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Summary: Asymptomatic carotid stenosis (ACS) can cause cognitive dysfunction, related to cerebral hypoperfusion and microemboli. These mechanisms could be treated by carotid revascularization, but the impact of carotid angioplasty stenting (CAS) or carotid endarterectomy (CEA) on cognitive functions remains unclear. The aim of this systematic review was to realize a report on the actual state of results about asymptomatic carotid stenosis revascularization and cognitive function. We performed a systematic literature review to analyze all studies assessing the impact of asymptomatic carotid stenosis revascularizations on cognitive functions. We reviewed all publications published in Medline database and Cochrane between January 2010 and January 2020 including subjects with a cognitive evaluation and receiving carotid revascularization for asymptomatic stenosis. We identified 567 records for review, and finally we included in the systematic review 20 studies about ACS revascularization and cognitive functions. Only observational studies analyzed the impact of CEA and CAS on cognitive functions. Thus, too heterogeneous data associated to the lack of randomized controlled trials with an evaluation of optimal medical treatment did not enable to affirm the interest of the revascularization management of ACS in cognitive domain. There was a lack of standardization and finally studies were too heterogeneous to conclude on the impact of carotid revascularization on cognitive functions. There is an urgent need to harmonize research in this domain in order to prevent and treat cognitive dysfunction related to ACS, especially in our society with an aging population.

IntroductionCOVID-19 convalescent plasma (CCP) is a possible treatment option for COVID-19. A comprehensive number of clinical trials on CCP efficacy have already been conducted. However, many aspects of CCP treatment still require investigations: in particular (1) Optimisation of the CCP product, (2) Identification of the patient population in need and most likely to benefit from this treatment approach, (3) Timing of administration and (4) CCP efficacy across viral variants in vivo. We aimed to test whether high-titre CCP, administered early, is efficacious in preventing hospitalisation or death in high-risk patients.Methods and analysisCOVIC-19 is a multicentre, randomised, open-label, adaptive superiority phase III trial comparing CCP with very high neutralising antibody titre administered within 7 days of symptom onset plus standard of care versus standard of care alone. We will enrol patients in two cohorts of vulnerable patients [(1) elderly 70+ years, or younger with comorbidities; (2) immunocompromised patients]. Up to 1020 participants will be enrolled in each cohort (at least 340 with a sample size re-estimation after reaching 102 patients). The primary endpoint is the proportion of participants with (1) Hospitalisation due to progressive COVID-19, or (2) Who died by day 28 after randomisation. Principal analysis will follow the intention-to-treat principle.Ethics and disseminationEthical approval has been granted by the University of Ulm ethics committee (#41/22) (lead ethics committee for Germany), Comité de protection des personnes Sud-Est I (CPP Sud-Est I) (#2022-A01307-36) (ethics committee for France), and ErasmusMC ethics committee (#MEC-2022-0365) (ethics committee for the Netherlands). Signed informed consent will be obtained from all included patients. The findings will be published in peer-reviewed journals and presented at relevant stakeholder conferences and meetings.Trial registrationClinical Trials.gov (NCT05271929), EudraCT (2021-006621-22)

ObjectivesThe objectives of this study were to describe the incidence of major adverse cardiovascular events (MACEs) in French patients newly benefiting from the French Long-term Illness scheme (LTI) for AS and to evaluate the effect of various treatments on the risk of MACE occurrence.MethodsThis national cohort study was based on the French national medico-administrative database SNDS containing data on hospitalization, the LTI, and outpatient care consumption. All French patients newly receiving LTI benefits for AS from 2010 to 2013 were included. The final follow-up date was 31 December 2018. The occurrences of MACEs [stroke and myocardial infarction (MI)] and comorbidities were identified from algorithms previously described in the literature. Competitive risk analysis using propensity score and inverse weighting was performed to calculate cumulative incidence functions and to determine subhazard ratios (SHRs) for the various treatments of interest.ResultsBetween 2010 and 2013, 22 929 patients were included [mean age 43.0 (s.d. 13.9) years, 44.9% mal]. The 8-year cumulative incidences of MACE, stroke, and MI were 1.81% (1.61–2.05), 0.97% (0.83–1.14), and 0.85% (0.71–1.04), respectively. NSAIDs [SHR: 0.39 (0.32–0.50), P ConclusionMACE incidence rates at 8 years are low in patients newly benefiting from LTI for AS. Our results support the hypothesis of a protective role of NSAIDs and anti-TNF in cardiovascular risk in these patients.

Background Fat mass distribution, especially in the abdominal visceral region, has been rarely evaluated in patients with PsA or psoriasis (PsO). Methods Patients with PsA and patients with PsO alone were evaluated and compared with control subjects (1:1 ratio in each patient group) matched for age, sex and BMI category. Body composition and fat distribution (android and visceral fat) were evaluated by DXA. Anthropometric measurements, disease activity and the systematic coronary risk evaluation (SCORE) cardiovascular risk were assessed. Metabolic parameters (insulin, homeostasis model assessment for insulin resistance), serum adipokines [total and high-molecular-weight adiponectin, leptin, resistin and retinol-binding protein-4 (RBP4)] were measured. Results Data for 52 patients with PsA and 52 patients with PsO and their respective paired controls were analysed. Android fat and visceral fat were found to be significantly higher in patients with PsO compared with their controls, while these measurements did not differ between patients with PsA and their controls. By multivariate analysis, after adjusting for age, sex and BMI, visceral fat was higher in PsO patients compared with PsA patients (P = 0.0004) and the whole group of controls (P = 0.0013). Insulin levels and HOMA-IR were increased in both PsA and PsO groups. High-molecular-weight/total adiponectin ratio was decreased in patients with PsO. RBP4 was significantly higher in both PsA and PsO patients. In patients with PsO, visceral fat strongly correlated with SCORE (r = 0.61). Conclusion Visceral fat accumulates more in PsO alone than in PsA. Visceral adiposity may be a more pressing concern in PsO relative to PsA. Trial registration The ADIPSO study (Évaluation du tissu ADIpeux et des adipokines dans le PSOriasis et le rhumatisme psoriasique et analyse de ses relations avec le risque cardiovasculaire) is a case–control study conducted in Besançon, France, and is registered on ClinicalTrials.gov under the number NCT02849795.

