Search

Les entretiens pharmaceutiques postopératoires (EPPO) ont été instaurés en 2016 pour les porteurs de prothèse totale de hanche (PTH). Étendus aux patients porteurs de prothèse de genou (PTG) en 2019 et implant mammaire (IM) en 2020, ils se déroulent au lit du patient, suivant un questionnaire pour évaluer les connaissances du patient sur des sujets tels que l’implant et sa traçabilité, les complications et leur prévention ainsi que le traitement de sortie.

Un grand nombre de remplacement de valve cardiaque (RVC) chirurgical est réalisé chaque année en France. Les valves cardiaques sont des dispositifs médicaux implantables avec une obligation réglementaire de traçabilité. Un état des lieux a montré que les informations bien que transmises par l’équipe médicale étaient peu maîtrisées par le patient notamment concernant les risques thrombotiques et infectieux ainsi que l’existence et l’importance de la carte implant. D’où la mise en place d’entretien pharmaceutique postopératoire (EPPO) en chirurgie cardiaque afin d’aider le patient à mieux comprendre sa prise en charge (PEC).

Afin de sécuriser le circuit du dispositif médical (DM), le déploiement d’armoires sécurisées au sein d’un bloc opératoire a été réalisé. L’objectif de cette étude est de déterminer l’impact sécuritaire, organisationnel et économique de la mise en place d’armoires sécurisées dédiées aux dispositifs médicaux (ASDM). La mise en place a eu lieu au sein d’un bloc de chirurgie cardiaque. L’impact sécuritaire a été évalué en comparant les taux de traçabilité des dispositifs médicaux implantables pré- et post-implantation. Un questionnaire de satisfaction réalisé auprès de la totalité des infirmières a complété cette analyse. Le montant des réapprovisionnements, l’évolution des stocks ainsi que les investissements à consentir pour le déploiement de l’ASDM ont fait l’objet d’une étude coût–bénéfice. D’un point de vue sécuritaire, le taux de traçabilité obtenu en un an a été excellent (100 %). Les utilisateurs ont été satisfaits à 87,5 % par ce nouveau système. L’ASDM a permis une diminution de la valeur des stocks, avec une réduction de 30 % pour les DM achetés et de 15 % pour les dispositifs médicaux implantables en dépôt-consignation. L’analyse coût–bénéfice a montré un retour sur investissement rapide. La réduction du stock réel (DM achetés) correspond à 46,6 % de l’investissement. Le déploiement d’armoires sécurisées dédiés aux dispositifs médicaux permet de sécuriser le stockage et la dispensation de ceux-ci. Cette technologie a aussi un impact économique non négligeable et est apprécié par les utilisateurs.

When diagnosed as primary lung cancer, metastases from the abdomen, plus false negative cases have little effect on epidemiology studies of male smokers, but may result in a severe dilution of the lung cancers among women and nonsmokers. We have attempted to quantitate this handicap for epidemiological studies using two approaches. The relative frequency of diagnosed primary lung and abdominal cancer among males, women, and nonsmokers differs substantially and is used here to calculate magnitude. The second approach postulates that the ratio of nonsmokers among persons with squamous cell lung cancer and primary adenocarcinoma of the lung would be constant by sex if there were no distortion by abdominal metastases. These two approaches indicate that the much higher ratio of metastatic disease diagnosed as primary lung cancer among nonsmoking women (factor of 15 to 20), makes it more difficult to identify an environmental carcinogen among women or nonsmokers than among male smokers in case-control studies. Copyright 2000 Harcourt Publishers Ltd

Chromosomal translocations in T-cell acute leukemias can activate genes encoding putative transcription factors such as the LIM proteins RBTN1 and RBTN2 and the DNA-binding basic helix-loop-helix transcription factor TAL1 associated with T-cell acute lymphocytic leukemia. While not expressed in normal T cells, RBTN2 and TAL1 are coexpressed in erythroid cells and are both important for erythroid differentiation. We demonstrate, using anti-RBTN2 and anti-TAL1 antisera, that the LIM protein RBTN2 is not phosphorylated and is complexed with the TAL1 phosphoprotein in the nucleus of erythroid cells. A complex containing both RBTN1 and TAL1 also occurs in a T-cell acute leukemia cell line. Since both RBTN2 and TAL1 are crucial for normal erythropoiesis, these data have important implications for transcription networks therein. Further, since both proteins can be involved in leukemogenesis, these data provide a direct link between proteins activated by chromosomal translocations in T-cell acute leukemia.

