Peripheral blood stem cells collection on spectra optia apheresis system using the continuous mononuclear cell collection protocol: A single center report of 39 procedures.

BACKGROUND: The aim of the study was to assess the performance of the new Continuous Mononuclear Cell Collection (CMNC) protocol on the Spectra Optia Apheresis System for collecting autologous Peripheral Blood Stem Cells (PBSC) in adult patients with respect to collection variables, CD34+ cells harvest prediction and engraftment data. In this retrospective study, 39 CMNC procedures on 23 mobilized patients with multiple myeloma and lymphoma were analyzed. CD34+ cells and blood cells yields, collection efficiencies (CE1 and CE2), cell losses were calculated. Engraftment data of 17 autologous transplantations were collected. RESULTS: Apheresis duration was 239 min for a product volume of 220 mL. Cell product haematocrit, MNC and platelets counts were acceptable (respectively 2.4%, 65%, 834 x 109/L). Median platelet loss was 27.3%. Median CD34+ CE1 and CE2 were 64.6% and 48.5% respectively. We harvested 2.92 × 106 CD34+ cells/kg, with a CD34 dose ≥ 2 × 106 /kg for 67% of the procedures. Linear correlation between preapheresis CD34 count and the CP CD34 dose/kg allowed a prediction model with a decrease trend for high WBC precount. Procedures were well tolerated. For 17 autologous transplantations, median time to neutrophils and platelets reconstitutions were 12 and 13 days respectively. CONCLUSIONS: Spectra Optia CMNC protocol successfully collected CD34+ cells with yields permitting the harvest of sufficient enriched grafts for autologous transplantation. The CD34+ cell yield prediction was excellent. PBSC collection with CMNC protocol had advantages of high processing rate, low product volume, and acceptable contamination by platelets. J. Clin. Apheresis 32:182-190, 2017. © 2016 Wiley Periodicals, Inc.

[Prevention of infections in adults and adolescents with systemic lupus erythematosus: Guidelines for the clinical practice based on the literature and expert opinion]. / Prévention des infections au cours du lupus systémique chez l'adulte et l'adolescent : élaboration de recommandations pour la pratique clinique, à partir d'une analyse de la littérature et de l'avis d'experts.

PURPOSE: To develop French recommendations about the management of vaccinations, the screening of cervical cancer and the prevention of pneumocystis pneumonia in systemic lupus erythematosus (SLE). METHODS: Thirty-seven experts qualified in internal medicine, rheumatology, dermatology, nephrology and pediatrics have selected recommendations from a list of proposition based on available data from the literature. For each recommendation, the level of evidence and the level of agreement among the experts were specified. RESULTS: Inactivated vaccines do not cause significant harm in SLE patients. Experts recommend that lupus patient should receive vaccinations accordingly to the recommendations and the schedules for the general public. Pneumococcal vaccination is recommended for all SLE patients. Influenza vaccination is recommended for immunosuppressed SLE patients. Live attenuated vaccines should be avoided in immunosuppressed patients. Yet, recent works suggest that they can be considered in mildly immunosuppressed patients. Experts have recommended a cervical cytology every year for immunosuppressed patients. No consensus was obtained for the prevention of pneumocystis pneumonia. CONCLUSION: These recommendations can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of SLE patients.

Epidemiological and evolutionary characteristics of heart failure in patients with left bundle branch block - A Moroccan center-based study.

