Prophylactic anti-coagulation in cancer palliative care: a prospective randomised study

Goals: The objective of this study was to determine utility of prophylactic anti-coagulation in cancer patients hospitalised for palliative care in a specialised centre. Materials and methods: Prospective 1:1 open randomised study was designed. Twenty patients aged 55 to 88years with advanced cancer and an estimated life expectancy of less than 6months were assigned to either receive treatment with 2,850/3,800U (70kg) of daily subcutaneous nadroparin or no treatment. Suspicion of venous thrombo-embolism (deep vein thrombosis and pulmonary embolism) was confirmed by echo-Doppler examination of the lower limbs and/or by spiral computed tomography scan of the lungs. Bleeding episodes were recorded. Platelet count was measured on days 7 and 14. Survival time from study entry was determined. Main results: One venous thrombo-embolism and one major bleeding occurred in the group receiving nadroparin, whereas two minor bleedings occurred in the control group. At 3months, nine of ten participants had died in the control group vs five of ten in the group receiving nadroparin (P = 0.141). Five participants could be discharged home (P = 0.141). Conclusions: Decision to administer prophylactic nadroparin in hospitalised cancer patients under palliative care remains a challenge. Better mobility score at admission and the likelihood to be discharged home may be useful for practical purposes. The observation of a potential influence of prophylactic nadroparin on survival deserves further studie

Commerce triangulaire : une relecture à partir de la démarche logistique

International audienceLe commerce triangulaire, dont une partie repose sur l’expansion d’un système esclavagiste, fait le lien entre les économies de l’Europe, de l’Afrique et des Amériques. Si la traite atlantique a débuté au milieu du XVe siècle entre l’Afrique et la péninsule ibérique, la traite triangulaire s’est développée, quant à elle, du XVIe siècle au XIXe siècle et a impliqué un nombre important de parties prenantes, tout particulièrement dans la gestion des flux. L’article s’appuie sur des travaux conduits par des spécialistes en histoire économique qui ont souligné le rôle clé joué par différents acteurs dans le commerce triangulaire, mais sans référence explicite à la démarche logistique. Tout en étant conscients de résumer la traite triangulaire à une activité homogène, alors qu’en plus de deux siècles de pratique intensive, elle a connu de multiples évolutions, les auteurs souhaitent proposer une analyse du phénomène à partir d’une rigoureuse organisation des transports fondée sur le modèle hub-and-spokes. Ce dernier renvoie, plus largement, à une logique de coordination des flux qui fonde la démarche logistique moderne

Prophylactic anti-coagulation in cancer palliative care: a prospective randomised study

GOALS: The objective of this study was to determine utility of prophylactic anti-coagulation in cancer patients hospitalised for palliative care in a specialised centre. MATERIALS AND METHODS: Prospective 1:1 open randomised study was designed. Twenty patients aged 55 to 88 years with advanced cancer and an estimated life expectancy of less than 6 months were assigned to either receive treatment with 2,850/3,800 U (70 kg) of daily subcutaneous nadroparin or no treatment. Suspicion of venous thrombo-embolism (deep vein thrombosis and pulmonary embolism) was confirmed by echo-Doppler examination of the lower limbs and/or by spiral computed tomography scan of the lungs. Bleeding episodes were recorded. Platelet count was measured on days 7 and 14. Survival time from study entry was determined. MAIN RESULTS: One venous thrombo-embolism and one major bleeding occurred in the group receiving nadroparin, whereas two minor bleedings occurred in the control group. At 3 months, nine of ten participants had died in the control group vs five of ten in the group receiving nadroparin (P = 0.141). Five participants could be discharged home (P = 0.141). CONCLUSIONS: Decision to administer prophylactic nadroparin in hospitalised cancer patients under palliative care remains a challenge. Better mobility score at admission and the likelihood to be discharged home may be useful for practical purposes. The observation of a potential influence of prophylactic nadroparin on survival deserves further studies

Commerce triangulaire : une relecture à partir de la démarche logistique

International audienceLe commerce triangulaire, dont une partie repose sur l’expansion d’un système esclavagiste, fait le lien entre les économies de l’Europe, de l’Afrique et des Amériques. Si la traite atlantique a débuté au milieu du XVe siècle entre l’Afrique et la péninsule ibérique, la traite triangulaire s’est développée, quant à elle, du XVIe siècle au XIXe siècle et a impliqué un nombre important de parties prenantes, tout particulièrement dans la gestion des flux. L’article s’appuie sur des travaux conduits par des spécialistes en histoire économique qui ont souligné le rôle clé joué par différents acteurs dans le commerce triangulaire, mais sans référence explicite à la démarche logistique. Tout en étant conscients de résumer la traite triangulaire à une activité homogène, alors qu’en plus de deux siècles de pratique intensive, elle a connu de multiples évolutions, les auteurs souhaitent proposer une analyse du phénomène à partir d’une rigoureuse organisation des transports fondée sur le modèle hub-and-spokes. Ce dernier renvoie, plus largement, à une logique de coordination des flux qui fonde la démarche logistique moderne

