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2.
BMC Pregnancy Childbirth ; 18(1): 496, 2018 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-30547830

RESUMO

BACKGROUND: The determination of foetal Rhesus D (RHD) status allows appropriate use of IgRh prophylaxis by restricting its use to cases of RHD feto-maternal incompatibilities. There is a degree of uncertainty about the cost-effectiveness of foetal RHD determination, yet screening programs are being introduced into clinical practice in many countries. This paper evaluates the impact of non-invasive foetal Rhesus D (RHD) status determination on the costs of managing RHD-negative pregnant women and on the appropriate use of anti-D prophylaxis in a large sample of RHD-negative pregnant women using individual prospectively collected clinical and economic data. METHODS: A prospective two-armed trial of RHD negative pregnant women was performed in 11 French Obstetric Departments. Non-invasive foetal RHD genotyping was performed before 26 weeks' gestation in the experimental arm whereas the control arm participants received usual care. The costs associated with patient management in relation to their RHD negative status (biological tests, anti-D prophylaxis and visits) were calculated from inclusion to the end of the postpartum period. The costs of hospital admissions during pregnancy and delivery were also determined. RESULTS: A total of 949 patients were included by 11 centres between 2009 and 2012, and 850 completed follow-up, including medical and biological monitoring. Patients were separated into two groups: the genotyping group (n=515) and the control group (n=335). The cost of the genotyping was estimated at 140 euros per test. The total mean cost per patient was estimated at €3,259 (SD ± 1,120) and €3,004 (SD ± 1,004) in the genotyping and control groups respectively. The cost of delivery represented three quarters of the total cost in both groups. The performance of managing appropriately RHD negative anti-D prophylaxis was 88% in the genotyping group, versus 65% in the control group. Using the costs related to RHD status (biological tests, anti-D immunoglobulin injections and visits) the incremental cost-effectiveness ratio (ICER) was calculated to be €578 for each percentage gain in women receiving appropriate management. CONCLUSION: Early knowledge of the RHD status of the foetus using non-invasive foetal RHD genotyping significantly improved the management of RHD negative pregnancies with a small increase in cost. TRIAL REGISTRATION: Clinical trials registry- NCT00832962 -13 January 2009 - retrospectively registered.


Assuntos
Feto/imunologia , Técnicas de Genotipagem , Cuidado Pré-Natal , Isoimunização Rh , Sistema do Grupo Sanguíneo Rh-Hr/genética , Imunoglobulina rho(D)/uso terapêutico , Análise Custo-Benefício , Feminino , França , Genótipo , Técnicas de Genotipagem/economia , Técnicas de Genotipagem/métodos , Humanos , Fatores Imunológicos/uso terapêutico , Gravidez , Resultado da Gravidez/epidemiologia , Cuidado Pré-Natal/economia , Cuidado Pré-Natal/métodos , Diagnóstico Pré-Natal/economia , Diagnóstico Pré-Natal/métodos , Isoimunização Rh/sangue , Isoimunização Rh/prevenção & controle , Imunoglobulina rho(D)/imunologia
3.
Ann Biol Clin (Paris) ; 76(1): 23-44, 2018 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-29386144

RESUMO

The SFBC Working Group on critical care testing describes in this paper the SFBC recommendations for the determination of maximal turnaround times (TAT) for laboratory medicine examination in emergency conditions. The table presented in a previous paper was updated, taken into account the clinical situations, as well as the emergency response capabilities of the medical laboratory. These new French recommendations must to be based to each local situation in a clinical-biological context between the physicians and the specialist in Lab Medicine.


