Numérique : impact sur le cycle de vie du document (Le)

Actes du colloque "Le numérique : impact sur le cycle de vie du document" organisé à l\u27université de Montréal par l\u27EBSI et l\u27ENSSIB du 13 au 15 octobre 2004. Son objectif était de traiter de façon interdisciplinaire la problématique suivante : « La numérisation, la diffusion des formats numériques originaux, les nouvelles méthodes d\u27indexation et d\u27analyse du document ainsi que le fonctionnement en réseau changent les données de base de la vie du document qui devient une sorte de phénix incessamment renaissant » (programme du colloque)

The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer : An Analysis Based on Individual Participant Data

BACKGROUND: Clinical staging of non-small cell lung cancer (NSCLC) helps determine the prognosis and treatment of patients; few data exist on the accuracy of clinical staging and the impact on treatment and survival of patients. We assessed whether participant or trial characteristics were associated with clinical staging accuracy as well as impact on survival. METHODS: We used individual participant data from randomized controlled trials (RCTs), supplied for a meta-analysis of preoperative chemotherapy (+/- radiotherapy) vs surgery alone (+/- radiotherapy) in NSCLC. We assessed agreement between clinical TNM (cTNM) stage at randomization and pathologic TNM (pTNM) stage, for participants in the control group. RESULT: Results are based on 698 patients who received surgery alone (+/- radiotherapy) with data for cTNM and pTNM stage. Forty-six percent of cases were cTNM stage I, 23% were cTNM stage II, and 31% were cTNM stage IIIa. cTNM stage disagreed with pTNM stage in 48% of cases, with 34% clinically understaged and 14% clinically overstaged. Agreement was not associated with age (P = .12), sex (P = .62), histology (P = .82), staging method (P = .32), or year of randomization (P = .98). Poorer survival in understaged patients was explained by the underlying pTNM stage. Clinical staging failed to detect T4 disease in 10% of cases and misclassified nodal disease in 38%. CONCLUSION: This study demonstrates suboptimal agreement between clinical and pathologic staging. Discrepancies between clinical and pathologic T and N staging could have led to different treatment decisions in 10% and 38% of cases, respectively. There is therefore a need for further research into improving staging accuracy for patients with stage I-IIIa NSCLC.Peer reviewe

Early acute microvascular kidney transplant rejection in the absence of anti-HLA antibodies is associated with preformed IgG antibodies against diverse glomerular endothelial cell antigens

International audienceBACKGROUND: Although anti-HLA antibodies (Abs) cause most antibody-mediated rejections of renal allografts, non-anti-HLA Abs have also been postulated to contribute. A better understanding of such Abs in rejection is needed.METHODS: We conducted a nationwide study to identify kidney transplant recipients without anti-HLA donor-specific Abs who experienced acute graft dysfunction within 3 months after transplantation and showed evidence of microvascular injury, called acute microvascular rejection (AMVR). We developed a crossmatch assay to assess serum reactivity to human microvascular endothelial cells, and used a combination of transcriptomic and proteomic approaches to identify non-HLA Abs.RESULTS: We identified a highly selected cohort of 38 patients with early acute AMVR. Biopsy specimens revealed intense microvascular inflammation and the presence of vasculitis (in 60.5%), interstitial hemorrhages (31.6%), or thrombotic microangiopathy (15.8%). Serum samples collected at the time of transplant showed that previously proposed anti-endothelial cell Abs-angiotensin type 1 receptor (AT1R), endothelin-1 type A and natural polyreactive Abs-did not increase significantly among patients with AMVR compared with a control group of stable kidney transplant recipients. However, 26% of the tested AMVR samples were positive for AT1R Abs when a threshold of 10 IU/ml was used. The crossmatch assay identified a common IgG response that was specifically directed against constitutively expressed antigens of microvascular glomerular cells in patients with AMVR. Transcriptomic and proteomic analyses identified new targets of non-HLA Abs, with little redundancy among individuals.CONCLUSIONS: Our findings indicate that preformed IgG Abs targeting non-HLA antigens expressed on glomerular endothelial cells are associated with early AMVR, and that cell-based assays are needed to improve risk assessments before transplant