Extracellular vesicles (EVs) are active components of red blood cell (RBC) concentrates and may be associated with beneficial and adverse effects of transfusion. Elucidating controllable factors associated with EV release in RBC products is thus important to better manage the quality and properties of RBC units. Erythrocyte-derived EVs (EEVs) and platelet-derived EVs (PEVs) were counted in 1226 RBC units (administered to 280 patients) using a standardized cytometry-based method. EV size and CD47 and annexin V expression were also measured. The effects of donor characteristics, processing methods, and storage duration on EV counts were analyzed by using standard comparison tests, and analysis of covariance was used to determine factors independently associated with EV counts. PEV as well as EEV counts were higher in whole-blood–filtered RBC units compared with RBC-filtered units; PEV counts were associated with filter type (higher with filters associated with higher residual platelets), and CD47 expression was higher on EEVs in RBC units stored longer. Multivariate analysis showed that EEV counts were strongly associated with filter type (P < .0001), preparation, and storage time (+25.4 EEV/µL per day [P = .01] and +42.4 EEV/µL per day [P < .0001], respectively). The only independent factor associated with PEV counts was the residual platelet count in the unit (+67.1 PEV/µL; P < .0001). Overall, processing methods have an impact on EV counts and characteristics, leading to large variations in EV quantities transfused into patients. RBC unit processing methods might be standardized to control the EV content of RBC units if any impacts on patient outcomes can be confirmed. The IMIB (Impact of Microparticles in Blood) study is ancillary to the French ABLE (Age of Transfused Blood in Critically Ill Adults) trial (ISRCTN44878718).

Objective Taenia solium (Ts) cysticercosis is a neglected zoonotic disease particularly prevalent in Madagascar. Few data are available for children, current data mainly rely on antibody prevalence. We sought to determine the Ts-antigen seroprevalence–determining active cysticercosis—amongst school children from various cities in Madagascar (excluding the capital) and evaluated associated risk factors. Methods In seven cities in Madagascar, the presence of cysticercosis in school children (n = 1751) was investigated in 2007 using the B158/B60 antigen (Ag)-ELISA. Results The overall prevalence based on Ag detection was 27.7% [95%CI: 10–37%]. Risk factors associated with Ag positivity were age, biotope, altitude and annual average rainfall. Conclusion These results highlight the high prevalence of active cysticercosis in Madagascar among school children in an urban setting. This high prevalence as well as the risk factors unraveled point to the emergency to implement appropriate Public Health measure son a national scale.

BackgroundThe strong geographic variations in the incidence rates of renal replacement therapy (RRT) for end-stage renal disease are not solely related to variations in the population's needs, such as the prevalence of diabetes or the deprivation level. Inequitable geographic access to health services has been involved in different countries but never in France, a country with a generous supply of health services and where the effect of the variability of medical practices was highlighted in an analysis conducted at the geographic scale of districts. Our ecological study, performed at the finer scale of townships in a French area of 8,370,616 inhabitants, investigated the association between RRT incidence rates, socioeconomic environment and geographic accessibility to healthcare while adjusting for morbidity level and medical practice patterns.MethodsUsing data from the Renal Epidemiology and Information Network registry, we estimated age-adjusted RRT incidence rates during 2010-2014 for the 282 townships of the area. A hierarchical Bayesian Poisson model was used to examine the association between incidence rates and 18 contextual variables describing population health status, socioeconomic level and health services characteristics. Relative risks (RRs) and 95% credible intervals (95% CrIs) for each variable were estimated for a 1-SD increase in incidence rate.ResultsDuring 2010-2014, 6,835 new patients ≥18 years old (4231 men, 2604 women) living in the study area started RRT; the RRT incidence rates by townships ranged from 21 to 499 per million inhabitants. In multivariate analysis, rates were related to the prevalence of diabetes [RR (95% CrI): 1.05 (1.04-1.11)], the median estimated glomerular filtration rate at dialysis initiation [1.14 (1.08-1.20)], and the proportion of incident patients ≥ 85 years old [1.08 (1.03-1.14)]. After adjusting for these factors, rates in townships increased with increasing French deprivation index [1.05 (1.01-1.08)] and decreased with increasing mean travel time to reach the closest nephrologist [0.92 (0.89-0.95]).ConclusionThese data confirm the influence of deprivation level, the prevalence of diabetes and medical practices on RRT incidence rates across a large French area. For the first time, an association was found with the distance to nephrology services. These data suggest possible inequitable geographic access to RRT within the French health system.

Database set-up directly impacts the quality and viability of research data, and therefore is a crucial part of the quality of clinical research. Setting up a quality database implies following a strict data-management process. Too much collected information threatens the quality of the information required to achieve the objectives of the study. Therefore, the data that will be collected and managed have to be cautiously discussed and selected. Case report forms (CRF) are the tools the most frequently used to collect the data specified by the protocol. An informative and well-structured document simplifies database design and data validation. Key elements are about choice of sequential or thematic structuring, information and type of information that should be entered and the importance of data standards and coding guide. Final database must be structured with unique ID patient, with one record per subject or per measure. Specific information must be provided for each variable according to the database specifications. The quality of the results is directly related to the quality of the collected data. The CRF should then be completed as fully and accurately as possible. Data validation relies on three key points: the CRF completion guidelines, the Edit Checks process and the Data clarification process. Various open source or business software applications provide all functionalities to set up a clinical data base and CRF. The General Data Protection Regulation (GDPR) standardizes and strengthens the protection of personal data across the EU and for other country’s data being “processed” within the EU. The General principles include lawfulness, fairness and transparency, restricted use of data, data minimization, accuracy, limited storage, confidentiality and probity, and accountability.

International audience; Objectives: Several studies have reported that patients operated on for non-small cell lung cancer (NSCLC) are at high risk of second primary lung cancer (SPLC). However, widely varying estimates of this risk have been reported, with very few studies taking into account that these patients are at particularly high competing risk of death, due to recurrence of the initial disease and to comorbidities. Risk factor evaluation over time has significant repercussions on the post-surgery surveillance strategy offered for NSCLC. This study primarily sought to measure the risk of SPLC in a long-term follow-up series, using statistical methods considering competing risks of death.Materials and methods: The cumulative SPLC risk was estimated using the cumulative incidence of patients with completely resected Stage I-III NSCLC diagnosed between 2002 and 2015 based on the Doubs and Belfort cancer registry (France). A proportional sub-distribution hazard model (sdRH) was used to investigate factors associated with SPLC risk in the presence of competing risks.Results: Among the 522 patients, adenocarcinoma and Stage I or II disease accounted for 52.3% and 75.7% of patients, respectively. Overall, 84 patients developed SPLC (16.1%). The cumulative risk of SPLC was 20.2% at 10 years post-surgery (95% confidence interval [CI]: 15.3-23.2), and 25.2% (CI: 19.4-31.3) at 14 years post-surgery. On multivariate analysis, the SPLC risk was significantly higher in patients with postoperative thoracic radiotherapy (sdRH 2.79; 95% CI: 1.41-5.52; p = 0.003).Conclusion: This study using appropriate statistical methods to consider competing risks showed that after complete NSCLC resection, the cumulative incidence function of SPLC was high, with patients receiving postoperative thoracic radiotherapy at higher risk. These data support the need for life-long follow-up of patients who undergo NSCLC surgery, with the objective of screening for SPLC.

