Fibrillation auriculaire et insuffisance cardiaque : une analyse de coût comparant la stratégie de contrôle de la fréquence à celle du contrôle du rythme

Contexte : La fibrillation auriculaire est commune chez les insuffisants cardiaques. L’efficacité des stratégies de contrôle de la fréquence et du rythme s’équivalent. Nous avons comparé l’impact économique des deux stratégies de traitement chez les patients avec fibrillation auriculaire et insuffisance cardiaque. Méthode : Dans cette sous-étude de l’essai Atrial Fibrillation and Congestive Heart Failure, la consommation de soins de santé des patients Québécois ainsi que leurs coûts ont été quantifiés grâce aux banques de données de la Régie de l’assurance-maladie du Québec et de l’Ontario Case Costing Initiative. Résultats : Trois cent quatre patients ont été inclus, âgés de 68±9 ans, fraction d’éjection de 26±6%. Les caractéristiques de base étaient bien réparties entre le contrôle du rythme (N=149) et de la fréquence (N=155). Les patients soumis au contrôle de la fréquence ont eu moins de procédures cardiovasculaires (146 versus 238, P<0.001) en raison du plus faible nombre de cardioversions et de moindres coûts reliés aux antiarythmiques (48 $±203 versus 1319$±1058 par patient, P<0.001). Ces différences ont été compensées par un surplus de dépenses dues aux hospitalisations non-cardiovasculaires, aux dispositifs cardiaques implantables et aux médicaments non-cardiovasculaires dans le groupe du contrôle de la fréquence. Au total, les coûts par patient avec les stratégies du contrôle de la fréquence et du rythme s’élèvent à 78 767 $±79 568 et 72 764$±72 800 (P=0.49). Interprétation : Chez les patients avec fibrillation auriculaire et insuffisance cardiaque, le contrôle de la fréquence est associé avec moins de procédures cardiovasculaires et une pharmacothérapie cardiovasculaire moins coûteuse. Toutefois, les coûts associés aux arythmies représentent moins de la moitié des dépenses de santé et le total des coûts s’équilibre entre les 2 stratégies.Background: Atrial fibrillation is common in patients with heart failure. Rhythm and rate-control strategies are associated with similar efficacy outcomes. We compared the economic impact of the two treatment strategies in patients with atrial fibrillation and heart failure. Methods: In a pre-specified substudy of the Atrial Fibrillation and Congestive Heart Failure trial, healthcare expenditures of patients from Quebec were analyzed from a single-payer perspective using a cost-minimization approach. In-trial resource utilization including hospitalizations, procedures, emergency department visits, outpatient encounters, and medications were estimated from Quebec Health Insurance Board administrative databases supplemented by disease-specific costs from the Ontario Case Costing Initiative. Results: A total of 304 patients were included, age 68±9 years, 86% male, ejection fraction 26±6%. Baseline characteristics were similar in rhythm (N=149) and rate-control (N=155) groups. Arrhythmia-related costs accounted for 45% of total expenditures. Rate-control patients had fewer cardiovascular procedures (146 versus 238, P<0.001), driven by fewer cardioversions, and lower costs related to antiarrhythmic drugs ($48±203 versus$1319±1058 per patient, P<0.001). However, these differences were offset by trends towards higher expenditures due to hospitalizations for non-cardiovascular diagnoses, implantable cardiac arrhythmia devices, and non-cardiovascular drugs with rate-control. Overall, the total cost per patient was similar with rate and rhythm-control strategies ($78 767±79 568 versus$72 764±72 800, P=0.49). Interpretation: In patients with atrial fibrillation and heart failure, rate control is associated with fewer cardiovascular procedures, most notably cardioversions, and less expensive cardiovascular drugs. However, arrhythmia-related costs account for less than half of all healthcare expenditures and overall costs are similar with the two strategies

Les relations donneurs d’ordres sous-traitants dans l’industrie aérospatiale au Québec : une étude exploratoire