Commerce triangulaire : une relecture à partir de la démarche logistique

International audienceLe commerce triangulaire, dont une partie repose sur l’expansion d’un système esclavagiste, fait le lien entre les économies de l’Europe, de l’Afrique et des Amériques. Si la traite atlantique a débuté au milieu du XVe siècle entre l’Afrique et la péninsule ibérique, la traite triangulaire s’est développée, quant à elle, du XVIe siècle au XIXe siècle et a impliqué un nombre important de parties prenantes, tout particulièrement dans la gestion des flux. L’article s’appuie sur des travaux conduits par des spécialistes en histoire économique qui ont souligné le rôle clé joué par différents acteurs dans le commerce triangulaire, mais sans référence explicite à la démarche logistique. Tout en étant conscients de résumer la traite triangulaire à une activité homogène, alors qu’en plus de deux siècles de pratique intensive, elle a connu de multiples évolutions, les auteurs souhaitent proposer une analyse du phénomène à partir d’une rigoureuse organisation des transports fondée sur le modèle hub-and-spokes. Ce dernier renvoie, plus largement, à une logique de coordination des flux qui fonde la démarche logistique moderne

Risk factors for early failure of native arteriovenous fistulas

Current guidelines recommend native arteriovenous fistulas (AVF) as the vascular access of choice for hemodialysis on account of the lower incidence of complications. However, this kind of vascular access has a high rate of early failure (early thrombosis or non-maturation). Our aim was to examine whether clear risk factors for early AVF failure could be identified in our patients

Associations between age-related changes in bone microstructure and strength and dietary acid load in a cohort of community-dwelling, healthy men and postmenopausal women

Background: The importance of dietary acid load (DAL) in the pathogenesis of osteoporosis is still debated. Age-related changes in bone microstructure and strength in relation to DAL remain largely unexplored. Objectives: We investigated the associations between changes in areal and volumetric bone mineral density (BMD), bone microstructure and strength, fracture risk, and DAL in a prospective cohort of 65-y-old healthy men and postmenopausal women

Fermented dairy products consumption is associated with attenuated cortical bone loss independently of total calcium, protein, and energy intakes in healthy postmenopausal women

\u3cp\u3eA longitudinal analysis of bone microstructure in postmenopausal women of the Geneva Retirees Cohort indicates that age-related cortical bone loss is attenuated at non-bearing bone sites in fermented dairy products consumers, not in milk or ripened cheese consumers, independently of total energy, calcium, or protein intakes.\u3c/p\u3e\u3cp\u3eINTRODUCTION: Fermented dairy products (FDP), including yogurts, provide calcium, phosphorus, and proteins together with prebiotics and probiotics, all being potentially beneficial for bone. In this prospective cohort study, we investigated whether FDP, milk, or ripened cheese consumptions influence age-related changes of bone mineral density (BMD) and microstructure.\u3c/p\u3e\u3cp\u3eMETHODS: Dietary intakes were assessed at baseline and after 3.0 ± 0.5 years with a food frequency questionnaire in 482 postmenopausal women enrolled in the Geneva Retirees Cohort. Cortical (Ct) and trabecular (Tb) volumetric (v) BMD and microstructure at the distal radius and tibia were assessed by high-resolution peripheral quantitative computerized tomography, in addition to areal (a) BMD and body composition by dual-energy X-ray absorptiometry, at the same time points.\u3c/p\u3e\u3cp\u3eRESULTS: At baseline, FDP consumers had lower abdominal fat mass and larger bone size at the radius and tibia. Parathyroid hormone and β-carboxyterminal cross-linked telopeptide of type I collagen levels were inversely correlated with FDP consumption. In the longitudinal analysis, FDP consumption (mean of the two assessments) was associated with attenuated loss of radius total vBMD and of Ct vBMD, area, and thickness. There was no difference in aBMD and at the tibia. These associations were independent of total energy, calcium, or protein intakes. For other dairy products categories, only milk consumption was associated with lower decrease of aBMD and of failure load at the radius.\u3c/p\u3e\u3cp\u3eCONCLUSION: In this prospective cohort of healthy postmenopausal women, age-related Ct bone loss was attenuated at non-bearing bone sites in FDP consumers, not in milk or ripened cheese consumers, independently of total energy, calcium, or protein intakes.\u3c/p\u3e\u3cp\u3eSTUDY REGISTRATION: ISRCTN11865958 ( http://www.isrctn.com ).\u3c/p\u3

Prepubertal Impact of Protein Intake and Physical Activity on Weight-Bearing Peak Bone Mass and Strength in Males

This 15-year prospective study in boys documents the tracking from prepuberty to the attainment of peak bone mass and strength of the positive interaction between protein intake and physical activity