Background:current data regarding areal bone mineral density (aBMD) in patients with psoriasis (PsO) or psoriatic arthritis (PsA) are conflicting. Results on Trabecular Bone Score (TBS) in these patients are lacking. 3D-analysis of cortical and trabecular bone from hip DXA is a new method for non-invasive bone structure assessment, providing separate assessment of the cortical layer and trabecular macrostructure.Objectives:Case-control study (NCT02849795)Methods:52 PsO and 52 PsA cases (CASPAR criteria) were each paired to a control subject matched for age, sex and body mass index (BMI). aBMD measurements at (L2-4) lumbar spine (LS), femoral neck (FN) and total hip (TH) were performed using DXA, Lunar GE. TBS was calculated from antero-posterior L2-L4 BMD image using TBS iNsight V1.8 (Med-Imaps, Pessac, France). 3D-SHAPER software (version 2.10, Galgo Medical S.L, Barcelona, Spain) was used to derive a 3D analysis from the hip DXA scans.Results:LS and TH aBMD measurements did not differ between patients with PsO or PsA and their respective controls (Table 1). Left FN BMD was higher in patients with PsO compared to controls (p = 0.028), a difference not observed on the right FN. TBS was similar in PsA patients and their controls while decreased values were observed in PsO patients (p = 0.04). In 3D analysis, none of the parameters differed between patients with PsA and their controls. For patients with PsO, no difference was found with the controls for 3D-DXA parameters from the right FN, while total hip cortical surface BMD (sBMD) of the left FN was higher in PsO compared to their controls (p = 0.037). Similarly, cortical thickness (Cth) of the intertrochanteric and shaft regions of the left FN was also higher in PsO (p = 0.032 and p = 0.033). Finally, analysis by region (neck, intertrochanteric and shaft) showed higher values for cortical sBMD from each region of the left FN in the patients with PsO (all p Conclusion:Our results showed comparable aBMD, TBS and 3D proximal femur parameters in patients with PsA and controls. This supports that PsA population is not at increased risk of osteoporosis. In patients with PsO, while LS bone microarchitecture seems impaired, FN displayed better cortical parameters than the controls. Although these results seem marginal, they support the fact that patients with PsO are not at high risk for osteoporosis and hip fracture.Table 1.PsA: psoriatic arthritis; PsO: psoriasis; M: male; F: female; BMI: body mass index; PASI: psoriasis area severity index; CPDAI: composite psoriatic disease activity index; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; aBMD: areal bone mineral density; LS: lumbar spine; FN: femoral neck; TH: total hip; TBS: trabecular bone score; sBMD: surface bone mineral density; Cth: cortical thickness; quantitative data are mean ± standard deviation; * and ***: paired t test comparing patients with psoriatic arthritis or psoriasis alone to their respective controls; * p < 0.05; *** p < 0.001).PsAPsA controlsPsOPsO controlsN52525252Age (years)52.5 ± 11.752.8 ±11.150.5 ± 12.850.7 ± 12.8Sex (M/F)25/2725/2738/1436/16Menopausal women18 (67%)16 (59%)5 (36%)8 (50%)BMI (Kg/m2)27.4 ± 5.927.7 ± 6.428.4 ± 5.828.2 ± 6.1PASI2.4 ± 4.18.4 ± 4.9CPDAI7.4 ± 3.3ESR (mm/h)19.8 ± 16.6 ***6.9 ± 5.810.7 ± 8.8 ***6.4 ± 6.4CRP (mg/L)10.5 ± 11.7 ***3.9 ± 4.86.0 ± 9.04.7 ± 5.5LS (L2-4) aBMD (g/cm2)1.27 ± 0.491.20 ± 0.201.25 ± 0.211.20 ± 0.18FN aBMD (g/cm2) right0.96 ± 0.120.94 ± 0.140.98 ± 0.150.98 ± 0.15 left0.96 ± 0.160.93 ± 0.121.0 ± 0.14 *0.97 ± 0.13TH aBMD (g/cm2)1.01 ± 0.161.00 ± 0.151.11 ± 0.221.06 ± 0.21L2-L4 TBS1.32 ± 0.111.32 ± 0.151.23 ± 0.15 *1.30 ± 0.16Cortical sBMD (left FN) (mg/cm2)169.7 ± 32.8163.1 ± 29.7182.0 ± 31.0 *173.5 ± 30.3Cth intertrochanteric (left FN) (mm)1.91 ± 0.201.94 ± 0.182.03 ± 0.23 *1.97 ± 0.19Cth shaft (left FN) (mm)2.98 ± 0.313.01 ± 0.283.19 ± 0.36 *3.09 ± 0.29Cortical sBMD (left FN) (mg/cm2)neck135.27 ± 26.9129.67 ± 21.9140.29 ± 24.2 *134.6 ± 22.5intertrochanteric162.32 ± 31.1155.34 ± 29.3171.39 ± 29.1 *163.1 ± 28.9shaft cort269.20 ± 49.0257.12 ± 47.3286.2 ± 47.5 *272.7 ± 45.2Disclosure of Interests:ERIC TOUSSIROT: None declared., Renaud Winzenrieth Employee of: GALGO MEDICAL, maxime DESMARETS: None declared., Daniel Wendling: None declared., Francois AUBIN: None declared., Gilles DUMOULIN: None declared.

BACKGROUND Blood products use has increased in France between 2000 and 2011. To understand the reasons for this increase, data about transfused patients and transfusion practices needed to be updated. STUDY DESIGN AND METHODS A nationwide cross-sectional survey was performed with health care establishments. Diagnoses and indication for the transfusion, pretransfusion laboratory results, and blood products used were collected during a randomly selected 24-hour period in 2011. All patients who received at least one blood product delivered on the survey day were included. RESULTS A total of 10,794 blood products were requested for 4720 patients: 8688 red blood cell (RBC) units, 842 platelet (PLT) concentrates, and 1264 fresh-frozen plasma (FFP) units. Hematologic and cancer pathologies included 46% of transfused patients, 34% of the patients had transfusions in a surgical context, and 32.4% of transfused patients were receiving medication with an impact on transfusion. Nearly half of RBC transfusions were performed with hemoglobin levels of less than 8 g/dL. PLT transfusions for prophylactic indication were prescribed with PLT counts of less than 20 × 109 and 50 × 109/L in 56.9 and 86.6% of patients, respectively. RBCs and PLTs transfusion practices were in agreement with national guidelines. FFP units were involved in 8.0% of all prescriptions. Among these, 57.4% were requested in the context of an acute hemorrhage and 8.4% for plasma exchange. The median of FFP use (n = 2) in a nonsurgical context, excluding plasma exchange, suggests an insufficient dosing of FFP. CONCLUSION Except for insufficient FFP dosing per patient and limitations on assessment of indications for prescribing, transfusion practices were in agreement with national guidelines.

