Applicability and precautions of use of liver injury biomarker FibroTest. A reappraisal at 7 years of age

<p>Abstract</p> <p>Background</p> <p>FibroTest (FT) is a validated biomarker of fibrosis. To assess the applicability rate and to reduce the risk of false positives/negatives (RFPN), security algorithms were developed. The aims were to estimate the prevalence of RFPN and of proven failures, and to identify factors associated with their occurrences.</p> <p>Methods</p> <p>Four populations were studied: 954 blood donors (P1), 7,494 healthy volunteers (P2), 345,695 consecutive worldwide sera (P3), including 24,872 sera analyzed in a tertiary care centre (GHPS) (P4). Analytical procedures of laboratories with RFPN > 5% and charts of P4 patients in with RFPN were reviewed.</p> <p>Results</p> <p>The prevalence of RFPN was 0.52% (5/954; 95%CI 0.17-1.22) in P1, 0.51% (38/7494; 0.36-0.70) in P2, and 0.97% (3349/345695; 0.94-1.00) in P3. Three a priori high-risk populations were confirmed: 1.97% in P4, 1.77% in HIV centre and 2.61% in Sub-Saharan origin subjects. RFPN was mostly associated with low haptoglobin (0.46%), and high apolipoproteinA1 (0.21%). A traceability study of a P3 laboratory with RFPFN > 5% permitted to correct analytical procedures.</p> <p>Conclusion</p> <p>The mean applicability rate of Fibrotest was 99.03%. Independent factors associated with the high risk of false positives/negatives were HIV center, subSaharan origin, and a tertiary care reference centre, although the applicability rate remained above 97%.</p

Diagnostic performance of FibroTest, SteatoTest and ActiTest in patients with NAFLD using the SAF score as histological reference

BACKGROUND: Blood tests of liver injury are less well validated in non‐alcoholic fatty liver disease (NAFLD) than in patients with chronic viral hepatitis. AIMS: To improve the validation of three blood tests used in NAFLD patients, FibroTest for fibrosis staging, SteatoTest for steatosis grading and ActiTest for inflammation activity grading. METHODS: We pre‐included new NAFLD patients with biopsy and blood tests from a single‐centre cohort (FibroFrance) and from the multicentre FLIP consortium. Contemporaneous biopsies were blindly assessed using the new steatosis, activity and fibrosis (SAF) score, which provides a reliable and reproducible diagnosis and grading/staging of the three elementary features of NAFLD (steatosis, inflammatory activity) and fibrosis with reduced interobserver variability. We used nonbinary‐ROC (NonBinAUROC) as the main endpoint to prevent spectrum effect and multiple testing. RESULTS: A total of 600 patients with reliable tests and biopsies were included. The mean NonBinAUROCs (95% CI) of tests were all significant (P < 0.0001): 0.878 (0.864–0.892) for FibroTest and fibrosis stages, 0.846 (0.830–0.862) for ActiTest and activity grades, and 0.822 (0.804–0.840) for SteatoTest and steatosis grades. FibroTest had a higher NonBinAUROC than BARD (0.836; 0.820–0.852; P = 0.0001), FIB4 (0.845; 0.829–0.861; P = 0.007) but not significantly different than the NAFLD score (0.866; 0.850–0.882; P = 0.26). FibroTest had a significant difference in median values between adjacent stage F2 and stage F1 contrarily to BARD, FIB4 and NAFLD scores (Bonferroni test P < 0.05). CONCLUSIONS: In patients with NAFLD, SteatoTest, ActiTest and FibroTest are non‐invasive tests that offer an alternative to biopsy, and they correlate with the simple grading/staging of the SAF scoring system across the three elementary features of NAFLD: steatosis, inflammatory activity and fibrosis

Les poètes satiriques normands du XVIIe siècle : actes du colloque tenu à l'Université de Caen Basse-Normandie, 13-14 octobre 2011

