stockholm, Sweden) 02/2013; · 2.27 Impact Factor

Publication Stats

713 Citations
215.66 Total Impact Points

Institutions

  • 2011–2015
    • University of Limoges
      Limages, Limousin, France
    • Unité Inserm U1077
      Caen, Lower Normandy, France
  • 2008–2014
    • Centre Hospitalier Universitaire de Limoges
      Limages, Limousin, France
    • Centre Hospitalier Universitaire de Poitiers
      Poitiers, Poitou-Charentes, France
    • French Institute of Health and Medical Research
      Lutetia Parisorum, Île-de-France, France
  • 2009–2012
    • Université René Descartes - Paris 5
      • Faculté de Médecine
      Lutetia Parisorum, Île-de-France, France
    • Centre Hospitalier Universitaire de Bordeaux
      Burdeos, Aquitaine, France
    • Centre Hospitalier Universitaire d'Angers
      • Service de gérontologie
      Angers, Pays de la Loire, France
  • 2010
    • Université Victor Segalen Bordeaux 2
      Burdeos, Aquitaine, France
  • 2007–2008
    • Hôpital Cochin (Hôpitaux Universitaires Paris Centre)
      • Service d’Urologie
      Lutetia Parisorum, Île-de-France, France
    • Deaconess Hospital Group Croix Saint - Simon
      Lutetia Parisorum, Île-de-France, France
  • 2006–2007
    • Assistance Publique – Hôpitaux de Paris
      Lutetia Parisorum, Île-de-France, France