BACKGROUND: In patients with heart failure, left bundle branch block (LBBB) seems to be associated with an increased risk of cardiovascular mortality. PURPOSE: The purpose of this study is to determine the in-hospital outcome of congestive heart failure patients with LBBB versus those without. METHODS: We conducted a prospective observational study at the Department of Intensive Care and Rhythmology at the Mohammed V Military Hospital of Rabat, where 330 patients were admitted for heart failure between January 2008 and September 2012. Screening out patients with missing data yielded a cohort of 274 patients. Among the 274 patients, only 110 had LBBB and a left ventricular ejection fraction lower than 50%. We randomly selected a subset of 110 patients diagnosed as non-LBBB to ensure a significant statistical comparison between LBBB and non-LBBB patients. We therefore considered two groups in our analysis: 110 heart failure (HF) patients with LBBB and 110 HF patients without LBBB. Patients with incomplete records were excluded. RESULTS: Male gender was dominant in both groups (82.7% vs. 66.7%, p = 0.005). Patients with LBBB had a higher prevalence of idiopathic dilated cardiomyopathy (39.1% vs. 4.8%, p < 0.001); and a higher prevalence of previous hospitalization for heart failure (64.5% vs. 23.3%, p < 0.001). The left ventricular ejection fraction was significantly lower in the group with LBBB (25.49% vs. 39.53%, p < 0.001). Age, cardiovascular risk factors, rhythmic and thromboembolic complications did not significantly differ. In patients with LBBB, 61.8% received cardiac resynchronization therapy performed both during the index hospital stay (50.9%) and previously (10.9%). Hospital outcome was marked by 20 in-hospital deaths in the group with LBBB and eight deaths in the group without LBBB (p = 0.008). CONCLUSION: Our analysis emphasizes increased in-hospital mortality and higher disease severity, over a short period of stay, in heart failure patients with left bundle branch block.

[Screening and management of cardiovascular risk factors in systemic lupus erythematosus: Recommendations for clinical practice based on the literature and expert opinion]. / Dépistage et prise en charge du risque cardiovasculaire au cours du lupus systémique : élaboration de recommandations pour la pratique clinique, à partir d'une analyse de la littérature et de l'avis d'experts.

PURPOSE: To develop French recommendations about screening and management of cardiovascular risk factors in systemic lupus erythematosus (SLE). METHODS: Thirty-nine experts qualified in internal medicine, rheumatology and nephrology have selected recommendations from a list developed based on evidence from the literature. For each recommendation, the level of evidence and the level of agreement among the experts were specified. RESULTS: Experts recommended an annual screening of cardiovascular risk factors in SLE. Statins should be prescribed for primary prevention in SLE patients based on the level of LDL-cholesterol and the number of cardiovascular risk factors, considering SLE as an additional risk factor. For secondary prevention, experts have agreed on an LDL-cholesterol target of <0.7 g/L. Hypertension should be managed according to the 2013 European guidelines, using renin-angiotensin system blockers as first line agents in case of renal involvement. Aspirin can be prescribed in patients with high cardiovascular risk or with antiphospholipid antibodies. CONCLUSION: These recommendations about the screening and management of cardiovascular risk factors in SLE can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of SLE patients.

[Hemoptysis revealing pulmonary artery aneurysm associated with intracardiac thrombosis: a delicate anticoagulation situation (a case report of Behçet's disease)]. / Hémoptysie révélant un anévrisme de l'artère pulmonaire associé à une thrombose intracardiaque: une situation délicate d'anticoagulation (à propos d'un cas de maladie de Behçet).

Behçet's disease is a vasculitis affecting both arteries and veins. Cardiac involvement is less well known. The association of an aneurysm of the pulmonary artery and intracardiac thrombosis is rare, and a therapeutic challenge. We report the case of a 26-year-old patient hospitalized for moderately abundant hemoptysis and New York Heart Association (NYHA) class III dyspnea, which illustrates the difficulty encountered when using anticoagulants in this complex situation.

[Drug-eluting stents: do we respect the on-label use in our daily practice?]. / Endoprothèses coronaires actives: respectons-nous les recommandations de la Société française de cardiologie et de la Haute Autorité de santé dans notre pratique quotidienne ?