L'industrie aérospatiale mondiale se réorganise pour relever dans les prochaines années les défis d'une croissance considérable. L'importance de cette industrie dans une économie nationale est clairement établie et explique le désir de pays en voie d'industrialisation d'acquérir l'infrastructure nécessaire pour atteindre le marché mondial. Ces nouvelles recrues de l'industrie bouleversent les règles du jeu et forcent les donneurs d'ordres et les sous-traitants à établir des réseaux globaux. Pour ce faire, ils doivent adopter des pratiques reconnues qui leur permettront d'interagir, d'innover et de se développer en partenariat avec des firmes étrangères. Dans cette étude exploratoire nous présentons les résultats d'une enquête sur les relations donneurs d'ordres/sous-traitants dans l'industrie de l'aérospatiale au Québec. Vingt trois entreprises ont été interrogées. L'enquête veut mettre en lumière l'adoption par les entreprises québécoises des meilleures pratiques en ce qui concerne la planification et le contrôle des relations, des transactions et des échanges entre les donneurs d'ordres et les sous-traitants.CENTOR (Centre de recherche sur les technologies de l’organisation réseau), Université Laval, Québe

Identifying conditions for inducible protein production in E. coli: combining a fed-batch and multiple induction approach

BACKGROUND: In the interest of generating large amounts of recombinant protein, inducible systems have been studied to maximize both the growth of the culture and the production of foreign proteins. Even though thermo-inducible systems were developed in the late 1970's, the number of studies that focus on strategies for the implementation at bioreactor scale is limited. In this work, the bacteriophage lambda P(L )promoter is once again investigated as an inducible element but for the production of green fluorescent protein (GFP). Culture temperature, induction point, induction duration and number of inductions were considered as factors to maximize GFP production in a 20-L bioreactor. RESULTS: It was found that cultures carried out at 37°C resulted in a growth-associated production of GFP without the need of an induction at 42°C. Specific production was similar to what was achieved when separating the growth and production phases. Shake flask cultures were used to screen for desirable operating conditions. It was found that multiple inductions increased the production of GFP. Induction decreased the growth rate and substrate yield coefficients; therefore, two time domains (before and after induction) having different kinetic parameters were created to fit a model to the data collected. CONCLUSION: Based on two batch runs and the simulation of culture dynamics, a pre-defined feeding and induction strategy was developed to increase the volumetric yield of a temperature regulated expression system and was successfully implemented in a 20-L bioreactor. An overall cell density of 5.95 g DW l(-1 )was achieved without detriment to the cell specific production of GFP; however, the production of GFP was underestimated in the simulations due to a significant contribution of non-growth associated product formation under limiting nutrient conditions

Langerhans cell (LC) proliferation mediates neonatal development, homeostasis, and inflammation-associated expansion of the epidermal LC network

Most tissues develop from stem cells and precursors that undergo differentiation as their proliferative potential decreases. Mature differentiated cells rarely proliferate and are replaced at the end of their life by new cells derived from precursors. Langerhans cells (LCs) of the epidermis, although of myeloid origin, were shown to renew in tissues independently from the bone marrow, suggesting the existence of a dermal or epidermal progenitor. We investigated the mechanisms involved in LC development and homeostasis. We observed that a single wave of LC precursors was recruited in the epidermis of mice around embryonic day 18 and acquired a dendritic morphology, major histocompatibility complex II, CD11c, and langerin expression immediately after birth. Langerin+ cells then undergo a massive burst of proliferation between postnatal day 2 (P2) and P7, expanding their numbers by 10–20-fold. After the first week of life, we observed low-level proliferation of langerin+ cells within the epidermis. However, in a mouse model of atopic dermatitis (AD), a keratinocyte signal triggered increased epidermal LC proliferation. Similar findings were observed in epidermis from human patients with AD. Therefore, proliferation of differentiated resident cells represents an alternative pathway for development in the newborn, homeostasis, and expansion in adults of selected myeloid cell populations such as LCs. This mechanism may be relevant in locations where leukocyte trafficking is limited

Étude des interactions entre les cellules HEK-293 et un adsorbant IMAC dans une colonne à lit en expansion

Essais de fluidisation dans une colonne développée au laboratoire -- Purification de la protéine TGF beta RIII-ED -- Validation du montage de purification intégrée -- Article : a study of the interaction of HEK-293 cells with streamline chelating adsorbent in expanded bed operation

Manipulation of a mollusc by a trophically transmitted parasite: convergent evolution or phylogenetic inheritance?