The structure of LIM domains has major implications for transcription because proteins such as Is1-1 contain two LIM domains associated with a homeodomain, and RBTN1/Ttg-1 and RBTN2/Ttg-2 contain two LIM domains but no homeodomain. Conserved cysteine and histidine residues in the LIM domains suggest a metal-binding role. RBTN and Is1-1 LIM proteins have been made in Escherichia coli and insect cell expression systems and their metal content has been determined using atomic absorption spectroscopy and electron paramagnetic resonance spectroscopy. LIM proteins expressed in soluble form contain zinc atoms, whereas bacterial inclusion bodies invariably also have Fe-S clusters. The latter are identified as linear [Fe3S4]+ clusters and appear to result from incorrect metal coordination by E. coli. These studies show that RBTN1, RBTN2, and Is1-1 are metalloproteins that contain zinc but not iron and, therefore, that the LIM domain represents a zinc-binding domain.

Stimulation of T cells with antigen results in activation of several kinases, including protein kinase C (PKC), that may mediate the later induction of activation-related genes. We have examined the potential role of PKC in induction of the interleukin 2 (IL-2) gene in T cells stimulated through the T cell receptor/CD3 complex. We have previously shown that prolonged treatment of the untransformed T cell clone Ar-5 with phorbol esters results in downmodulation of the alpha and beta isozymes of PKC, and abrogates induction of IL-2 mRNA and protein. Here we show that phorbol ester treatment also abolishes induction of chloramphenicol acetyltransferase activity in Ar-5 cells transfected with a plasmid containing the IL-2 promoter linked to this reporter gene. The IL-2 promoter contains binding sites for nuclear factors including NFAT-1, Oct, NF-kappa B, and AP-1, which are all potentially sensitive to activation of PKC. We show that induction of a trimer of the NFAT and Oct sites is not sensitive to phorbol ester treatment, and that mutations in the NF-kappa B site have no effect on inducibility of the IL-2 promoter. In contrast, mutations in the AP-1 site located at -150 bp almost completely abrogate induction of the IL-2 promoter, and appearance of an inducible nuclear factor binding to this site is sensitive to PKC depletion. Moreover, cotransfections with c-fos and c-jun expression plasmids markedly enhance induction of the IL-2 promoter in minimally stimulated T cells. Our results indicate that the AP-1 site at -150 bp represents a major, if not the only, site of PKC responsiveness in the IL-2 promoter.

The mortality rates from anencephalus from 1950-1969 in Canadian cities are shown to be strongly correlated with city growth rate and with horizontal geomagnetic flux, which is directly related to the intensity of cosmic radiation. They are also shown to have some association with the magnesium content of drinking water. Prior work with these data which showed associations with magnesium in drinking water, mean income, latitude and longitude was found to be inadequate because it dismissed the observed geographic associations as having little biological meaning, and because the important variables of geomagnetism and city growth rate were overlooked.

Analysis has been made of several ventilatory function field measurements made on uranium miners in 1957 and in 1960. Results show that cumulative exposure to the atmosphere in uranium mines adds to the loss in ventilatory function which results from aging and from cigaret smoking. The data indicate that high radon daughter levels are associated with transient improvement in ventilatory function. Two possible explanations of this “transient improvement” are discussed. Long exposures within uranium mines are definitely detrimental to ventilatory function.

Previous reports have shown a small but definite increase of cancer of the lung among uranium miners in a defined study group. In the present study all men with cancer of the lung found during a 16-yr period were analyzed. The cases were collected in an area covering 15 counties, embracing the uranium industry in Western Colorado and Eastern Utah. Comparison of the tumor cell types revealed the uranium miners to have a high proportion (57 per cent) of the undifferentiated variety of tumors; 76 per cent of these were of the oat cell type. The comparison group, matched for age and smoking, had only 18 per cent of the undifferentiated cell type tumors. Only 37 per cent of the lung tumors of the uranium miners were of the epidermoid variety in contrast to 62 per cent for the control group. The difference in cell type cannot be attributed to cigarets or age. Differences in survival time, symptoms and tumor location were also noted.

The concentrations of 210Pb and 210Po in samples of rib and vertebra from 22 uranium miners are compared to the miners' 222Rn daughter exposures. A correction was made for the excretion of 210Pb from the skeleton during the time interval of exposure to the end of their mining experience and to the miners' death. A correlation was observed between the log of the 210Pb concentration in bone and the log of the miners' cumulative exposure adjusted for Pb excretion to the end of the mining experience, R = 0.92 (P < 0.001). More 210Pb was observed in the bone than was predictable from exposure to short-lived 222Rn daughters alone, and the possible source of this 210Pb is discussed. In addition, a linear correlation was observed between the 210Pb concentration in blood to that in the bone samples, R = 0.85 (P = 0.005). The use of blood 210Pb levels to estimate cumulative exposure in a mine atmosphere appears promising, and the possibility is discussed.