Impact de la chimiothérapie adjuvante de type FNC sur le devenir du cancer du sein

TOURS-BU Médecine (372612103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

[Pneumatic tube system for blood products transport].

International audienceBlood product transport from blood bank to the patient care areas of hospitals is a key step in the transfusion process. The pneumatic tube system is now widely used in hospitals. Strict performance specifications must be respected to guarantee blood safety: robustness, easy to use and respect the constraints imposed to blood products. To secure the disposal of blood products ordered to a carrier (delivery step), a security device must be deployed (video camera, barcode reading, fax, chip), allowing in particular to limit the risk of addressing error when sending (in the case of device with several arrival stations) or picked up by the wrong carrier

Test device for Blood transfusion safety: How acoustics can help preventing any red cells incompatibility

International audienceDuring red cells concentrates transfusion, red cells incompatibilities still occur despite the laboratory controls based on immuno-hematologic techniques. Red cells incompatibilities appear when patient’s antibodies bind to red cells to be transfused. Up to now, all pre-transfusion testing are addressed using techniques based on immunology. This is time consuming, expensive and some incompatibility situations cannot be addressed at the patient’s bedside. In this position paper, we propose a completely novel paradigm. Our hypothesis is that red blood cells sensitized by the patient’s antibodies see their deformability greatly reduced. This induces changes of the rheological properties of the “red cells concentrate /patient’s blood” mixture. Studies described in this position paper aim at characterizing these modifications by measuring the characteristics of acoustic waves propagating in the mixture and to produce a mobile and automated acousto-micro-fluidic device which would allow detecting any incompatibility at the patient’s bed side

BLOOD-TO-BLOOD IMMUNOLOGICAL COMPATIBILITY TEST: A possibility with fluorescent immuno-biochips

International audienceOne of the most feared transfusion accident is the haemolytic reaction. A majority of countries impose a compatibility test before each transfusion, at the patient’s bedside or in laboratory. Regardless of the test performed, it does not prevent human errors and nothing ensures an “error free” procedure. Complete crossmatch is the only test ensuring a complete blood compatibility between donors and patients. It relies on the direct or indirect detection of agglutinations which occur when the patient’s plasma is mixed with the red cells to be transfused. It requires extracting plasma. The work described here will help avoid all the immunologic incompatibilities by the use of a compatibility test without plasma extraction. It relies on an immuno- biochip technology in a microfluidic environment with fluorescence detection. This position paper presents preliminary results obtained with artificial samples together with comments on the state of industrial competition and the new device market positioning

An automated medical device for ultimate ABO compatibility test at the patient’s bedside - Towards the automation of point-of-care transfusion safety

International audienceIn blood transfusion, accidents still occur because of ABO mismatch between donor and patient’s blood. These errors, sometimes lethal, are principally due to wrong identification of patient and/or blood product or to human errors. The best way to avoid these errors is to perform an ultimate ABO compatibility test at the patient’s bedside immediately prior to transfusion. Ideally, this test should be performed automatically, without human interpretation and with minimum blood exposure for nurses. This ideal and ultimate method is not yet employed because of the lack of suitable device. In this paper, we propose a system that may fulfil the above mentioned requirements. It is based on selective blood capture on biochip surfaces in a device which automatically drives the different fluids, performs optical detection of captured red cells and finally interprets the optical reading in terms of ABO compatibility. So far, our device achieved blood compatibility test with 99.3 % sensitivity and 97.9 % specificity

Immunologic blood transfusion accidents: toward a complete compatibility test at the patient’s bedside

International audienceIn most countries in order to ensure the transfusion safety, a direct compatibility test between the red cell concentrate and the receiver’s blood is performed (crossmatch prior any blood transfusion). In some countries (like France), an ultimate ABO compatibility is required, the test is performed at the patient’s bedside and crossmatch is only performed for patients who present irregular antibodies. Up to now, and whatever the country, no complete solution is able to detect an immunological conflict at the patient’s bedside and to prevent 100% of incompatible transfusions

Optical detection of red blood cells captured on biochips for RH1 compatibility control at the patient’s bedside

International audienceEvery year, several millions of red cell concentrates are transfused. For each of them, a pretransfusional compatibility test is performed. In France, an ABO compatibility test at the patient’s bedside is performed, but rhesus compatibility is not yet checked. However, rhesus antigens are very immunogenic and could lead to Rh incompatibility or Rh disease. Rh incompatibility occurs when a woman with Rh-negative blood type is exposed to Rh-positive blood cells

Biochip technology applied to an automated ABO compatibility test at the patient bedside