Organisé par le Centre de recherche Laslar, Université de Caen Basse-Normandie ; réunis par Jean-François Castille et Marie-Gabrielle Lallemand.Entre la fin des guerres de religion et le procès de Théophile de Viau (1623), le genre de la satire s’épanouit en France. C’est en Normandie que sont nés la plupart des poètes satiriques du début du XVIIe siècle : Sigogne, Berthelot, Sonnet de Courval, Du Lorens, Angot de l’Éperonnière, Auvray, sans oublier Vauquelin de La Fresnaye. À part ce dernier, tous ces auteurs sont tombés dans l’oubli, et les travaux critiques les concernant sont encore rares : cet ouvrage figure désormais au nombre de ces travaux. Il contribue à la redécouverte et à la réhabilitation d’un corpus poétique peu connu, mais, à bien des égards, stupéfiant

Impact of a program of physiotherapy and health education on the outcome of obstetric fistula surgery

Objective Surgery is the only successful treatment for most obstetric fistulae. The present study measured the impact of a structured program of pre- and postoperative physiotherapy and health education on the outcome of surgery for obstetric fistula. Methods We compared the postoperative outcomes of 2 consecutive groups of women with obstetric fistulae who were recruited and followed-up by 2 local nongovernmental organizations at a hospital in Tanguiéta, Benin. The first group of women (n = 99) had fistula repair using standardized techniques. The second group (n = 112) had a standardized surgical approach plus a structured program of pre- and postoperative health education and physiotherapy. Results The program had a significant positive impact on recovery in general and on urinary incontinence in particular. After physiotherapy, the odds of recovery were 2.72 times greater for women in the physiotherapy group than for control patients, and the probability of postoperative stress incontinence was considerably higher for patients in the control group than for those in the physiotherapy group (P < 0.001). Conclusion A structured program of health education and physiotherapy by experienced nurses and physiotherapists improves the likelihood of a successful outcome after surgical repair of obstetric fistula. © 2013 International Federation of Gynecology and Obstetrics

Mode de vie et alimentation à la fin du Moyen Age au château de Blandy-les-Tours. Approche pluridisciplinaire des latrines de la salle de l'Auditoire

Dans le château de Blandy-les-Tours, la fouille de deux fosses de latrines a permis d'aborder des domaines non pris en compte par les travaux archéologiques précédents, qui s'étaient essentiellement attachés à comprendre le monument. Ces deux fosses recelaient en effet un mobilier diversifié de céramique, verre, métal, monnaies et des matériaux de construction en quantité importante, jusqu'alors inconnue dans le château. Les sédiments ont été prélevés, tamisés et traités afin d'y rechercher parasites, graines et pollens, écailles de poissons et os d'oiseaux qui ont apporté des renseignements très intéressants et nouveaux sur le château : l'alimentation végétale et animale, l'hygiène, les occupations des habitants et surtout leur statut social ont pu être mis en évidence par la consommation d'aliments rares, la possession d'objets prestigieux (un flacon bleu de type Murano), etc. Bien que certains apports soient encore à l'état d'hypothèses, l'architecture et le fonctionnement de deux fosses de latrines médiévales ont été étudiés et la micromorphologie, alliée à la palynologie, en a précisé l'utilisation. Perçue par les chercheurs comme fondamentale, la démarche pluridisciplinaire ainsi entreprise devait aboutir à cette monographie.Clavel Benoît, Dietsch Marie-France, Gauthier Agnès et al. Mode de vie et alimentation à la fin du Moyen-Âge au château de Blandy-les-Tours. Approche pluridisciplinaire des latrines de la salle de l’Auditoire. Tours : Fédération pour l'édition de la Revue archéologique du Centre de la France, 2006. 184 p. (Supplément à la Revue archéologique du centre de la France, 28

Mode de vie et alimentation à la fin du Moyen Age au château de Blandy-les-Tours. Approche pluridisciplinaire des latrines de la salle de l'Auditoire