Drug-eluting stents (DES) are known to dramatically reduce restenosis. However, they are more expansive than bare-metal stents (BMS) and they require prolonged dual antiplatelet therapy. In France, the French Society of Cardiology and the "Haute Autorité de santé" have defined recommendations for the use of DES (restricted to patients in high-risk group). The aim of this work was to evaluate our practice (whether these recommendations were well respected or not in our center). Between November 2007 and January 2008 then November 2008 and January 2009 we evaluated all Percutaneous Coronary Interventions (PCI). Two hundred and sixteen (216) patients (mean age 65 ± 13 years, 164 (76 %) were males and, 41 (19 %) were diabetics) had a PCI for stable angina or silent ischemia (47 %), unstable angina or acute coronary syndrome (ACS) ST- (26 %), ACS ST+<48 hours (24 %) or ACS ST+>48 hours-1 month (3 %). Two hundred and seventy six (276) stents were used, including 35 % of DES. The recommendations were well respected in 82 % of cases. However, 27 % of BMS were implanted in patients in whom DES were indicated. The French recommendations for DES are a reference to help practitioners, but they require to be adapted to each patient, depending on clinical state and their ability to be treated with prolonged dual antiplatelet therapy.

Compatibility of interspecific Manihot crosses presaged by protein electrophoresis .

Cross incompatibility of wild Manihot species with cassava (M. esculenta) can impede their utilization for improving this cultigen. We tested whether compatibility could be determined based on electrophoresis results. Manihot pilosa, M. glaziovii, M. reptans, and M. cearulescens were tested. These species were allowed to hybridize with cassava to determine whether hybridization coincides with the similarity index based on electrophoresis analysis. Gene markers of leaf shape, stem surface, disk color, and fruit shape were used to confirm hybridization. Manihot pilosa and M. glaziovii successfully hybridized with cassava, while the others failed to do so under natural conditions. This result coincided with the similarity index from electrophoresis.

[Clinical and economical evaluation of bivalirudin during percutaneous coronary interventions]. / Evaluations clinique et économique de la bivalirudine au cours des procédures d'angioplasties coronaires.

Bivalirudin, with provisional GP IIb/IIIa inhibitor use allows the same protection against ischemic complications while reducing the hemorrhagic complications compared with the systematic association of a GP IIb/IIIa inhibitor plus heparin (The Randomized Evaluation in PCI Linking Angiomax to Reduced Clinical Events-2 [Replace-2]). In clinical practice, the use of heparin is not systematically associated with a GP IIb/IIIa inhibitor. That's why we studied the clinical and economic interest of bivalirudin only versus heparin (UFH) only. Opened pragmatic monocentric study carried out in 2007. We made a chronological matching: for each patient treated with bivalirudin, we included the next patient with the same clinical presentation treated with unfractionated heparin. Ninety-two patients were included (46 in each group). The need for a GP IIb/IIIa inhibitor during the PCI was not significantly different between the two groups (p=0.11). No major hemorrhagic complications were observed in the two groups. Prevalence of ecchymosis was not significantly different: 22 % in the UFH group versus 13 % in the bivalirudin group (p=0.27). The average troponin level the next day was significantly higher in the bivalirudin group (p=0,049), although the change in troponin levels before and after the procedure was similar in the two groups. The average cost by patient of anticoagulation by bivalirudin and HNF is very different, respectively 473+/-150 and 51+/-146 euro (p=0.0001). Bivalirudin can be an interesting alternative for patients with a high risk of having complications. But considering its cost this therapy must be used only for selected patients.

[Case report and review of a voluminous right atrial myxoma revealed by heart failure]. / Volumineux myxome de l'oreillette droite révélé par une insuffisance cardiaque congestive.

Right atrial myxoma is a rare disease and its clinical presentation is not specific. The usual mode of revelation is heart failure. The most frequent complications are pulmonary embolism and atrioventricular valve obstruction by the tumor. A 49-year-old woman was admitted to intensive care unit for heart failure. The echocardiogram showed a voluminous right atrial myxoma, appending to the interatrial septum. Its surgical excision under extracorporeal circulation was successfully performed. Histology confirmed the final diagnosis of myxoma. No complication was observed at 6 months follow-up.

Cytogenetic and molecular analysis of an apomictic cassava hybrid and its progeny.