BACKGROUND Red blood cell (RBC) storage lesions and RBCs from females transfused into male recipients may have adverse effects on transfusion recipients' survival. We hypothesized that the effect of donor sex and the effect of age of blood on mortality would be most apparent in cardiac surgery patients. STUDY DESIGN AND METHODS Using data from French Blood Services and two university hospitals, we conducted a retrospective cohort study on cardiac surgery patients whose first transfusion occurred between 2007 and 2011. The age of blood and donor sex effects on 1-year survival were studied using Cox regression modeling, with time-dependent stratification on the number of RBCs and adjustments for the type of surgery and other products transfused. RESULTS Among the 2715 cardiac surgery patients, 85.1% were alive after 1 year. Age of blood and donor sex were associated with survival before adjustments (p

Background:Obesity is a leading comorbidity in both psoriasis (Pso) and psoriatic arthritis (PsA) and is associated with common metabolic complications and increased cardiovascular (CV) risk. Obesity is also a risk factor for the onset of these diseases. Body composition and fat distribution have been rarely evaluated in Pso and PsA.Objectives:In this study, we aimed to characterize the fat mass distribution in patients with Pso or PsA compared to a control group, with a special emphasis on the android/visceral region.Methods:case-control study (NCT02849795). Patients with Pso (plaque psoriasis) or PsA (CASPAR criteria) were evaluated. Each patient was paired to a control subject, recruited in the same outpatient population, and matched for sex, age and body mass index (BMI) category. Clinical assessment included BMI, anthropometric measurements (waist circumference, waist /hip ratio), disease activity (PASI for Pso, CPDAI for PsA) and the SCORE CV risk score. Laboratory parameters of inflammation (ESR, CRP, IL-6), lipid parameters (total cholesterol, LDL and HDL cholesterol, triglycerides), metabolic parameters (glycemia, insulin, HOMA), serum adipokines (total and high molecular weight [HMW] adiponectin, leptin, resistin and retinol binding protein 4 [RBP4]) were measured. Body composition (lean mass, fat mass) and fat distribution (android/gynoid regions and visceral fat) were evaluated (DEXA, Lunar GE, CoreScan). Our primary criteria was the fat mass in the android/visceral region. Comparisons between patients and controls were performed with paired t tests, between all groups with ANCOVA (adjusted for age, sex, and BMI category) and Tukey post-hoc tests. Pearson correlations between CV risk and fat mass were calculated within groups.Results:52 patients with Pso and 52 patients with PsA and their respective paired-control were evaluated. Total fat mass was increased in Pso but not in PsA. Android fat and visceral fat were found higher in Pso (pConclusion:visceral fat is increased in patients with Pso but not in PsA. In parallel, both groups showed an elevation of circulating RBP4. Patients with Pso and PsA were also characterized by metabolic disturbances as showed by the increase in HOMA, and specific adipokine changes. In the Pso group, visceral fat is associated with CV risk evaluated by SCORE. Weight control and reduction of fat mass, especially visceral fat mass, may thus be an important concern in patients with Pso and appears less relevant in PsA.Disclosure of Interests:None declared

Etat de la question Plusieurs etudes ont montre que les survivants d’un cancer du poumon sont a haut risque de developper un second cancer broncho-pulmonaire (SCBP). L’evaluation du risque de SPBC au cours du temps a d’importante repercussion sur la strategie de surveillance post-chirurgicale des cancers du poumon non a petites cellules (CPNPC). L’objectif principal de cette etude etait de mesurer le risque de SCP sur le long terme en tenant compte du risque competitif de deces. Materiel et methodes Le risque cumule de SCBP a ete estime a l’aide de l’incidence cumulee chez des patients operes en resection complete d’un CPNPC de stade I a III diagnostiques entre 2002 et 2015 et recenses par le registre des tumeurs du Doubs et du Territoire de Belfort. Un modele de sous-distribution des risques proportionnels (sdRH, Fine & Gray) a ete utilise pour determiner les facteurs associes au risque de SCP en presence de risques competitifs. Resultats Parmi les 522 patients, 52,3 % presentaient des adenocarcinomes et 75,7 % des stades I ou II. En tout, 84 patients ont developpe un SCBP (16,1 %). Le risque cumule de SCP etait de 20,2 % 10 ans apres la chirurgie (95 %IC : [15,3–23,2]), et 25,2 % [19,4–31,3] a 14 ans. En multivarie, le taux de SCBP etait significativement plus eleve chez les patients ayant recu de la radiotherapie thoracique adjuvante (sdRH 2,79 ; p = 0,003). Conclusion Cette etude a montre qu’apres resection complete d’un CPNPC, l’incidence cumulee de SCBP etait elevee. Les patients recevant de la radiotherapie thoracique adjuvante presentaient le risque le plus important de SCBP. Cela confirme la necessite d’un suivi a long terme de ces patients dans l’objectif d’une detection precoce d’un SCBP.

Background A better knowledge of the connections between platelet concentrate (PC) characteristics and transfusion outcomes in day-to-day practice would help improve the selection process of the most appropriate PC. Study design and methods In this study of prophylactic platelet transfusions in patients with hematologic malignancies between 2002 and 2012, outcome criteria were corrected count increments (CCIs) and platelet transfusion intervals (TIs, in days). Studied characteristics were ABO matching status, platelet source, dose, storage duration, irradiation, washing, and transfusion sequence number (TSN). The analysis consisted of multivariable linear mixed-effects models with adjustments for patient diagnosis, sex, and type of treatment. Results Overall, 869 patients and 6662 platelet transfusions were analyzed. For each day after the second day of storage, the CCI and TI decreased by 0.88 and 0.06 day, respectively. Compared to ABO-identical, transfusion with major ABO-incompatible PCs decreased the CCI and TI by 0.79 and 0.21 day, respectively. Platelet washing reduced the CCI and TI by 2.28 and 0.24 day, respectively. There was no significant association between platelet source or irradiation and CCI or TI. TI increased as the platelet dose per kg increased. Both CCI and TI decreased as the TSN increased. Conclusion Transfusion outcomes were significantly related to several PC-related factors. Associations for ABO matching status and storage duration were stronger than previously reported. Taking into account such factors when selecting a PC for transfusion could be beneficial to the recipient.

Introduction : En France, l’augmentation de la demande faite a la psychiatrie s’ajoute aux difficultes de renouvellement des generations de psychiatres, menacant l’accessibilite aux soins, en particulier dans les secteurs ruraux et semi-ruraux. Cette etude avait pour objectif de decrire le lieu d’exercice des psychiatres formes en Franche-Comte et d’analyser les facteurs associes a leur installation dans cette region, notamment au sein des zones les plus deficitaires.Methodes : Il s’agit d’une etude epidemiologique observationnelle retrospective associee a une enquete qualitative realisee au moyen d’entretiens semi-directifs aupres d’internes en poste.Resultats : Entre 1994 et 2013, 160 internes sont entres en formation de psychiatrie en Franche-Comte. En octobre 2013, 87 exercaient en tant que psychiatres dont 57 % en Franche-Comte. La region d’exercice apparaissait significativement liee au lieu de naissance (p = 0,03). Les 18 entretiens realises ont montre qu’au-dela des facteurs familiaux et de qualite de vie (opportunites professionnelles du conjoint, proximite familiale, vivre en ville), les possibilites de travailler en equipe, la mise en place de projets novateurs et les valeurs defendues par l’etablissement pouvaient constituer des facteurs d’attractivite pour les jeunes psychiatres.Conclusion : Si l’augmentation des effectifs annuels d’internes semble pouvoir repondre, a long terme, aux problemes demographiques rencontres en Franche-Comte, des mesures urgentes, structurelles et organisationnelles paraissent necessaires. La creation de postes a temps partage, la facilitation d’installation des psychiatres au sein de maisons de sante pluridisciplinaires, les delegations de tâches et la telemedecine pourraient, entre autres, permettre une amelioration de l’offre de soins psychiatriques en Franche-Comte.