Dans le château de Blandy-les-Tours, la fouille de deux fosses de latrines a permis d'aborder des domaines non pris en compte par les travaux archéologiques précédents, qui s'étaient essentiellement attachés à comprendre le monument. Ces deux fosses recelaient en effet un mobilier diversifié de céramique, verre, métal, monnaies et des matériaux de construction en quantité importante, jusqu'alors inconnue dans le château. Les sédiments ont été prélevés, tamisés et traités afin d'y rechercher parasites, graines et pollens, écailles de poissons et os d'oiseaux qui ont apporté des renseignements très intéressants et nouveaux sur le château : l'alimentation végétale et animale, l'hygiène, les occupations des habitants et surtout leur statut social ont pu être mis en évidence par la consommation d'aliments rares, la possession d'objets prestigieux (un flacon bleu de type Murano), etc. Bien que certains apports soient encore à l'état d'hypothèses, l'architecture et le fonctionnement de deux fosses de latrines médiévales ont été étudiés et la micromorphologie, alliée à la palynologie, en a précisé l'utilisation. Perçue par les chercheurs comme fondamentale, la démarche pluridisciplinaire ainsi entreprise devait aboutir à cette monographie.Clavel Benoît, Dietsch Marie-France, Gauthier Agnès et al. Mode de vie et alimentation à la fin du Moyen-Âge au château de Blandy-les-Tours. Approche pluridisciplinaire des latrines de la salle de l’Auditoire. Tours : Fédération pour l'édition de la Revue archéologique du Centre de la France, 2006. 184 p. (Supplément à la Revue archéologique du centre de la France, 28

Awareness of the severity of liver disease re-examined using software-combined biomarkers of liver fibrosis and necroinflammatory activity

International audienceBackground Effective antiviral treatment (direct-acting antiviral agents (DAAs)), the requirement for a fibrosis score to support DDA reimbursement and a screening strategy, such as the USA baby boomer campaign, should lead to an increased awareness of liver disease severity.Objective To compare the awareness of liver disease severity between the USA and France, two countries with similar access to hepatitis C virus (HCV) and hepatitis B virus (HBV) treatments, similar rules for treatment reimbursement and similar availability of validated fibrosis tests, but with different policies, as France has no screening.Method The global database of the FibroTest–ActiTest, including 1 085 657 subjects between 2002 and 2014, was retrospectively analysed. Awareness was defined as the test prescription rate and was compared between the USA and France, according to year of birth, gender and dates of DAA availability and screening campaign (2013–2014).Results In the USA 252 688 subjects were investigated for HCV, with a dramatic increase (138%) in the test rate in 2013–2014 (119 271) compared with 2011–2012 (50 031). In France 470 762 subjects were investigated (subjects with HCV and other disease) and the rates were stable. In USA 82.4% of subjects and in France 84.6% were classified as either the highest or lowest priority. The most striking difference was the higher test rate in women born between 1935 and 1944 in France 30 384/200 672 (15.1%) compared with the USA 8035/97 079 (8.3%) (OR=1.98 (95% CI 1.93 to 2.03) p<0.0001). This resulted in twice as many cases of cirrhosis being detected, 2.6% (5191/200 672 women) and 1.3% (1303/97 079), respectively, despite the same prevalence of cirrhosis in this age group (17.1% vs 16.2%) and without any clear explanation as to why they had not been included in the USA screening.Conclusions This study highlighted in the USA the association between awareness of liver disease and both the HCV campaign and DAA availability. In comparison with France, there was a dramatically lower awareness of cirrhosis in the USA for women born between 1935 and 1944

One-year follow-up of women who participated in a physiotherapy and health education program before and after obstetric fistula surgery

Objective To investigate whether the positive impact of a program of physiotherapy and health education on the outcome of obstetric fistula surgery was maintained after 1 year. Methods The present follow-up analysis included 108 women who underwent obstetric fistula surgery at a center in Tanguiéta, Benin, between March 2011 and March 2012, and who had received a structured program of physiotherapy and health education before and after surgery. After discharge, follow-up visits were made 3, 6, and 12 months after surgery. The Ditrovie scale was used to measure quality of life (QoL), and continence and performance of the physiotherapy exercises were assessed. Results Mean QoL score was 36.9 (range 16.0-49.0) before surgery. Overall, 84 women were followed up for 1 year. Their mean QoL score had improved significantly to 18.5 (range 10.0-47.0; P &lt; 0.001). Between hospital discharge and 1 year, the number of women with a closed fistula increased from 48 (57.1%) to 53 (63.1%) and the number with urinary stress incontinence reduced from 11 (13.1%) to 9 (10.7%). Conclusion Results obtained after surgery and physiotherapy were maintained at 1 year, and QoL had improved significantly. When women are encouraged to continue exercises, improvements are also seen in residual stress incontinence