International audienceIn the field of blood transfusion, there is a need to improve the bedside pre-transfusion ABO compatibility test. In France, this test is mandatory for each red cell concentrates transfusion. It is performed manually and serious transfusion accidents still occur, principally due to human errors. Therefore, an automated ABO compatibility test is required. Works concerning objective interpretation of ABO compatibility test have been reported but the proposed techniques cannot be easily translated to the patient's bedside. We propose a prototype device which demonstrates the easy use of biochip technology to perform this test: it contains a fluidic system, biochips (two to test the patient and two to test the red cell concentrates) and an optical absorbance detection module. When blood is applied to the biochips, red blood cells are trapped onto the surface if antigens and antibodies are complementary (positive chips). If they are not complementary, very little red blood cells are adsorbed (negative chips). Percentages of surface covered with red blood cells in negative biochips are 2% ± 2 (red cell concentrates) and 1% ± 1 (whole blood). This proves that the fluidic configuration leads to an optimum control of fluids flows with little retention of red blood cells in the circuitry. These percentages increase to 96% ± 3 and 82% ± 8 for red cell concentrates and whole blood respectively. This demonstrates a strong and specific immunocapture of red blood cells on positive chips. Furthermore, optical detection proves to be efficient at critical red blood cells concentrations (108 C/mL) and absorbance strongly correlates to the percentage of red blood cells captured by antibodies

Impact of Metformin on the Prognosis of Cirrhosis Induced by Viral Hepatitis C in Diabetic Patients

International audienceContext: Insulin resistance plays a role in hepatocarcinogenesis and is decreased by metformin treatment. Objective: The aim of the study was to assess the influence of metformin treatment on the prognosis of compensated hepatitis C virus (HCV) cirrhosis in patients with type 2 diabetes. Design and Setting: We studied an observational prospective cohort (1988-2007) at a university hospital referral center. Patients: A total of 100 consecutive diabetic patients (53 men, age 61 +/- 11 yr) with ongoing HCV cirrhosis and no contraindication for metformin were included in a screening program for hepatocellular carcinoma (HCC). Main Outcomes: The patients were prospectively followed up for HCC incidence, liver-related death, or hepatic transplantation. Results: The level of platelet count was significantly lower in patients treated with metformin (n = 26) compared with those not treated with metformin (n = 74) [117 (interquartile range, 83-166) vs. 149 (105-192) Giga/liter, P = 0.045]. During a median follow-up of 5.7 (3.8-9.5) yr, one patient was lost to follow-up, 39 developed a HCC, and 33 died from liver causes or were transplanted. The 5-yr incidence of HCC was 9.5 and 31.2% (P = 0.001) and of liver-related death/transplantation, 5.9 and 17.4% (P = 0.013), in patients who received metformin treatment and in those who did not, respectively. In multivariate analysis, metformin treatment was independently associated with a decrease in HCC occurrence [hazard ratio, 0.19 (95% confidence interval, 0.04-0.79); P = 0.023] and liver-related death or transplantation [hazard ratio, 0.22 (95% confidence interval, 0.05-0.99); P = 0.049]. Conclusions: In patients with type 2 diabetes and HCV cirrhosis, use of metformin is independently associated with reduced incidence of HCC and liver-related death/transplantation. (J Clin Endocrinol Metab 96: 2601-2608, 2011

The CRP level and STATE score predict survival in cirrhotic patients with hepatocellular carcinoma treated by transarterial embolization

International audienceBackground: Prognostic biomarkers are needed in a heterogeneous population of patients with intermediate hepatocellular carcinoma (HCC) treated by transarterial (chemo)embolization. We aimed to validate the prognostic value of serum CRP levels and the STATE score, combining CRP, albumin and tumor burden.Methods: All cirrhotic patients with HCC treated by a first transarterial (chemo)embolization (2007-2013) in our institution were included. Overall survival was assessed using the Kaplan-Meier method, log rank, univariate and multivariate Cox analyses.Results: Among 157 patients included, 87% were men, 86% had Child Pugh A. Etiologies of liver disease included alcohol (57%), hepatitis C (32%), hepatitis B (11%) and/or metabolic syndrome (32%); 89% of patients were classified BCLC B. 33% of the patients had a CRP >1mg/dl and 33% a STATE score conferring poor prognosis (1mg/dl (20 vs. 8 months, P=0.00186). Median overall survival was 6.73 months for patients with a STATE score <18 vs. 22.23 months for patients with STATE-score ≥18 (P=0.0002). In multivariate analysis, a STATE score <18 was independently associated with increased mortality (HR: 2.06 (CI95%: 1.28-3.34), P=0.0031).Conclusion: In cirrhotic patients with HCC who underwent transarterial treatment, serum CRP level and STATE score at baseline can predict overall survival