Sickle cell disease (SCD) is a chronic inflammatory disease associated with multiple organ damage, chronic anemia, and infections. SCD patients have a high rate of alloimmunization against red blood cells (RBCs) following transfusion and may develop autoimmune diseases. Studies in mouse models have suggested that regulatory T cells (Treg) play a role in alloimmunization against RBC antigens. We characterized the phenotype and function of the Treg cell population in a homogeneous cohort of transfused SCD patients. We found that the distribution of Treg subpopulations differed significantly between SCD patients and healthy blood donors. SCD patients have a particular Treg phenotype, with strong CTLA-4 and CD39 expression and weak HLA-DR and CCR7 expression. Finally, we show that this particular phenotype is related to SCD rather than alloimmunization status. Indeed, we observed no difference in Treg phenotype or function in vitro using autologous feeder cells between strong and weak responders to alloimmunization.

International audience; IntroductionLa transfusion de concentrés de globules rouges (CGR) est le traitement symptomatique de l’anémie et contribue à l’oxygénation des tissus au cours de pathologies sévères. Nous menons une recherche sur l’effet des caractéristiques des CGRs sur la survie des patients dans les CHU de Besançon et Dijon : l’étude STeF-BFC. Nous étudions l’effet de la durée de conservation (DC) et du sexe du donneur (SD) des CGR sur la survie à un an de patients de chirurgie cardiovasculaire. Dans ce type d’étude, le nombre de CGR reçus est un facteur de confusion majeur. Il s’agit d’un biais d’indication mais aussi un biais de survivant (il faut avoir survécu jusqu’à la transfusion pour en bénéficier).MéthodesNous proposons de contrôler ce facteur dans l’analyse de survie à l’aide d’une régression à risque proportionnel de Cox avec stratification dépendante du temps. Dans notre étude, les modèles étaient ajustés sur les caractéristiques de base des patients (âge, sexe, type de chirurgie cardiaque, la co-transfusion de plasma et de plaquettes). Le nombre exact de CGR transfusés, la DC (en jours), et le SD étaient des variables dépendantes du temps mises à jour toutes les 24 heures. La DC était estimée par la durée maximale cumulative des CGR transfusés au cours de l’hospitalisation. De même, le sexe du donneur (en trois catégories : CGR de donneurs du même sexe, CGR de donneurs du sexe opposé ou les deux) était évalué chaque jour sur la base des transfusions passées. Enfin, les modèles étaient stratifiés sur le nombre de CGR. Les patients étaient donc à risque de décès dans la première strate avec la première transfusion et passaient d’une strate à la suivante avec chaque jour de transfusion.RésultatsParmi les 2715 patients analysés, 85,1 % étaient en vie 12 mois après transfusion. L’analyse univariée, montrait une diminution de la survie avec l’augmentation de la DC (p < 0,001) et lors de transfusions de CGR de donneurs de sexe opposé SD (p < 0,0001). La modélisation avec stratification dépendante du temps ne retrouvait pas d’association significative de la DC (risque relatif RR [IC95 %] pour 15–20 j = 0,94 [0,67–1,31] ; 21–28 j = 0,99 [0,72–1,38] ; > 28 j = 0,97 [0,69–1,35] ; classe de référence < 15 jours) ou du SD (RR les deux sexes = 0,89 [0,61–1,31], sexe opposé = 1,22 [0,81–1,82] ; classe de référence même sexe) au risque de décès. En l’absence de stratification, on retrouvait un effet dose de la DC issu en réalité d’une interaction entre le nombre de CGR et la DC, avec un effet significatif seulement chez les patients massivement transfusés (20 CGR et plus).ConclusionCette approche permet de tenir compte des biais d’indication et de survivant lié au nombre de CGR dans l’étude de l’effet des caractéristiques des CGR sur la morbidité et mortalité de patients transfusés. Contrairement à d’autres études, nous n’avons pas mis en évidence d’effet de la DC ou du SD. La stratification, en fournissant un effet moyen de la DC entre les strates, a permis de contrôler un facteur de confusion lié à la transfusion d’un grand nombre de CGR. Cette méthode semble applicable à d’autres situations cliniques impliquant des interventions répétées où le nombre de traitements est un facteur de confusion important : par exemple le nombre de cures de chimiothérapies dans le cancer.

Introduction Les determinants des variations infra-regionales d’incidence de l’IRCT traitee par dialyse ou greffe sont discutes. Nous avons analyse a l’echelle cantonale la correlation spatiale entre taux standardises d’incidence de l’IRCT et differents indicateurs contextuels de morbi-mortalite, d’environnement socio-economique, d’offre de soins et de pratiques nephrologiques. Methodes L’analyse a concerne 6835 nouveaux patients atteints d’IRCT, domicilies dans les regions Grand Est et Bourgogne-Franche-Comte, enregistres par le registre REIN entre 2010 et 2014. Des taux et ratios standardises d’incidence (RSI) ont ete calcules et cartographies a l’echelle cantonale, leur heterogeneite et l’autocorrelation spatiale ont ete testees. Un modele de Poisson Bayesien hierarchique a effet aleatoire a ete utilise pour produire un lissage des RSI et calculer les risques relatifs (RR) associes a une variation d’un ecart type des variables contextuelles disponibles a l’echelle cantonale ou departementale. Resultat Les taux standardises d’incidence cantonaux variaient de 21 a 499 par million d’habitants ; les RSI lisses de 0,56 a 1,78. En analyse multivariee, les taux standardises d’incidence par canton variaient significativement avec la prevalence cantonale de l’ALD diabete (RR [IC95 %] 1,08 [1,04–1,12], le niveau socioeconomique du canton mesure par le score FDEP (RR [IC95 %] 0,96 [0,92–0,99], le temps de trajet moyen des habitants du canton au centre lourd de dialyse le plus proche RR [IC95 %] 0,92 [0,89–0,95]) et les pratiques nephrologiques observees pour les patients dialyses du departement : debit median de filtration glomerulaire (DFG) a la mise en dialyse (RR [IC95 %] 1,12 [1,05–1,21]) et proportion de patients âges de 85 ans et plus parmi les dialyses (RR [IC95 %] 1,08 [1,02–1,14]). Conclusion Ces resultats montrent pour la premiere fois l’impact de la distance au centre de dialyse et un lien avec le score FDEP. L’etude confirme l’association avec la morbidite par diabete et l’effet des variations spatiales de pratiques nephrologiques (DFG et proportion de patients âges parmi les dialyses) retrouves dans d’autres travaux. Ainsi l’accessibilite geographique aux centres de dialyse et les pratiques nephrologiques contribuent aux disparites d’incidence de l’IRCT traitee observees entre territoires.