Assuntos
Cuidados Críticos , Ciência de Laboratório Médico/normas , Testes Imediatos/normas , Prática Profissional/normas , Acreditação , Cuidados Críticos/classificação , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Cuidados Críticos/normas , Emergências/classificação , França , Humanos , Ciência de Laboratório Médico/organização & administração , Sociedades Médicas/normas
4.
Transfusion ; 58(2): 294-305, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29193111

RESUMO

BACKGROUND: In addition to titration by indirect antiglobulin test most widely used, anti-D quantitation by continuous-flow analysis (CFA) may be performed to assess severity of maternal immunization. Only five studies have reported its added value in the management of pregnancies complicated by anti-D immunization. STUDY DESIGN AND METHODS: A retrospective study of 74 severe anti-D-immunized pregnancies was conducted from January 1, 2013, to December 31, 2014, in the Trousseau Hospital in Paris (France). Concentration of maternal anti-D was measured by titration and by CFA two-stages method (2SM; total amount of anti-D) and one-stage method (1SM; high-affinity IgG1 anti-D). These biologic data were analyzed according to the severity of the hemolytic disease of the fetus and the newborn. RESULTS: The value of 5 IU anti-D/mL in maternal serum is validated as a threshold to trigger ultrasonographic and Doppler fetal close follow-up. A high 1SM/2SM ratio was associated with a higher risk of intrauterine transfusion (IUT). For pregnancies requiring IUT and without increasing titer, maternal 1SM anti-D concentration tends to correlate with the precocity of fetal anemia. In the "without-IUT" group 1SM and 2SM anti-D concentrations correlate significantly with cord bilirubin levels of the newborn at birth. CONCLUSION: Altogether our results underline the importance of anti-D quantitation by CFA to optimize the management of anti-D-alloimmunized pregnancies.


Assuntos
Ecocardiografia Doppler em Cores , Transfusão Feto-Materna , Isoanticorpos , Complicações na Gravidez , Sistema do Grupo Sanguíneo Rh-Hr/sangue , Adulto , Feminino , Transfusão Feto-Materna/sangue , Transfusão Feto-Materna/diagnóstico por imagem , Humanos , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/diagnóstico por imagem , Estudos Retrospectivos
5.
Fetal Diagn Ther ; 42(3): 225-231, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28278506

RESUMO

BACKGROUND: The Doppler measurement of middle cerebral artery peak systolic velocity (MCA-PSV) is considered the gold standard for the noninvasive detection of moderate to severe anemia. However, the accuracy of this test has not been evaluated so far, specifically beyond 34 weeks. OBJECTIVES: To assess the accuracy of MCA-PSV to detect moderate to severe fetal anemia and to identify risk factors associated with false-positive and false-negative MCA-PSV values after 34 weeks. STUDY DESIGN: We studied a retrospective cohort of 150 pregnant women with severe alloimmunization who delivered between 2010 and 2014 and correlated MCA-PSV and fetal or neonatal hemoglobin levels. RESULTS: Sensitivity to predict severe anemia was 69%, with a false-negative rate of 3.6%. When MCA Doppler assessment was normal, the identification of serosal effusions increased the detection rate of severe fetal anemia to 94%, with a false-negative rate of 0.8%. False-positive MCA-PSV measurements were more frequent in fetuses with 1 previous intrauterine transfusion (p = 0.0002), but were not associated with MCA resistance index, intrauterine growth restriction and fetal heart rate. CONCLUSIONS: Between 34 and 37 weeks, sensitivity of MCA-PSV Doppler assessment alone is 69% and increases to 94% when also considering signs of hydrops. False-positive MCA-PSV measurements are more frequent in case of former fetal transfusion.


Assuntos
Anemia/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Ultrassonografia Pré-Natal , Anemia/imunologia , Velocidade do Fluxo Sanguíneo , Feminino , Idade Gestacional , Humanos , Gravidez , Valores de Referência , Estudos Retrospectivos , Sensibilidade e Especificidade
6.
Ann Biol Clin (Paris) ; 74(2): 130-55, 2016 Mar-Apr.
Artigo em Francês | MEDLINE | ID: mdl-27029720

RESUMO

SFBC working group on critical care testing describes in this paper guideline for the management of laboratory medicine examination process in emergency conditions. After a summary on French standards and regulations, the critical care testing perimeter and definitions of stat levels are presented in different contexts. The complete examination process is described. Guidelines are proposed for each step, to manage sub-process in a risk management approach. The following steps were studied: ordering (by specialties), sampling, transport, reception, analysis, validation and release. In summary, we proposed a list of examinations allowed to be prescribed in stat conditions with a short list and complementary tests as a function of clinical setting. These guidelines need to be adapted in clinicobiological contracts.