International audienceWe investigated the influence of infection by the trematode Curtuteria australis on the burrowing behaviour of its intermediate host, the bivalve Austrovenus stutchburyi. Laboratory experiments and field observations revealed that cockles, unable to bury completely or even partially under the sediment, have a reduced foot length compared with buried individuals. The ability to bury proved to be highly repeatable in field experiments: cockles found at the surface and transplanted to an experimental area did not bury themselves, and cockles found buried stayed buried when relocated. All metacercariae of C. australis were found strictly in the foot and for each of 3 samples collected in different sites, there was a negative and significant relationship between the relative length of the foot and the parasite load. A predation test conducted under natural conditions indicated that cockles with the stunted foot and the altered behaviour are significantly more susceptible to predation by aquatic birds than other cockles. Given that the definitive host of C. australis is an oystercatcher, we first discuss our results in the context of transmission strategy. Comparisons with other studies on more or less related trematode species parasitic in bivalves and evolving under similar constraints for their transmission, shed light on the origin of this adaptation in C. australis

Fluctuating asymmetry and parasitism in six New Zealand insects

International audiencePositive associations between parasitic infections and developmental instability are often reported in the literature. In some cases, developmentally unstable individuals are of lower genetic quality and more prone to infection, whereas in other cases, parasites appear to directly cause developmental instability. We determined whether parasitism correlated with fluctuating asymmetry in femur length, a measure of developmental instability, in two species of cockroaches harbouring benign nematodes, and four species of grasshoppers infected with harmful gregarine protozoans. We found no evidence that the more asymmetrical individuals were more heavily parasitized, in either of the six insect species. These results provide several exceptions to the pattern generally reported in the recent literature, and suggest that, at least among insects, fluctuating asymmetry and parasitism are not always associated

Fluctuating asymmetry in an insect host: a big role for big parasites?

International audienceParasites are expected to be associated with host developmental instability because developmentally unstable hosts may be more susceptible to, or more frequently exposed to, parasitic infections compared with developmentally- stable ones, or because parasites may directly disrupt host development. In this study, we analysed the relationship between developmental stability in the weta Pleioplectron simplex (Orthoptera) and infections by hairworm and mermithid parasites. These parasites have a long development in their host and the size of adult worms exceeds the length of the host by a considerable amount (15-20 cm). For one character (femora) we found that fluctuating asymmetry was significantly higher in parasitized individuals compared with unparasitized ones, in each of two samples collected in different years. Because no relationship was observed between the level of fluctuating asymmetry and the parasite size or number, however, infection by hairworm and mermithid parasites could be more a consequence of developmental instability than a cause. For other characters (tibia, external and internal spines of femora), the level of fluctuating asymmetry between parasitized and unparasitized individuals was not significantly different. Our results are discussed in relation to ecological constraints met by hairworm and mermithid parasites to complete their life cycle

Exploitation of manipulators: ‘hitch-hiking’ as a parasite transmission strategy

International audienceFor many parasites with complex life cycles, manipulation of host behaviour is an adaptation to increase the probability of successful transmission. Since manipulation is likely to be costly, other parasites may exploit hosts already manipulated so as to ensure their transmission without investing in manipulation. Such a cheating strategy, called 'hitch-hiking', could be adaptive in a range of situations. We first propose and discuss criteria that should be met by any parasite to be considered a hitch-hiker. Then, to understand the evolution of the hitch-hiking strategy, we use simple mathematical models to analyse the influence of several variables on the potential benefits for a nonmanipulative parasite of actively seeking a ride to the definitive host with a manipulative parasite. The models suggest that the prevalence or abundance of manipulative parasites will be a key determinant of whether hitch-hiking can be an advantageous option for other parasites