HLA-matched bone marrow transplantation (BMT) is a cure for nonmalignant hematological disorders; however, rejection rates are high and correlate with the number of antecedent transfusions. Recently, using murine models, we reported that minor antigens (mHAs) in transfused leukoreduced red blood cell (RBC) or platelet units induce rejection of subsequent BMT. To study RBCs as an immunogen, we utilized transgenic donors that express a model mHA selectively on RBCs (HOD mouse). Transfusion of HOD blood did not induce BMT rejection of marrow that shared mHAs with the HOD RBCs. Similarly, no endogenous anti-HOD CD8(+) T-cell response was detected with antigen-specific tetramer reagents. Adoptively transferred OT-I T cells rapidly expanded after HOD blood transfusion; however, only a semi-effector phenotype was observed (tumor necrosis factor-α and interferon-γ secretion, but essentially no Granzyme B). After initial expansion, OT-I T cells contracted rapidly to very low levels. A similar trend was observed by in vivo CTL assay, with only transient lytic activity. Together, these data indicate that RBCs may not be the component of RBC units that induces BMT rejection, and suggest that contaminating platelets or leukocytes may be responsible.

When successful, human leukocyte antigen (HLA)–matched bone marrow transplantation with reduced-intensity conditioning is a cure for several nonmalignant hematologic disorders that require chronic transfusion, such as sickle cell disease and aplastic anemia. However, there are unusually high bone marrow transplant (BMT) rejection rates in these patients. Rejection correlates with the number of transfusions before bone marrow transplantation, and it has been hypothesized that preimmunization to antigens on transfused blood may prime BMT rejection. Using a novel mouse model of red blood cell (RBC) transfusion and major histocompatibility complex–matched bone marrow transplantation, we report that transfusion of RBC products induced BMT rejection across minor histocompatibility antigen (mHA) barriers. It has been proposed that contaminating leukocytes are responsible for transfusion-induced BMT rejection; however, filter leukoreduction did not prevent rejection in the current studies. Moreover, we generated a novel transgenic mouse with RBC-specific expression of a model mHA and demonstrated that transfusion of RBCs induced a CD8+ T-cell response. Together, these data suggest that mHAs on RBCs themselves are capable of inducing BMT rejection. Cellular immunization to mHAs is neither monitored nor managed by current transfusion medicine practice; however, the current data suggest that mHAs on RBCs may represent an unappreciated and significant consequence of RBC transfusion.

Blood products use has increased in France between 2000 and 2011. To understand the reasons for this increase, data about transfused patients and transfusion practices needed to be updated.A nationwide cross-sectional survey was performed with health care establishments. Diagnoses and indication for the transfusion, pretransfusion laboratory results, and blood products used were collected during a randomly selected 24-hour period in 2011. All patients who received at least one blood product delivered on the survey day were included.A total of 10,794 blood products were requested for 4720 patients: 8688 red blood cell (RBC) units, 842 platelet (PLT) concentrates, and 1264 fresh-frozen plasma (FFP) units. Hematologic and cancer pathologies included 46% of transfused patients, 34% of the patients had transfusions in a surgical context, and 32.4% of transfused patients were receiving medication with an impact on transfusion. Nearly half of RBC transfusions were performed with hemoglobin levels of less than 8 g/dL. PLT transfusions for prophylactic indication were prescribed with PLT counts of less than 20 × 10Except for insufficient FFP dosing per patient and limitations on assessment of indications for prescribing, transfusion practices were in agreement with national guidelines.

A number of studies have demonstrated that non-neuronal acetylcholine can play a role in the regulation of T cell function. Recently, we reported that CD8(+) T cells, from mice with a targeted deletion of the M(1) muscarinic receptor, had a defect in differentiating into cytolytic T lymphocytes when stimulated in vitro. In the current report, we analyze the in vivo function of CD8(+) T cells from mice with targeted deletions of either M(1) or M(5) muscarinic receptors. M(1) or M(5) knockout mice were infected with either lymphocytic choriomeningitis virus or vesicular stomatitis virus. Expansion of anti-viral CD8(+) T cells was monitored by staining with tetramer reagents specific for the immunodominant peptides of the viruses. No defect in expansion of CD8(+) T cells was observed in either M(1) or M(5) knockout mice. The extent to which one can draw a generalized conclusion that M(1) and M(5) are not involved in anti-viral immunity depends upon issues of antigen strength, genetic background, induction of redundant receptors, and the potential for qualitative defects in the expanded CD8(+) T cells.

Purpose To compare graft survival between 3 10-year periods and according to surgical techniques performed in the last years. Design Cohort study. Methods setting: Regional center (Besancon University Hospital, France). patients: All 1132 patients operated on between 1983 and 2014. Graft and patient baseline characteristics, risk factors for failure, surgical procedures, and postoperative corneal status were collected. main outcome measures: Five-year survival rate in the whole cohort; 1-year and 3-year survival rates, respectively, among 88 patients with endothelial dystrophy (ED) or postoperative bullous keratopathy (PBK) operated on using endothelial lamellar keratoplasty (ELK) or penetrating keratoplasty (PK), and among 56 patients with keratoconus operated on using anterior lamellar keratoplasty (ALK) or PK. Results Between the 1983–1993 and the 2004–2014 periods, overall 5-year graft survival rate increased from 61.4% to 76.5% ( P = .0004). The main prognostic factors were preoperative diagnosis, graft endothelial density, and postoperative lens status. After adjusting for these factors, difference in survival rates was no longer significant (hazard ratio 0.90 for the second and 1.17 for the third period, compared to the first, P = .4191). Only 1 graft failure, after PK, occurred among the 56 patients with keratoconus. Among the 88 patients with ED or PBK, the 1-year graft survival was higher with PK (90.6%) than with ELK (60.8%) ( P = .0025) but no significance remained after adjustment (hazard ratio 3.22, P = .1304). Conclusions Despite numerous changes in graft procedures and surgical techniques, no noticeable improvement in graft survival was found during the last 30 years while taking into account other prognostic factors.