Assuntos
Técnicas de Laboratório Clínico/normas , Cuidados Críticos , Manejo de Espécimes/normas , Acreditação , Técnicas de Laboratório Clínico/métodos , Cuidados Críticos/legislação & jurisprudência , Cuidados Críticos/métodos , Cuidados Críticos/normas , Emergências , Serviços Médicos de Emergência/legislação & jurisprudência , Serviços Médicos de Emergência/normas , França , Humanos , Gestão de Riscos/legislação & jurisprudência , Gestão de Riscos/normas
7.
Prenat Diagn ; 34(11): 1023-30, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24851784

RESUMO

AIM: The aim of this study was to assess the prognosis of parvovirus B19 infection with severely anemic and/or hydropic fetuses according to initial ultrasound and biological criteria. MATERIAL AND METHODS: Retrospective study of 20 cases of congenital parvovirus B19-proven infection (positive PCR) complicated by fetal anemia and/or hydrops was examined. Anemia was suspected on an elevated peak systolic velocity of the middle cerebral artery and was confirmed by fetal blood sampling. RESULTS: Survival rate was 70% (14/20) overall and 76% (13/17) for fetuses with one or more transfusions. When fetal effusion regressed after the transfusion, all 11 fetuses survived, and neonatal condition was favorable for all. Among the 14 live-born children, there was one neonatal death and one admission to the neonatal care unit with no major complications. CONCLUSION: Despite active management by transfusion in fetuses with parvovirus B19 infection, mortality remained substantial during the acute phase of anemia and fetal hydrops. Regression of effusion appears to be an important variable for prognosis. Non-anemic forms exist with isolated refractory ascites or pleural effusion. Maternal mirror syndrome appears to reflect the intensity and persistence of the fetal anemia.


Assuntos
Anemia/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Hidropisia Fetal/diagnóstico por imagem , Infecções por Parvoviridae/diagnóstico por imagem , Parvovirus B19 Humano , Anemia/complicações , Anemia/congênito , Anemia/terapia , Transfusão de Sangue Intrauterina , Feminino , Doenças Fetais/terapia , Idade Gestacional , Humanos , Hidropisia Fetal/terapia , Infecções por Parvoviridae/complicações , Infecções por Parvoviridae/terapia , Parvovirus B19 Humano/isolamento & purificação , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico por imagem , Complicações Infecciosas na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Ultrassonografia
9.
Transfusion ; 53(2): 363-72, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22690701

RESUMO

BACKGROUND: Several studies showed in people of African descent the existence of a genetic linkage between RHD alleles encoding a variant D antigen and a given altered RHCE*ce allele. RHCE*ceBI is a rare allele encountered in people of African descent, that encodes a Hr- hr(S) - Rhce protein. Our study shows that RHCE*ceBI appears to be genetically linked to two very similar variant RHD alleles, RHD*DOL1 and RHD*DOL2, and demonstrates for the first time that DOL-2 is a partial D antigen. STUDY DESIGN AND METHODS: After finding out an individual with both RHCE*ceBI and RHD*DOL presumed to be in cis, we hypothesized a genetic linkage between those two genes. All individuals (n = 7) known to carry RHCE*ceBI in our laboratory, including the index case, were fully investigated at the serologic and molecular level. RESULTS: One individual with alloanti-D, being homozygous for RHCE*ceBI and RHD*DOL2, allowed us to confirm the genetic linkage between those two genes, as well as the partial D status of DOL-2. In the six RHCE*ceBI remaining individuals, three were found with RHD*DOL2 and 3 with RHD*DOL1, likely in cis. Three of them made an alloanti-D; one was DOL-1 and two were DOL-2. CONCLUSION: The rare RHCE*ceBI allele appears to be in cis either with RHD*DOL1 or with RHD*DOL2 in people of African descent. DOL-1 and DOL-2 must be considered as partial D antigens. We recommend a systematic search for RHD*DOL1 and RHD*DOL2 in people found to carry RHCE*ceBI and vice versa, especially in patients with sickle cell disease.


