22 research outputs found
L'assistant social et le réseau de l'accompagnement en fin de vie dans le Valais central: quelles postures possibles?
Alors que l’accompagnement des mourants s’est professionnalisé et spécialisé durant ces trois dernières décennies, les changements culturels et sociaux, qui contextualisent aujourd’hui la fin de vie en Valais, requièrent de plus en plus l’intervention des travailleurs sociaux. Les assistants sociaux se trouvent néanmoins confrontés à un dilemme : devoir assurer le lien entre la personne en fin de vie et son monde, ou rompre ce lien en affiliant la personne et sa situation au domaine médical. Entre leurs représentations de la fin de vie et leurs valeurs, entre les injonctions des pouvoirs (médicaux et institutionnels) et leurs identifications professionnelles d’intégration sociale, les assistants sociaux doivent jongler dans une pluralité de rôles et de postures pour que l’accompagnement social des mourants puisse être une plus-value dans une vision globale du soutien à la personne, ou pour qu’ils puissent l’identifier comme faisant partie de leurs compétences. La fin de vie ne révèle donc pas seulement à l’assistant social les ruptures, les craintes et les tabous que la mort peut engendrer, mais elle dévoile aussi ses responsabilités, dans la défense de son métier et dans l’affirmation de ses compétences
Quality-adjusted survival analysis shows differences in outcome after immunosuppression or bone marrow transplantation in aplastic anemia
Bone marrow transplantation (BMT) and immunosuppression (IS) have improved the prognosis of aplastic anemia; both treatments have specific advantages and drawbacks but similar survival rates. Analysis of additional endpoints may help in treatment decisions. In a single-center study, patients with aplastic anemia treated with IS (n=155) or BMT (n=52) were compared for survival, event-free survival, and quality-adjusted time without symptoms and toxicity (Q-TWiST). Probability of overall and event-free survival at 15 years was similar among both groups (BMT 51±15% and 25±14%, IS 53±10% and 27±8%), with more early deaths in the transplant group and more late deaths in the IS group. There were differences in terms of mean duration of seven analyzed health states: time with symptoms from treatment-related toxicity (IS 0.36 years, BMT 0.27), transfusion dependency (IS 0.66 years, BMT 0.1 years), partial remission (IS 3.27 years, BMT 1.42), and secondary clonal disorder (IS 0.68 years, BMT 0.04) was significantly longer for IS compared to BMT (p≤0.001). Patients treated with BMT spent more time with extensive chronic graft-versus-host disease (GvHD) (IS 0 years, BMT 0.96, p<0.023) and in CR without drugs (IS 1.22 years, BMT 2.43, p=0.056). In conclusion, survival, event-free survival, and Q-TWiST are similar. BMT-treated patients had longer periods free from symptoms, while IS-treated patients needed closer medical care, transfusion support, and medication
Immunomodulation with romiplostim as a second-line strategy in primary immune thrombocytopenia: The iROM study.