An interspecific hybrid between cassava and Manihot glaziovii acquired an apomixis gene from the parent M. glaziovii. This hybrid was exposed to open pollination during three subsequent generations. Seven sibs and the maternal progenitor of the fourth generation were genotyped using six microsatellite loci previously developed for cassava. All sibs were identical with each other and with their maternal progenitor. Sibs of selfed M. glaziovii proved to be identical when examined with these microsatellite loci. The chromosome complement of the apomictic clone was 2n = 38. We observed multi-embryonic aposporic embryo sacs.

[Impact of patient adherence to recommended medications on outcomes in populations with coronary artery disease]. / Impact de l'adhérence aux traitements médicamenteux sur le pronostic des patients coronariens.

Prescribing recommended medications is associated with improved outcomes in coronary artery disease patients. Likewise, adherence to prescribed medications, which frequently appears far from optimal, is significantly correlated with improved survival in "real world" observational databases. The present article reviews currently available data on the impact of medication adherence on outcomes in patients with coronary artery disease.

[Risk stratification of acute coronary syndromes]. / Stratification du risque des syndromes coronaires aigus.

In acute coronary syndromes, risk stratification is essential, particularly in those without ST-elevation, and is based upon clinical and biological markers. Among them, recent and repeated anginal attacks, ST-segment modifications on admission electrocardiogram, and increased markers of myonecrosis (particularly increased troponine levels) are strong predictors of untoward outcome. These variables can be used to construct risk scores, among which the TIMI and GRACE scores are the most widely used. These scores may prove helpful to define the optimal diagnostic and therapeutic management of the patients.

[Early surgery in infective endocarditis. Retrospective study apropos of 30 cases]. / Chirurgie précoce dans l'endocardite infectieuse. Etude rétrospective à propos de 30 cas.

AIM: The aim of this study is to stress the interest of the early surgery in infective endocarditis (IE), its indications and prognostic implications. METHODS: It is a retrospective descriptive study of 30 cases (29 men and 1 woman with an average age of 35+/-12 years) with IE underwent surgery management in the acute phase between September 1993 and June 2005. RESULTS: They were 25 rheumatic lesions, 2 aortic bicuspids and 3 mechanical valves prosthesis. Four twenty-six percent of the patients were operated for hemodynamic deterioration and 10% for embolic complication. We report 3 cases (that is to say 10%) of IE late form on prosthesis. Three patients died in the first post operative month by respectively total desinsertion of mitral prosthesis on peroperative, 1 septic shock at the 13th post operative day and 1 tamponade at the 14th postoperative day. On 72 months an average follow-up, 26 were controlled regularly: 25 evolved favourably and 1 died in third postoperative year (severe heart failure). CONCLUSION: A high early surgery rate is related to good long term results and does not increase in hospital mortality. The reduced mortality was particularly evident among patients with moderate to severe congestive heart failure.

[First autochthonous cases, caused by the Dengue-3 serotype in Federal District, Brazil]. / Apparition des premiers cas autochtones causes par le sérotype Dengue-3 dans le District fédéral, Brésil.

During the first four months of 2003, the survey laboratory of the Federal District (LACEN Laboratory of Virology), Brasília, Brazil, isolated ten strains of dengue virus serotype 3, five of them autochthonous, and the remaining ones from cases imported from Tocantins, Goias and Bahia States. The virus isolations were performed in C6/36 cell culture inoculated with total blood collected between the 1st and the 5th days after the onset of the symptoms. The age of the patients varied from 26 to 59 years old. The strains were typed as DEN-3 by indirect immunofluorescence assay using serotype-specific monoclonal antibodies. Viral RNAs were extracted from total blood using the trizol method. The nested RT-PCR method detected DNA products of 290 bp, confirming the serotype identifications. The introduction of DEN-3 in Brazil and especially in the Federal District represents a serious threat, since most people are susceptible to this serotype and many have already been infected by serotypes DEN-1 or DEN-2, thus increasing the risk of epidemic of more severe forms of the disease. The use of a fast and reliable method for continuous monitoring of the circulation of this serotype is of primary importance for the prevention and control of future epidemics.