BACKGROUND: Most alloantigens on transfused red blood cells (RBCs) are weakly immunogenic, with only a 2 to 6 percent overall immunization rate even in patients receiving multiple transfusions. Although recipient genetics may contribute to responder and/or nonresponder status, in most cases HLA type does not predict humoral response to RBC antigens. In contrast, rates of alloimmunization do correspond to the underlying disease status of transfusion recipients, suggesting that acquired host factors may play an important role. In this context, it was hypothesized that the inflammatory status of a transfusion recipient would influence immunization to transfused RBCs. STUDY DESIGN AND METHODS: A novel murine model for alloimmunization to RBC antigens was developed with the mHEL mouse, which expresses hen egg lysozyme (HEL) as a model blood group antigen. Leukoreduced mHEL RBCs were transfused into wild-type recipient mice, and anti-HEL responses were monitored. To test the stated hypothesis, some recipient animals were injected with polyinosinic polycytidylic acid (poly(I:C)), a synthetic double-stranded RNA molecule that induces viral-like inflammation. RESULTS: Similar to the immunogenicity of most RBC antigens in humans, transfusion of mHEL RBCs into uninflamed mice was only a weak immunogen. In contrast, poly(I:C)-treated mice had a significant increase in both the frequency and the magnitude of alloimmunization to the mHEL antigen. CONCLUSIONS: These findings demonstrate that recipient inflammation with poly(I:C) significantly enhances humoral immunization to transfused alloantigens in a murine model. Moreover, these data suggest that the inflammatory status of human transfusion recipients may regulate the immunogenicity of transfused RBCs.

Introduction Les caracteristiques des concentres plaquettaires (CP) peuvent affecter l’efficacite de la transfusion, mais ceci n’a jamais ete etudie dans une cohorte de patients en pratique clinique courante « vie reelle ». Materiels et methodes Dans cette etude retrospective des transfusions prophylactiques de CP chez des patients hospitalises pour hemopathie maligne entre 2002 et 2012, les criteres de jugement etaient le corrected count increment (CCI) et l’intervalle entre transfusions (IT, en jours). Les caracteristiques etudiees etaient le statut ABO, la source, la dose, la duree de stockage, l’irradiation, et le rang de la transfusion. L’analyse a consiste en un modele lineaire mixte avec ajustement sur le diagnostic patient et la phase de traitement. Resultats Au total, 869 patients et 6662 CP ont ete analyses. Le CCI et l’IT etaient diminues respectivement de 0,88 ( p p = 0.0002) pour chaque jour de stockage supplementaire apres le deuxieme jour. La transfusion ABO incompatible abaissait le CCI et l’IT respectivement de 0,79 ( p = 0,008) et 0,21 ( p = 0,006) en comparaison aux CP ABO identiques. L’IT etait plus eleve pour des doses superieures a 0,5—0,7 × 1011 par kg, (+0,49 jour pour une dose ≥ 0.9 × 1011, p p p = 0,04). Conclusion Les caracteristiques des CP impactaient moderement, mais significativement l’issue de la transfusion. L’effet retrouve etait souvent plus prononce que dans les essais controles ayant etudie cette question. L’accumulation de ces facteurs peut avoir un impact clinique et devrait donc etre evitee.

In France, the challenges of replacing departing psychiatrists with a new generation are compounded by an increased demand for psychiatric care, which threatens the accessibility of health care, particularly in rural and semi-rural areas. The objective of this study was to describe the location of psychiatrists trained in the Franche-Comté region, and to analyze the factors associated with establishing their practice in the region, particularly in the most understaffed areas.We conducted a retrospective observational study, completed by a qualitative investigation with semi-directive interviews with psychiatrists and psychiatry residents.Between 1994 and 2013, 160 students entered psychiatry residencies in Franche-Comté. As of October 2013, 87 of them were full-time psychiatry practitioners and, 57% of them worked in Franche-Comté. The region of practice was associated with their birthplace (p=0.03). The qualitative investigation showed that, apart from family- and quality of life-related factors (work opportunities for the spouse, family closeness, desire to live in urban areas), opportunities to work in a team, implementation of dynamic and innovative projects and values of the establishment were also considered when choosing a site of practice.While the current increase in the number of psychiatry residents may respond, in the long run, to health care demographic problems in Franche-Comté, more specific interventions also seem necessary. Creation of time-shared jobs, facilitating the establishment of psychiatric practices within multidisciplinary clinics, task shifting and telemedicine may allow improvement of the psychiatric care offered in Franche-Comté.

International audience; Sickle cell disease (SCD) is a chronic inflammatory disease associated with multiple organ damage, chronic anemia, and infections. SCD patients have a high rate of alloimmunization against red blood cells (RBCs) following transfusion and may develop autoimmune diseases. Studies in mouse models have suggested that regulatory T cells (Treg) play a role in alloimmunization against RBC antigens. We characterized the phenotype and function of the Treg cell population in a homogeneous cohort of transfused SCD patients. We found that the distribution of Treg subpopulations differed significantly between SCD patients and healthy blood donors. SCD patients have a particular Treg phenotype, with strong CTLA-4 and CD39 expression and weak HLA-DR and CCR7 expression. Finally, we show that this particular phenotype is related to SCD rather than alloimmunization status. Indeed, we observed no difference in Treg phenotype or function in vitro using autologous feeder cells between strong and weak responders to alloimmunization.

Introduction Les concentres de globules rouges (CGR) sont transfuses pour traiter l’anemie et contribuer a l’oxygenation des tissus au cours de pathologies severes. Certaines etudes ont montre un effet deletere d’une duree de conservation (DC) des CGR prolongee sur la mortalite postoperatoire a court terme apres chirurgie cardiaque, mais les donnees de la litterature sur ce sujet restent controversees. Les donnees de l’Etablissement francais du sang (EFS) contiennent les caracteristiques detaillees des produits transfuses. Les donnees PMSI apportent une information sur le patient et son contexte clinique lors de l’hospitalisation. Le chainage de ces donnees permet d’etudier l’effet des caracteristiques des produits transfuses sur le devenir des receveurs sur un grand nombre de patients. L’objectif de cette etude etait d’analyser l’effet de la DC des CGR transfuses sur la survie a 12 mois des patients de chirurgie cardiaque receveurs de transfusion. Methodes Les donnees nominatives de l’EFS concernant les patients adultes receveurs d’une premiere transfusion de CGR entre 2007 et 2011 aux CHU de Besancon et de Dijon ont ete chainees avec les donnees PMSI au sein de chaque DIM. Ont ete inclus, les patients hospitalises pour chirurgie cardiovasculaire, selectionnes a l’aide de la racine du GHM de l’hospitalisation (racine en 05C, maladies de l’appareil circulatoire avec prise en charge chirurgicale). Le statut vital des patients a ete obtenu aupres du RNIPP en juillet 2014. Une modelisation de Cox a ete utilisee pour evaluer l’influence de la DC des CGR (estimee par la DC en jours du CGR transfuse le plus ancien) sur la survie 12 mois apres transfusion des patients avec ajustement sur l’âge, le sexe, le nombre de CGR transfuses, et le type de chirurgie (determine par la racine de GHM). La proportionnalite des risques au cours du temps a ete testee. Resultats Parmi les 2715 patients analyses, 85,1 % etaient en vie 12 mois apres la transfusion. L’analyse univariee, montrait une diminution de la survie avec l’augmentation de la DC (p 5 CGR = 4,94 [3,83–6,38] ; classe de reference 28 j = 1,05 [0,77–1,44] (classe de reference Conclusion Nous proposons ici une methode innovante pour etudier l’influence des caracteristiques des CGR a l’aide des donnees EFS et PMSI. Il s’agit de la premiere etude francaise de survie apres transfusion utilisant les donnees du PMSI. Elle illustre l’interet du chainage inter-etablissement des grandes bases de donnees. Cette etude ne confirme pas l’effet de la DC des CGR sur la survie apres chirurgie cardiaque. Elle retrouve cependant un effet pronostic du nombre de CGR transfuses vraisemblablement lie a un biais d’indication.