Assuntos
Grupo com Ancestrais do Continente Africano/genética , Epistasia Genética , Sistema do Grupo Sanguíneo Rh-Hr/genética , Alelos , Epistasia Genética/fisiologia , Feminino , Frequência do Gene , Variação Genética/genética , Variação Genética/fisiologia , Humanos , Recém-Nascido , Masculino , Gravidez , Isoformas de Proteínas/genética , Análise de Sequência de DNA , Testes Sorológicos
10.
Obstet Gynecol ; 118(6): 1323-9, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22105262

RESUMO

OBJECTIVE: To evaluate the results of management of very early fetal anemia (before 20 weeks of gestation) in cases of red-cell alloimmunization. METHODS: Retrospective study of the outcome of all in utero transfusions performed before 20 weeks of gestation and all pregnancies requiring an in utero transfusion before 20 weeks in our reference center from January 1990 through August 2011 in cases with severe alloimmunization. RESULTS: Twenty-five in utero transfusions were performed in 18 pregnancies in 16 patients during the study period. A vascular access was performed successfully in 22 of the 24 cases in which it was attempted. An intraperitoneal transfusion was necessary in two cases. Two in utero deaths attributable to the intravascular procedure occurred during attempts before 18 weeks of gestation and another, not associated with a transfusion, at 29 weeks. The overall survival rate was 83.3% (compared with 88.0% when the first in utero transfusion took place before 22 weeks). The risk of fetal loss for each transfusion was 8.0% before 20 weeks and 6.3% before 22 weeks. An intraperitoneal transfusion at 17 2/7 weeks allowed one fetus to survive until the first intravascular in utero transfusion could take place at 18 2/7 weeks. CONCLUSION: Fetal anemia before 20 weeks remains at high risk of lethal complications compared with later gestational ages. Technical difficulties in a vascular access are mainly encountered before 18 weeks of gestation. At an earlier gestational age, intraperitoneal transfusion may gain the days necessary to perform an intravascular transfusion more safely. LEVEL OF EVIDENCE: III.


Assuntos
Anemia/terapia , Transfusão de Sangue Intrauterina/estatística & dados numéricos , Doenças Fetais/terapia , Idade Gestacional , Adulto , Anemia/imunologia , Anemia/mortalidade , Feminino , Doenças Fetais/imunologia , Doenças Fetais/mortalidade , França/epidemiologia , Humanos , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
11.
Obstet Gynecol ; 118(2 Pt 2): 439-42, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21768847

RESUMO

BACKGROUND: Small-volume fetomaternal hemorrhage is frequently observed after intrauterine transfusion. The Kleihauer-Betke test, the reference method for identifying fetomaternal hemorrhage, cannot be used after intrauterine transfusion, because the adult red blood cells used for transfusion cannot be distinguished from maternal red blood cells. CASE: Massive fetomaternal hemorrhage secondary to intrauterine transfusion led to fetal hemorrhagic stroke. We used a method based on blood group identification in the maternal blood to confirm and to quantify fetomaternal hemorrhage. CONCLUSION: Fetal stroke may result from severe hypovolemia and low cerebral blood flow caused by fetomaternal hemorrhage, rather than from fetal anemia itself.


