Prolonged Complete Response after GEMOX Chemotherapy in a Patient with Advanced Fibrolamellar Hepatocellular Carcinoma

The only currently validated treatment for advanced hepatocellular carcinoma (HCC) is sorafenib. However, sorafenib has been mainly studied in patients with HCC developed in cirrhotic liver. Chemotherapy might be more suitable for patients with HCC in non-cirrhotic liver. We report the case of a young woman with fibrolamellar HCC in a non-cirrhotic liver, with histologically proven metastatic ganglionary relapse after surgical resection of the primary tumour. Chemotherapy with gemcitabine and oxaliplatin (GEMOX regimen) achieved a complete response without relapse five years after discontinuation of chemotherapy. This exceptional case raises the question of clinical trials specifically designed for patients with HCC in non-cirrhotic liver

Risk factors for sporadic campylobacteriosis: a systematic review and meta-analysis

Campylobacter spp. is an important causative agent of diarrheal illness worldwide. The disease is frequently associated with foodborne transmission, but other routes of exposure are increasingly recognized. A systematic review and meta-analysis of case-control studies were performed to determine the main risk factors associated with sporadic campylobacteriosis. Suitable scientific articles published up to March 2017 were identified through a systematic literature search and subject to methodological quality assessment. From each study, odds ratios (OR) as measures of association were extracted or calculated, as well as study characteristics such as study population, design, type of model used and risk factor categorization. Mixed-effects meta-analytical models were adjusted by population type to appropriate data partitions. From 4453 identified references, the quality assessment stage was passed by 71 case-control studies focusing on sporadic campylobacteriosis. The eligible studies were conducted between 1981 and 2012 and provided 1336 ORs for meta-analysis. The meta-analysis identified international travel (pooled OR=4.626), recent use of gastric antacids (pooled OR=2.911), occupational exposure to animals/carcasses (pooled OR=3.022), and food consumption (in particular raw or undercooked eggs, poultry, beef, and dairy) as the main risks factors for sporadic campylobacteriosis in the mixed population. In the child population, the main risk factors concerned environmental/animal transmission routes (e.g. drinking untreated water (pooled OR=3.261), exposure to recreational water (pooled OR=3.156), exposure to farm/rural environment (pooled OR=3.128), contact with farm animals (pooled OR=2.747), person-to-person transmission (pooled OR=2.736) and consumption of raw milk (pooled OR =2.603). The results of this meta-analysis highlight the importance of overlooked routes and vehicles of transmission (environment, animal contact, and other food vehicles) of Campylobacter that should be explored in dedicated studies.The authors would like to thank Anses staff and the members of the Anses Working Group on Source Attribution of Foodborne Diseases: Moez Sanaa, Laurence Watier, Jean Christophe Augustin, Frédéric Carlin, Laurent Guillier, Nathalie Jourdan-Da Silva, Alexandre Leclercq, Anne Thébault, Nicole Pavio, Isabelle Villena. U. Gonzales-Barron and V. Cadavez are grateful to the Foundation for Food Science and Technology (FCT, Portugal) and FEDER under Programme PT2020 for financial support to CIMO ( UID/AGR/00690/2019 ). U. Gonzales-Barron thanks the national funding by FCT , P.I., through the Institutional Scientific Employment Program contract.info:eu-repo/semantics/publishedVersio

Risk factors for sporadic salmonellosis: a systematic review and meta-analysis

Non-typhoidal Salmonella is an important causative agent of diarrheal illness worldwide. A systematic review and meta-analysis of case-control studies were performed to determine the main risk factors associated with sporadic salmonellosis. Suitable scientific articles published up to 2017 were identified through a systematic literature search and subject to methodological quality assessment. From each study, odds ratios (OR) were extracted or calculated, as well as study characteristics such as population type, design, type of model used and risk factor categorization. Mixed-effects meta-analytical models were adjusted by population type to appropriate data partitions. From 3858 identified references, the quality assessment stage was passed by 62 case-control studies focusing on sporadic salmonellosis which provided 1154 ORs for meta-analysis. The meta-analysis identified host-specifics factors, travel, environmental, animal and food exposures as significant risk factors of salmonellosis in the mixed population. For the mixed population, foods significantly associated with salmonellosis were eggs and egg products, composite foods, and meat (pork, red meats other than beef and poultry meats). In the child population, the main risk factors were found for person-to-person transmission, recent use of gastric anti-acids or antibiotics, contact with pets and farm animals, environmental, and food vehicles. Breastfeeding was found to be a protective factor for children. The food vehicles identified in children comprised dairy (milk formula), produce, meat and eggs products. Untreated drinking water was a risk factor for the children and mixed population. The result of the meta-analysis conducted at the international level is very important in the context of increasing international trade in foodstuffs and changes in food consumption patterns.The authors would like to thank Anses staff and the members of the Anses Working Group on Source Attribution of Foodborne Diseases: Moez Sanaa, Jean Christophe Augustin, Fr´ed´eric Carlin, Alexandre Leclercq, Nicole Pavio, Isabelle Villena, and Laurence Watier. U. Gonzales-Barron and V. Cadavez are grateful to the Foundation for Science and Technology (FCT, Portugal) for financial support through national funds FCT/MCTES to CIMO (UIDB/00690/2020). U. Gonzales- Barron acknowledges the national funding by FCT, P.I., through the institutional scientific employment program contract.info:eu-repo/semantics/publishedVersio