Thrombopoietin receptor agonists (TPO-RAs) stimulate platelet production, which might restore immunological tolerance in primary immune thrombocytopenia (ITP). The iROM study investigated romiplostim's immunomodulatory effects. Thirteen patients (median age, 31 years) who previously received first-line treatment received romiplostim for 22 weeks, followed by monitoring until week 52. In addition to immunological data, secondary end-points included the sustained remission off-treatment (SROT) rate at 1 year, romiplostim dose, platelet count and bleedings. Scheduled discontinuation of romiplostim and SROT were achieved in six patients with newly diagnosed ITP, whereas the remaining seven patients relapsed. Romiplostim dose titration was lower and platelet count response was stronger in patients with SROT than in relapsed patients. In all patients, regulatory T lymphocyte (Treg) counts increased until study completion and the counts were higher in patients with SROT. Interleukin (IL)-4, IL-9 and IL-17F levels decreased significantly in all patients. FOXP3 (Treg), GATA3 (Th2) mRNA expression and transforming growth factor-β levels increased in patients with SROT. Treatment with romiplostim modulates the immune system and possibly influences ITP prognosis. A rapid increase in platelet counts is likely important for inducing immune tolerance. Better outcomes might be achieved at an early stage of autoimmunity, but clinical studies are needed for confirmation
The sympathomimetic agonist mirabegron did not lower JAK2-V617F allele burden, but restored nestin-positive cells and reduced reticulin fibrosis in patients with myeloproliferative neoplasms: results of phase II study SAKK 33/14
The β-3 sympathomimetic agonist BRL37344 restored nestin-positive cells within the stem cell niche, and thereby normalized blood counts and improved myelofibrosis in a mouse model of JAK2-V617F positive myeloproliferative neoplasms. We therefore tested the effectiveness of mirabegron, a β-3 sympathomimetic agonist, in a phase II trial including 39 JAK2-V617F positive MPN with a mutant allele burden >20%. Treatment consisted of mirabegron 50 mg daily for 24 weeks. The primary endpoint, reduction of the JAK2-V617F allele burden ≥50%, was not reached in any of the patients. One patient achieved a 25% reduction in JAK2-V617F allele burden by 24 weeks. A small subgroup of patients showed hematological improvement. As a side study, bone marrow biopsies were evaluated in 20 patients.We found an increase in the nestin+ cells from a median of 1.09 (interquartile range 0.38-3.27)/mm2 to 3.95 (interquartile range 1.98-8.79)/mm2 (p<0.0001) and a slight decrease of reticulin fibrosis from a median grade of 1.0 (interquartile range 0-3) to 0.5 (interquartile range 0-2) (p=0.01) between start and end of mirabegron treatment. Despite the fact that the primary endpoint of reducing JAK2-V617F allele burden was not reached, the observed effects on nestin+ MSCs and reticulin fibrosis is encouraging and shows that mirabegron can modify the microenvironment where the JAK2-mutant stem cells are maintained
Real-world Data From the Swiss Lenalidomide in MDS del(5q) (SLIM)-Registry Identify New Chances and Challenges in Lenalidomide Treatment of Patients With MDS del(5q).
IMPORTANCE DE LA SENSIBILISATION DE L'ALLERGENE LATEX CHEZ LES CHIENS ATTEINTS DE DERMATITE ATOPIQUE, ETUDE PROSPECTIVE
Lors de dermatite atopique (DA) canine, les allergènes en cause ne sont pas toujours identifiés. Le latex, produit par les hévéas et contenant du caoutchouc naturel, est présent de manière ubiquitaire dans l'environnement. Il provoque des allergies parfois graves chez l'homme. L'objectif de cette étude prospective est d'explorer l'importance de cet allergène chez les chiens atteints de DA. Des intradermoréactions (IDR) à l'allergène latex ont été réalisées chez 50 chiens atteints de DA et chez 24 chiens témoins, pour deux concentrations différentes de latex. A respectivement 10 IR/mL et 5 IR/mL, des IDR positives ont été observées chez 56 % et 30 des chiens atteints de DA, et chez 29 % et 4 % des chiens témoins. Ces résultats évoquent une association entre la DA et la sensibilisation au latex. Une estimation préliminaire du degré d'exposition des chiens (atteints de DA et témoins) au latex a été effectuée grâce à un questionnaire soumis à leurs propriétaires. Il n'a pas été possible de mettre en évidence une association entre l'exposition au latex et des 1DR positives à cet allergène. Il a été en effet difficile d'identifier une population de chiens particulièrement exposés au latex, contrairement à ce qui est observé chez l'homme, pour lequel des groupes bien définis sont très exposés, par l'intermédiaire de leur profession par exemple.MAISONS-ALFORT-Ecole Vétérin (940462302) / SudocSudocFranceF
The use of an optimized DRIFTS-FTIR method for the forensic analysis and classification of silicone condom lubricants
Severe events in donors after allogeneic hematopoietic stem cell donation
The risk for donors of allogeneic hematopoietic stem cells transplants is generally considered negligible. This study shows that hematopoietic stem cell donation is associated with a small but definite risk of fatalities and serious adverse event