Assuntos
Transfusão de Sangue Intrauterina/efeitos adversos , Transfusão Feto-Materna/etiologia , Complicações Hematológicas na Gravidez/etiologia , Antígenos de Grupos Sanguíneos/isolamento & purificação , Cesárea , Feminino , Hemoglobina Fetal/análise , Transfusão Feto-Materna/diagnóstico , Humanos , Recém-Nascido , Imagem por Ressonância Magnética , Masculino , Gravidez , Complicações Hematológicas na Gravidez/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Resultado do Tratamento , Adulto Jovem
12.
Proteomics ; 5(15): 3876-84, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16130169

RESUMO

We have undertaken to continue the proteomic study of human umbilical vein endothelial cells (HUVECs) using the combination of 2-DE, automated trypsin digestion, and PMF analysis after MALDI-TOF MS and peptide sequencing using nano LC-ESI-MS/MS. The overall functional characterization of the 162 identified proteins from primary cultures of HUVECs confirms the metabolic capabilities of endothelium and illustrates various cellular functions more related to cell motility and angiogenesis, protein folding, anti-oxidant defenses, signal transduction, proteasome pathway and resistance to apoptosis. In comparison with controls cells, the differential proteomic analysis of HUVECs treated by the pro-apoptotic topoisomerase inhibitor etoposide further revealed the variation of eight proteins, namely, GRP78, GRP94, valosin-containing protein, proteinase inhibitor 9, cofilin, 37-kDa laminin receptor protein, bovine apolipoprotein, and tropomyosin. These data suggest that etoposide-induced apoptosis of human vascular endothelial cells results from the intricate involvement of multiple apoptosis processes including at least the mitochondrial and the ER stress pathways. The presented 2-D pattern and protein database, as well as the data related to apoptosis of HUVECs, are available at http://www.huvec.com.


Assuntos
Apoptose/fisiologia , Células Endoteliais/metabolismo , Endotélio Vascular/citologia , Apoptose/efeitos dos fármacos , Células Cultivadas , Bases de Dados de Proteínas , Eletroforese em Gel Bidimensional , Etoposídeo , Proteínas de Choque Térmico/metabolismo , Humanos , Glicoproteínas de Membrana/metabolismo , Chaperonas Moleculares/metabolismo , Inibidores da Síntese de Ácido Nucleico/farmacologia , Proteoma , Proteômica/métodos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Veias Umbilicais/citologia
13.
Endothelium ; 11(3-4): 141-9, 2004 May-Aug.
Artigo em Inglês | MEDLINE | ID: mdl-15370291

RESUMO

This study was undertaken to examine the possibilities of endothelial protection toward toxicity of anticancer drugs. To test the hypothesis that estradiol (E2) and cyclosporin A (CsA) can interfere within programmed cell death in human umbilical vein endothelial cells (HUVECs), apoptosis was induced by etoposide with and without E2 or CsA. All the concentrations of E2 tested (from 10(-9) to 10(-5) M) failed to protect HUVECs. For CsA a dual effect was observed: used at 1 or 10 microg/mL in coincubation with etoposide, CsA significantly reduced etoposide-induced apoptosis but complete inhibition was not reached, whereas used at 50 microg/mL CsA did not protect HUVECs anymore and even had deleterious effects. Furthermore, a 24-h pretreatment of HUVECs by CsA at 10 microg/mL significantly protected the cells by preventing both bcl-2 level decrease and caspase-3 activation related to etoposide-induced apoptosis. Protective effects of CsA toward endothelial cells were concentration dependent; in pretreatment at 10 microg/mL, CsA was an effective protector and might contribute in vivo to inhibit obvious toxic effects caused by anticancer drugs.


