Familial amyloid polyneuropathy: elaboration of a therapeutic patient education programme, "EdAmyl".

BACKGROUND: Transthyretin-related amyloidosis (ATTR) is an autosomal dominant disease affecting the peripheral and autonomic nervous system, heart, eyes and kidneys. It is the most disabling hereditary polyneuropathy in adults. The French National Reference centre for this disease was accredited in 2005 with 10 lines of action. One of them is to inform and educate patients about their disease to improve their care and reduce morbidities. We thus decided to elaborate a therapeutic patient education (TPE) programme, starting with patients' needs assessment. METHODS: A qualitative research study was conducted with one-to-one semi-structured interviews of selected individuals. Recorded interviews were analysed to identify the skills that patients need to acquire. A TPE programme was elaborated on the basis of these findings. RESULTS: Seven patients, one asymptomatic carrier and two healthy spouses were interviewed. Analysis of the interviews showed that interviewees had a good knowledge of the disease and its symptoms but they had difficulties explaining the disease mechanism and did not have an adequate knowledge of the available treatment options, although they knew that liver transplant might halt progression of the disease. ATTR amyloidosis appeared to have a major negative impact on the patient's physical and mental well-being. Patients feared loss of autonomy and having to require assistance from their relatives and spouses. All interviewees were keen to participate in a TPE programme. Based on this needs assessment, we identified seven skills that patients need to acquire and several pedagogical goals to be achieved during the education programme. An interdisciplinary team then elaborated a complete TPE programme. CONCLUSION: Elaboration of a TPE programme for ATTR amyloidosis required to obtain useful information from the patients themselves, and their relatives, concerning their perception of their disease. This needs' assessment constituted the basis for designing the first TPE programme, to our knowledge, for ATTR amyloidosis. After translation, this programme could be applied in other EU countries and worldwide for this rare disease.

Determination of polybrominated diphenyl ethers in fish tissues by matrix solid-phase dispersion and gas chromatography coupled to triple quadrupole mass spectrometry: case study on European eel (Anguilla anguilla) from Mediterranean coastal lagoons.

This paper describes the development and validation of an analytical methodology to determine 28 polybrominated diphenyl ethers (PBDEs) in European eel (Anguilla anguilla) tissues using matrix solid-phase dispersion (MSPD) and gas chromatography coupled to triple quadrupole mass spectrometry (GC-QQQ-MS/MS). A total of 28 PBDEs were targeted, including tri- to deca-brominated congeners. The robustness and effectiveness of the proposed sample preparation procedure was demonstrated in lipid-rich eel tissues. The use of batch MSPD with activated silica gel and H(2)SO(4)-impregnated silica gel, followed by H(2)SO(4) digestion and multilayer cartridge clean-up allowed for complete lipid removal and eliminated matrix effects during GC-QQQ-MS/MS analysis. The average PBDE recoveries from eel muscle samples spiked with PBDEs at two levels were in the range 56.2-119.0%. Precision was satisfactory since relative standard deviations were lower than 19.6%, regardless of spike level, and method quantification limits ranged between 1 and 170 pg g(-1) (wet weight). The method demonstrated its successful application for the analysis of eel samples from two coastal lagoons located on the western French Mediterranean coast. All samples tested positive, but for tri- to hexa-brominated congeners only and total PBDE levels observed in this study were in the range 0.08-1.80 ng g(-1) wet weight.

Development of analytical procedures for trace-level determination of polybrominated diphenyl ethers and tetrabromobisphenol A in river water and sediment.

The aim of this work was to develop procedures for the simultaneous determination of selected brominated flame retardants (BFRs) in river water and in river bed sediment. The target analytes were polybrominated diphenyl ethers (PBDEs) and tetrabromobisphenol A (TBBPA). To determine dissolved BFRs, a novel mixed-mode solid-phase extraction procedure was developed by combining a hydrophobic sorbent (C(18)) with a silica-based anion exchange sorbent, so as to overcome the negative artefact induced by dissolved organic carbon. Extraction recoveries exceeded 73% for most analytes, except for BDE-183 and BDE-209 (57%). As regards suspended sediment and river bed sediment, extraction was carried out by means of ultrasonication (recoveries: 73-94%). These procedures, combined to gas chromatography coupled to negative chemical ionisation mass spectrometry (GC-NCI-MS), enabled the determination of BFRs at trace level: 3-160 pg L(-1) in river water, 5-145 pg g(-1) in bed sediment. These methods were applied to the determination of PBDEs and TBBPA in a suburban river (near Paris, France). PBDEs were systematically detected in the water column (SigmaBDEs, 2,300-4,300 pg L(-1)); they partitioned between the dissolved and particulate phases and BDE-209 was the dominant congener, followed by BDE-99 and BDE-47. TBBPA was detected in the dissolved phase only (<35-68 pg L(-1)). All selected BFRs were ubiquitous in bed sediments and levels ranged from 3,100 to 15,100 pg g(-1) and from 70 to 280 pg g(-1) (dry weight), for SigmaBDEs and TBBPA, respectively.