[Management of infarction with ST elevation in the acute phase: the current guidelines]. / Prise en charge de l'infarctus avec sus-déalage de ST au stade aigu: recommandations actuelles.

The 2002 and 2005 recommendations of the European Society of Cardiology for the management of ST-elevation myocardial infarction at the acute stage are reviewed. Primary angioplasty should, whenever possible, constitute the default strategy, but intravenous thrombolysis still has an important role, particularly in the first few hours following symptom onset.

[Admission and fasting blood glucose are important prognostic markers in acute coronary syndromes]. / Glycémie d'admission et glycémie a jeun, marqueurs pronostiques dans les syndromes coronaires aigus.

This paper reviews current evidence on the role of admission and fasting glycaemia as prognostic markers in patients with acute coronary syndromes. Though both parameters are correlated, they give different prognostic information and are related to both in-hospital complications, including death, and long-term outcomes. As hyperglycemia at the acute stage of myocardial infarction is an independent predictor of untoward cardiovascular events, blood glucose measurements should become routine in all patients presenting with acute coronary syndromes.

[Uterine rupture of the unscarred uterus. About 28 cases]. / Rupture utérine sur utérus sain gravide. A propos de 28 cas.

OBJECTIVES: To determine the etiologic factors explaining the appearance of uterine rupture on unscarred gravid uterus and to value the maternal and foetal prognosis of this complication. PATIENTS AND METHODS: The authors report a study of 28 cases of uterine rupture on unscarred gravid uterus, recorded between January 1989 and December 1997, at the department of obstetrics and gynecology, Farhat Hached University Hospital, Sousse, Tunisia. RESULTS: Out of the 72283 deliveries during the study period, there were 28 ruptured uteri of unscarred uterus giving a hospital incidence of one in 2581 deliveries. Multiparity, neglected labour dystocia and obstetric procedure were the common etiologic factors accused in the occurring of this complication. To be added to these factors: the low socio-economic status of the patients and lack of antenatal care. The surgical management was conservative (repair) in 19 cases (67.9%); hysterectomy was indicated in nine cases (32.1%). Maternal and fetal morbidity and mortality were important: we deplore two maternal deaths (7.1%) and seven fetal deaths (24.1%). DISCUSSION AND CONCLUSION: Uterine rupture on unscarred uterus is a relatively rare complication of the pregnancy. However, its incidence remains high in developing countries. Its occurrence is significantly associated with grandmultiparity, lack of antenatal care and low socio-economic status of the patients.

[Management of the bank of biological material in the hospital-based SEROCO and HEMOCO cohorts of HIV-infected patients]. / Utilisation de la biothèque dans les cohortes hospitalières SEROCO et HEMOCO de patients infectés par le VIH.

The French SEROCO and HEMOCO hospital-based cohorts have enrolled and followed HIV-infected patients, before and after the highly active antiretroviral therapy era. Among the objectives in 1988, was explicitly mentioned the constitution of a centralised bank of biological material (serums at enrollment and every 6 months, PBMC at enrollment and every 18 months). This paper details the organisation of the bank and the numerous studies performed from this bank, and presents a few simple decision rules which have been developed with the growing acquired experience.

Cercarial shedding patterns of Schistosoma bovis and S. haematobium from single and mixed infections of Bulinus truncatus.

The cercarial shedding of Schistosoma bovis and S. haematobium were studied in single and mixed infections in the snail host Bulinus truncatus. The two species displayed a distinctive diurnal cercarial emergence with an earlier shedding pattern for S. bovis than S. haematobium (the average emergence peaks were respectively at 0800 h and 1200 h). In mixed infections, each species kept its own cercarial shedding rhythm with no marked alterations. The cercarial emergence pattern is proposed as a new method to identify natural mixed infections in the snail intermediate hosts. The interactions between the two parasites are discussed.