Assuntos
Ciclosporina/farmacologia , Citoproteção/efeitos dos fármacos , Células Endoteliais/efeitos dos fármacos , Estradiol/farmacologia , Etoposídeo/antagonistas & inibidores , Antineoplásicos Fitogênicos/antagonistas & inibidores , Antineoplásicos Fitogênicos/toxicidade , Apoptose/efeitos dos fármacos , Apoptose/fisiologia , Caspase 3 , Caspases/efeitos dos fármacos , Caspases/metabolismo , Linhagem Celular , Citoproteção/fisiologia , Relação Dose-Resposta a Droga , Regulação para Baixo/efeitos dos fármacos , Regulação para Baixo/fisiologia , Interações de Medicamentos/fisiologia , Células Endoteliais/metabolismo , Etoposídeo/toxicidade , Humanos , Proteínas Proto-Oncogênicas c-bcl-2/efeitos dos fármacos , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo
14.
Cell Biol Int ; 27(10): 825-30, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14499662

RESUMO

Angiotensin-converting enzyme (ACE) inhibitors were shown to improve endothelial dysfunction in various human diseases and some of these inhibitors have been proposed as enhancers of antioxidant defences. We measured glutathione peroxidase (GPX), superoxide dismutase (SOD) and malondialdehyde (MDA) in human endothelial cells treated with captopril or enalaprilat, two ACE inhibitors, and we showed that both inhibitors decreased GPX and SOD activities but not MDA, the end-product of lipoperoxidation. Captopril and enalaprilat were also unable to protect against etoposide-induced apoptosis in endothelial cells, indicating that they cannot be considered as protective drugs for the endothelium, in particular in clinical situations involving oxidative stress or apoptosis. Moreover, when used at high concentration captopril, but not enalaprilat, was toxic for endothelial cells with both necrotic and apoptotic effects.


Assuntos
Antioxidantes/metabolismo , Apoptose , Captopril/farmacologia , Enalaprilato/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Células Cultivadas , Relação Dose-Resposta a Droga , Endotélio Vascular/citologia , Etoposídeo/farmacologia , Glutationa Peroxidase/biossíntese , Humanos , Peroxidação de Lipídeos , Malondialdeído/metabolismo , Necrose , Estresse Oxidativo , Superóxido Dismutase/biossíntese , Veias Umbilicais/citologia
15.
Proteomics ; 3(5): 714-23, 2003 May.
Artigo em Inglês | MEDLINE | ID: mdl-12748950

RESUMO

The endothelium is a single layer of cells lining the inside face of all blood vessels. It constitutes a major metabolic organ which is critically involved in the generation and the regulation of multiple physiological and pathological processes such as coagulation, hemostasis, inflammation, atherosclerosis, angiogenesis and cancerous metastasis dissemination. In order to increase our knowledge about the protein content and the main biological pathways of human vascular endothelial cells, we have undertaken the proteomic analysis of the most explored present endothelial cell model, i.e. primocultures of human umbilical vein endothelial cells (HUVECs). Using low levels of protein loads (~ 30 nug), the association of two-dimensional electrophoresis with matrix-assisted laser desorption/ionization-time of flight mass spectrometry, liquid chromatography-tandem mass spectrometry and database interrogations allowed us to identify 53 proteins of suspected endothelial origin in quiescent HUVECs. Beside cytoskeletal proteins such as actin, tubulin, tropomyosin and vimentin, we identified various proteins more especially implicated in cellular motility and plasticity (e.g. cofilin, F-actin capping protein and prefoldin), in regulation of apoptosis and senescence (protease inhibitor 9, glucose related proteins, heat shock proteins, thioredoxin peroxidase, nucleophosmin) as well as other proteins implicated in coagulation (annexin V, high mobility group protein), antigen presentation (valosin containing protein and ubiquitin carboxyl terminal hydrolase isozyme L1) and enzymatic capabilities (glutathione-S-transferase, protein disulfide isomerases, lactate deshydrogenase). The presented annotated 2-D maps of HUVECs will be soon available on the web at http://www. huvec.com.


Assuntos
Endotélio Vascular/química , Proteômica/métodos , Células Cultivadas , Cromatografia Líquida , Eletroforese em Gel Bidimensional , Humanos , Espectrometria de Massas , Mapeamento de Peptídeos , Proteoma/isolamento & purificação , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Veias Umbilicais/química
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