0323: Mid-term follow-up and quality of life in patients after Fontan surgery

BackgroundThe Fontan procedure (atriopulmonary Fontan) and total cavo-pulmonary connection are designed to treat univentricular heart. Whereas peri-operative mortality has declined, the current challenge is long-term outcome.ObjectiveTo evaluate the outcome and quality of life of survivors with Fontan circulation.MethodsThis retrospective monocentric study aimed patients who had follow-up after Fontan surgery at the University Hospital of Lille. Data were collected on medical records. The quality of life was evaluated between June and October 2014 by two scales: Paediatric Quality of Life Inventory TM (PedsQL) before 26 years of age and Medical Outcome Study Short Form 36 (MOS SF 36) after 26 years.ResultsAmong 96 patients who underwent Fontan procedure, median follow-up was 9.6 (6.1-12.5) years after the last intervention. Nine-year global survival was 93%. 95% of patients had total cavo-pulmonary connection and 5% had atrio-pulmonary connection. Arrhythmia occurred in 27.1%, single ventricle dysfunction in 87.4%, leak of the atrio-ventricular valve in 58.9%. Protein-losing enteropathy affected 4.2% of patients and thromboembolic events appeared in 17.7%. Total score of quality of life was 66.5% according to the PedsQL and 62.5% to the MOS SF36.ConclusionThis French cohort of survivors with Fontan circulation has the same initial characteristics than which described in the literature. The level of quality of life was comparable to general population. The question of global rehabilitation of these patients must be raised

Serum (1 → 3)‐β‐D‐glucan could be useful to rule out invasive candidiasis in neonates with an adapted cut‐off

International audienceAim We assessed the diagnostic accuracy of serum (1 -> 3)-beta-D-glucan (BDG) for neonatal invasive candidiasis (NIC) using the recommended cut-off usually used in adults for detecting invasive candidiasis and searched for an optimal cut-off for ruling out NIC.Methods We conducted a prospective cross-sectional study at Nantes University medical centre from January 2017 to July 2018. All consecutive newborn infants of less than 28 days of corrected age, with clinically suspected NIC, who underwent BDG assay, were included. Sensitivity and specificity were calculated by using the recommended cut-off of 80 pg/mL. Receiver operating characteristic curve analysis was used to identify an optimal cut-off value.Results We included 55 newborn infants with 61 episodes of suspected NIC. Their median gestational and chronological ages were 28.0 weeks (interquartile range [IQR] 26.4-34.1) and 10.0 days (IQR 6.0-22.0), respectively. Of 61 episodes, seven revealed NIC. Sensitivity and specificity were 85.7% (95% confidence interval [CI] 42.1%-99.6%) and 51.9% (37.8%-65.7%) with the recommended cut-off, respectively. An optimal cut-off of 174 pg/mL offered the same sensitivity but higher specificity 77.8% (64.4%-88.0%).Conclusion The recommended cut-off of 80 pg/mL was probably too low for ruling out NIC. A higher cut-off might have been more appropriate

Impact of routine S100B protein assay on CT scan use in children with mild traumatic brain injury

International audienceAbstract Objectives To evaluate the impact of implementing a modified Pediatric Emergency Care Applied Research Network (PECARN) rule including the S100B protein assay for managing mild traumatic brain injury (mTBI) in children. Methods A before-and-after study was conducted in a paediatric emergency department of a French University Hospital from 2013 to 2015. We retrospectively included all consecutive children aged 4 months to 15 years who presented mTBI and were at intermediate risk for clinically important traumatic brain injury (ciTBI). We compared the proportions of CT scans performed and of in-hospital observations before (2013–2014) and after (2014–2015) implementation of a modified PECARN rule including the S100B protein assay. Results We included 1,062 children with mTBI (median age 4.5 years, sex ratio [F/M] 0.73) who were at intermediate risk for ciTBI: 494 (46.5%) during 2013–2014 and 568 (53.5%) during 2014–2015. During 2014–2015, S100B protein was measured in 451 (79.4%) children within 6 h after mTBI. The proportion of CT scans and in-hospital observations significantly decreased between the two periods, from 14.4 to 9.5% (p=0.02) and 73.9–40.5% (p<0.01), respectively. The number of CT scans performed to identify a single ciTBI was reduced by two-thirds, from 18 to 6 CT scans, between 2013–2014 and 2014–2015. All children with ciTBI were identified by the rules. Conclusions The implementation of a modified PECARN rule including the S100B protein assay significantly decreased the proportion of CT scans and in-hospital observations for children with mTBI who were at intermediate risk for ciTBI

