Identification of T‐cell epitopes from benzylpenicillin conjugated to human serum albumin and implication in penicillin allergy

International audienceAbstract Background There is in vitro evidence that T cells from allergic patients react to benzylpenicillin‐human serum albumin ( BP ‐ HSA ) bioconjugates. Our group has recently shown the existence of naïve CD 4 + T cells recognizing BP ‐ HSA in healthy donors. However, BP ‐haptenated peptides from HSA participating in the immunization of allergic patients have never been identified. The purpose of the present study is to identify immunodominant BP ‐haptenated peptides from HSA involved in immunization of patients to BP and to refine the frequency calculation of naïve CD 4 + T cells recognizing BP . Methods Co‐cultures were established with CD 4 + T cells from non‐allergic donors and mature autologous dendritic cells ( DC s) loaded with BP ‐ HSA or BP ‐haptenated peptides from HSA . The CD 4 + T‐cell response specific for BP ‐ HSA or for individual BP ‐haptenated peptides was measured using an interferon‐γ ( IFN ‐γ) ELIS pot assay. The frequency of BP ‐specific CD 4 + T cells was then calculated using the Poisson distribution. BP ‐ HSA and BP ‐haptenated peptides recognition by allergic patients was evaluated on peripheral blood mononuclear cells ( PBMC s) using a lymphocyte transformation test ( LTT ). Results Results showed that BP ‐ HSA and BP ‐haptenated peptides were recognized by naïve T cells from 15/16 and 13/14 tested healthy donors, respectively. Most donors responded to 3 peptides with BP covalently bound on lysines 159, 212, and 525. Two of these benzylpenicilloylated peptides (lysines 159 and 525) were also found to induce PBMC s proliferation in patients with allergic reaction to penicillins. Conclusion This study identifies and characterizes for the first time the BP ‐haptenated peptides from HSA involved in the immunization of patients to penicillins

Colectomie droite par abord robotique. Recommandations formalisées d’experts sous l’égide de l’Association française de chirurgie (AFC)

Twenty-seven experts under the aegis of the French Association of Surgery (AFC) offer this reference system with formalized recommendations concerning the performance of right colectomy by robotic approach (RRC). For RRC, experts suggest patient installation in the so-called “classic” or “suprapubic” setup. For patients undergoing right colectomy for a benign pathology or cancer, RRC provides no significant benefit in terms of intra-operative blood loss, intra-operative complications or conversion rate to open laparotomy compared to laparoscopy. At the same time, RRC is associated with significantly longer operating times. Data from the literature are insufficient to define whether the robot facilitates the performance of an intra-abdominal anastomosis, but the robotic approach is more frequently associated with an intra-abdominal anastomosis than the laparoscopic approach. Experts also suggest that RRC offers a benefit in terms of post-operative morbidity compared to right colectomy by laparotomy. No benefit is retained in terms of mortality, duration of hospital stay, histological results, overall survival or recurrence-free survival in RRC performed for cancer. In addition, RRC should not be performed based on the cost/benefit ratio, since RRC is associated with significantly higher costs than laparoscopy and laparotomy. Future research in the field of RRC should consider the evaluation of patient-targeted parameters such as pain or quality of life and the technical advantages of the robot for complex procedural steps, as well as surgical and oncological results

Professional risks when carrying out cytoreductive surgery for peritoneal malignancy with hyperthermic intraperitoneal chemotherapy (HIPEC): A French multicentric survey

International audienceBACKGROUND:Over the last two decades, many surgical teams have developed programs to treat peritoneal carcinomatosis with extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Currently, there are no specific recommendations for HIPEC procedures concerning environmental contamination risk management, personal protective equipment (PPE), or occupational health supervision.METHODS:A survey of the institutional practices among all French teams currently performing HIPEC procedures was carried out via the French network for the treatment of rare peritoneal malignancies (RENAPE).RESULTS:Thirty three surgical teams responded, 14 (42.4%) which reported more than 10 years of HIPEC experience. Some practices were widespread, such as using HIPEC machine approved by the European Community (100%), individualized or centralized smoke evacuation (81.8%), "open" abdominal coverage during perfusion (75.8%), and maintaining the same surgeon throughout the procedure (69.7%). Others were more heterogeneous, including laminar flow air circulation (54.5%) and the provision of safety protocols in the event of perfusate spills (51.5%). The use of specialized personal protective equipment is ubiquitous (93.9%) but widely variable between programs.CONCLUSION:Protocols regarding cytoreductive surgery/HIPEC and the associated professional risks in France lack standardization and should be established