Roles des auteurs L. Bardiaux a mis en place la collecte des donnees. L. Bardiaux, A. Seigeot et E. Monnet ont concu l’etude. A. Seigeot, A. Rumpler et F. Leroux ont verifie les donnees et ont realise le data management. A. Seigeot, E. Monnet, M. Desmarets, et L. Bardiaux ont analyse les donnees et redige le manuscrit. Tous les auteurs ont lu et approuve le manuscrit. Etat de la question Les caracteristiques des concentres plaquettaires (CP) peuvent influencer sur les resultats de la transfusion, mais cela n’a jamais ete etudie a partir de cohorte de patients representatifs de la « vrai vie ». Materiel et methodes Dans cette etude retrospective concernant des transfusions de CP prophylactiques chez des patients atteints d’hemopathies malignes entre 2002 et 2012, les reponses a la transfusion ont ete mesurees par le « Corrected Count Increment » (CCI) et les intervalles entre transfusion de plaquettes ((IT), en jours). Les caracteristiques etudiees etaient la compatibilite ABO, le type de plaquettes, la dose, la duree de stockage, l’irradiation, la deplasmatisation, et le rang de la transfusion. Un modele lineaire mixte a ete realise avec des ajustements sur le diagnostic et le traitement du patient. Resultats Au total, 869 patients et 6662 CP ont ete analyses. Le CCI et IT diminuaient respectivement de 0,88 et 0,06 par jour, apres le deuxieme jour de stockage. Les transfusions de CP ABO incompatibles diminuaient le CCI et le IT respectivement de 0,79 et 0,21, par rapport aux CP ABO identiques. L’IT etait plus eleve pour les doses plus elevees que la dose recommandee (0,5 a 0,7 × 1011 par 10 kg). La deplasmatisation reduisait le CCI et l’IT respectivement de 2,28 et 0,24. Conclusion En conclusion, les facteurs lies aux CP affectaient moderement mais significativement le CCI et l’IT. Chez ces patients, la delivrance de CP avec plusieurs facteurs de mauvaise efficacite transfusionnelle devrait etre evitee.

PURPOSE: This longitudinal study aimed at comparing heart rate variability (HRV) in elite athletes identified either in 'fatigue' or in 'no-fatigue' state in 'real life' conditions. METHODS: 57 elite Nordic-skiers were surveyed over 4 years. R-R intervals were recorded supine (SU) and standing (ST). A fatigue state was quoted with a validated questionnaire. A multilevel linear regression model was used to analyze relationships between heart rate (HR) and HRV descriptors [total spectral power (TP), power in low (LF) and high frequency (HF) ranges expressed in ms(2) and normalized units (nu)] and the status without and with fatigue. The variables not distributed normally were transformed by taking their common logarithm (log10). RESULTS: 172 trials were identified as in a 'fatigue' and 891 as in 'no-fatigue' state. All supine HR and HRV parameters (Beta+/-SE) were significantly different (P

Laboratoire d’accueil : centre d’investigation clinique, CHRU de Besancon, Inserm CIC1431, 2, place Saint-Jacques, 25030 Besancon. Responsable : Pr Elisabeth Monnet ( elisabeth.monnet@univ-fcomte.fr ). Etat de la question La duree de conservation (DC) des concentres de globules rouges (CGR) peut avoir un effet negatif sur la survie des patients de chirurgie cardiovasculaire (CCV) transfuses. Une etude suggere aussi un effet nefaste des CGR de femmes sur la survie des receveurs masculins (sans ajustement sur la pathologie). Nous avons fait l’hypothese d’un effet sexe du donneur (SD) maximal dans le contexte inflammatoire suivant une CCV. L’etude portait sur les effets de la DC et du SD sur la survie de patients de CCV. Materiel et methodes A l’aide des donnees de l’etablissement francais du sang et de deux CHU francais, nous avons mene une etude de cohorte retrospective sur les receveurs d’une premiere transfusion de CGR, ayant beneficie d’une CCV, entre 2007 et 2011. Les risques relatifs (RR) de deces a un an en relation avec la DC et le SD ont ete estimes par modelisation de Cox, avec ajustement sur plusieurs facteurs de confusion (dont le nombre de transfusions et le type de chirurgie). Resultats Parmi les 2715 patients analyses, 85,1 % etaient en vie a un an. L’analyse univariee montrait une diminution de la survie avec l’augmentation de la DC ( p p Conclusion Dans cette premiere etude francaise de survie apres transfusion, les donnees n’ont pas montre d’effet de la DC ou du SD sur la survie. Contrairement aux resultats de travaux precedents, les CGR de femmes semblent sans danger pour les receveurs masculins. Cette etude confirme que les pratiques francaises actuelles sont sures pour les patients transfuses.

L’influence de la duree de conservation des CGR sur la mortalite apres transfusion reste controversee. La survie des receveurs masculins pourrait etre alteree apres transfusion de CGR de donneuses. L’etude visait a estimer la survie des receveurs d’une premiere transfusion et a analyser l’effet pronostique de la conservation et du sexe du donneur sur la survie, en particulier apres chirurgie cardiovasculaire (CCV). Les donnees EFS et hospitalieres des patients adultes receveurs d’une premiere transfusion de CGR entre 2007 et 2011 aux CHU de Besancon et Dijon ont ete compilees. Le statut vital provenait du registre des personnes physiques. La survie apres transfusion a ete estimee pour l’ensemble des receveurs. L’influence de la conservation du plus ancien CGR et du sexe du donneur sur la survie a un an apres CCV ont ete analyses par modele de Cox avec ajustement sur l’âge, le sexe du receveur, le nombre de CGR, et le type de CCV code dans le systeme d’information hospitalier (SIH). Parmi les 12 700 patients analyses, 72,2 % d’entre eux etaient en vie a un an, alors que 85,1 % des 2716 patients ayant subi une CCV etaient en vie a un an. Dans ces resultats preliminaires, la duree de conservation des CGR et une discordance du sexe donneur/receveur semblaient avoir un effet negatif sur la survie apres CCV en analyse univariee ( p Il s’agit de la premiere etude francaise de survie apres transfusion. Nous proposons une methode innovante pour etudier l’influence des caracteristiques des CGR a l’aide de donnees du SIH. Une limite de la methode est qu’elle requiert un croisement nominatif au sein des hopitaux.