Évaluation à l'occasion de leur hospitalisation de la qualité de l'anticoagulation orale chez des patients traités par antivitamines K

Contexte : Les complications associées à une anticoagulation insuffisante ou excessive sous traitement par antivitamines K (AVK) pourraient être évitées par une prise en charge plus rigoureuse. Objectif : L'objectif de cette étude était d'isoler, parmi les patients hospitalisés au Centre Hospitalier Universitaire d'Amiens, ceux qui étaient sous anticoagulants oraux et d'évaluer chez eux les caractéristiques de ce traitement le jour de l'hospitalisation. Méthodes : La qualité de la prise en charge de ces traitements était appréciée par le niveau de l'INR (international normalised ratio [rapport international normalisé]) à l'entrée, la conformité de l'indication thérapeutique au résumé des caractéristiques du produit (RCP), le respect des contre-indications, la prise en compte des interactions médicamenteuses et la connaissance du traitement anticoagulant par le patient lui-même. Résultats : Parmi les 2498 patients adultes hospitalisés pendant les 14 jours de l'étude, 86 recevant un traitement AVK ont été retenus pour l'étude. Il s'agissait de 30 femmes et 56 hommes, d'âge compris entre 26 et 95 ans (âge moyen 70 ans). A l'admission, sept patients présentaient une complication hémorragique et deux présentaient un accident thrombotique. L'évolution s'est faite vers le décès chez un patient et vers un glaucome séquellaire chez un autre. Dans 17,5 % des cas, la prescription n'était pas conforme au RCP. Ce pourcentage augmente à 67 % dans le groupe des patients ayant eu un effet pouvant être relié à un traitement inadéquat. Dans 41 % des cas, l'INR se situait hors de la zone thérapeutique correspondant à l'indication. Le schéma posologique était complexe chez 11 % des patients. Six associations médicamenteuses étaient déconseillées (4 fois avec l'aspirine < 3 g/jour et 2 fois avec un anti-inflammatoire non stéroïdien [AINS]). D'après les réponses données aux questions posées aux patients, il apparaît que ceux-ci connaissent mal leur traitement : 16/66 connaissaient les risques liés à la fois à un surdosage et à un traitement insuffisant, 25/66 savaient que certains aliments sont à consommer sans excès, 10/66 connaissaient la fourchette dans laquelle doit se situer leur INR et 8/66 savaient que les injections intramusculaires sont contre-indiquées. Conclusions : Ces résultats suggèrent que la qualité de la prise en charge des patients sous AVK devrait pouvoir être améliorée. Les risques liés au traitement par AVK sont probablement sous-estimés par les médecins et l'information faite au patient semble insuffisante ou mal adaptée (car trop complexe)

Evaluation of Changes Over Time in the Drug Burden and Medication Regimen Complexity in ESRD Patients Before and After Renal Transplantation

International audienc

Timeliness of vaccination in infants followed by primary-care pediatricians in France

Vaccination status is more often evaluated by up-to-date vaccination coverage rather than timeliness of immunization. Delaying vaccination may be dangerous during infancy. The aim of this study was to identify the importance of potentially dangerous vaccination delay (previously defined) and determinants of these delays. We conducted a national, prospective, vaccination survey in June 2014, with primary care pediatricians. Children, 2 to 24 months of age, were included. Data about vaccination were extracted from their health books. Additional data were collected through a standardized questionnaire. Vaccine coverage rate and timeliness were calculated. Variables associated with a potentially dangerous vaccination delay as previously defined were determined by a multivariable analysis. Among the 443 included children (mean age 10.8 months, 49% males), 13% to 58% of vaccine doses according to vaccine type were done with a potentially dangerous delay. Globally, 47% of children had at least one potentially dangerous immunization delay. We identified two risk factors of potentially dangerous delayed immunization globally: an increasing age of the child (adjusted odds ratio: 1.2, 95% confidence interval [CI]: 1.1–1.3, p < 10−3), and a working mother (adjusted OR: 2.4, 95% CI: 1.2–4.7, p = 0.01). Despite a good vaccine coverage rate, a large number of children had a potentially dangerous vaccination delay. A high level of vigilance regarding these immunization delays, and particularly to the patients sharing the risk factors of immunization delay identified here, can increase quality and effectiveness of the vaccine protection