NODULES THYRODIENS DE L'ADULTE (TECHNIQUE ET INTERETS DE LA CYTOPONCTION ECHOGUIDEE A L'AIGUILLE FINE ET EVALUATION DES CRITERES ECHOGRAPHIQUES. ETUDE PROSPECTIVE REALISEE AU CHU D'AMIENS)

AMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Prise en charge de la grossesse chez les patientes transplantées rénales de la région Normandie-Nord-Picardie

La transplantation rénale chez les femmes jeunes leur permet de retrouver une autonomie et surtout d être enceinte sans mettre en jeu leur pronostic vital. Le nombre de grossesses chez ces patientes ne cesse d augmenter. Leur prise en charge doit être connue des praticiens. Objectifs : Analyser la prise en charge des grossesses chez les transplantées rénales dans nos services. Méthodes : Etude rétrospective des différents paramètres de prise en charge de 51 grossesses chez 46 patientes. Résultats : Les complications retrouvées sont essentiellement obstétricales avec un taux de pré-éclampsie de 10%, un taux de prématurité de 29%. Il n y a pas eu de rejet de greffe ni de dégradation de la fonction rénale des patientes. Conclusion : Le pronostic des grossesses chez les transplantées rénales est bon lorsque certaines conditions de départ sont respectées. Toutefois, elles nécessitent un suivi rapproché et sont exposées à plus de complications obstétricales par rapport à la population générale. Nous proposons un protocole de prise en charge de la grossesse chez les patientes transplantées rénales.Kidney transplantation allows young women to recover independence and become pregnant without endangering their lives. The number of pregnancies among kidney transplanted women is growing constantly. The needs and care of these patients must be known by health practitioners. Goals: Analyzing the care and treatment of kidney transplanted women in our hospital wards. Methodology: Retrospective study of the care and treatment of 51 pregnancies among 46 women. Results: The complications that were found are essentially obstetrical with a 10% rate of preeclampsia and a 29% rate of prematurity. No graft rejection or debilitation of renal functions have been noticed among patients. Conclusion: Pregnancy forecast in kidney transplants is positive when a number of parameters are mobilized from the start. Nevertheless, daily care and treatment package must be provided as these women are more at risk of obstetrical complications than the general population. We are suggesting a care and treatment protocol for pregnant kidney transplanted women.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Intérêt du scanner hélical dans l'imagerie de la colique néphrétique (étude prospective comparative avec l'urographie intra veineuse)

AMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Access to innovative drugs for metastatic lung cancer treatment in a French nationwide cohort: the TERRITOIRE study

International audienceBackground: Territorial differences in the access to innovative anticancer drugs have been reported from many countries. The objectives of this study were to evaluate access to innovative treatments for metastatic lung cancer in France, and to assess whether socioeconomic indicators were predictors of access at the level of the municipality of residence.Methods: All incident cases of metastatic lung cancer hospitalised for a chemotherapy in public hospitals in 2011 were identified from the French National Hospital discharge database. Information on prescription of innovative drugs from an associated database (FICHCOMP) was crossed with the population density of the municipality and a social deprivation index based on national census data.Results: Overall, 21,974 incident cases of metastatic lung cancer were identified, all of whom were followed for 2 years. Of the 11,486 analysable patients receiving chemotherapy in the public sector, 6959 were treated with a FICHCOMP drug at least once, principally pemetrexed. In multivariate analysis, prescription of FICHCOMP drugs was less frequent in patients ≥66 years compared to those ≤55 years (odds ratio: 0.49 [0.44–0.55]), in men compared to women (0.86 [0.79–0.94]) and in patients with renal insufficiency (0.55 [0.41–0.73]) and other comorbidities. Prescription rates were also associated with social deprivation, being lowest in the most deprived municipalities compared to the most privileged municipalities (odds ratio: 0.82 [0.72–0.92]). No association was observed between the population density of the municipality and access to innovative drugs.Conclusion: Although access to innovative medication in France seems to be relatively equitable, social deprivation is associated with poorer access. The reasons for this need to be investigated and addressed