[Vaccination status and factors associated with pneumococcal vaccination in geriatric short-stay care]

Nearly two-thirds of geriatric short-stay patients were eligible for pneumococcal vaccination. Among patients eligible for vaccination, less than 5 % had received at least one injection of pneumococcal vaccine on admission. We found no modifiable factors associated with vaccination status, but several avenues for improving vaccination coverage.

Peripheral blood and BM CD34+ CD38− cells show better resistance to cryopreservation than CD34+ CD38+ cells in autologous stem cell transplantation

BACKGROUND

We and others have shown a critical role for CD34+ CD38- cells in hematopoietic recovery after autologous stem cell transplantation (ASCT), in particular for platelet reconstitution. Thus a routine assessment of CD34+ CD38- cells in freezing-thawing procedures for autografting could represent an important tool for predicting poor engraftment.

METHODS

To compare the impact of cryopreservation on CD34+ CD38+ and CD34+ CD38- hematopoietic stem cell subsets, 193 autograft products collected in 84 patients with malignancies were assessed before controlled-rate cryopreservation in 10% DMSO and after thawing for autografting.

RESULTS

Cell counts after thawing were significantly different from the pre-freezing counts for total CD34+ (P<0.0001) and CD34+ CD38+ (P<0.0001) cells, but not for CD34+ CD38- cells (P=0.252). Median losses for CD34+, CD34+ CD38+ and CD34+ CD38- cells were, respectively, 11.8%, 11.4% and 0.0%. The magnitude of fresh/post-thawing percentage cell variation was significantly different when comparing between the CD34+ CD38+ and CD34+ CD38- cell subsets (P<0.001). Moreover, CD34+ CD38- cells exhibited recovery values > or =100% in 85/160 graft products, compared with 51/193 in CD34+ CD38+ cells (P<0.0001). Also, recovery values > or =90% were significantly better in the CD34+ CD38- (98/160 grafts) than in the CD34+ CD38+ subsets (89/193 grafts) (P<0.01).

DISCUSSION

In this work we have demonstrated that CD34+ cells that do not express the CD38 Ag show a significantly better resistance to cryopreservation. This could represent another example of the particular ability of less committed progenitor cells to overcome environmental injuries. Moreover, we consider routine assessment of CD34+ CD38- cells before freezing as clinically relevant, but post-thawing controls may be avoided because of their good resistance to freezing.

Evaluation of current practices in surgical antimicrobial prophylaxis in primary total hip prosthesis—a multicentre survey in private and public French hospitals

Deep wound infection is a rare but dreaded postoperative complication after total hip prosthesis (THP) procedures but its incidence can be reduced by systemic antimicrobial prophylaxis. The objective of the present study was to evaluate whether antimicrobial prophylaxis for elective primary THP in patients without any history of hip infection, in orthopaedic wards, participating on a voluntary basis, in French public hospitals and private institutions, complies with published guidelines. Three types of data were collected from anaesthetic and surgical records (November 2000-January 2001) in participating hospitals: (1) administrative data on the hospitals and orthopaedic wards, (2) data on patients, (3) data on compliance of practices with five critical criteria derived from published French guidelines. These criteria concerned administration of prophylaxis, choice of antimicrobial agent, dose of first injection, timing of administration and total length of prophylaxis. Thirty institutions sent data files on 1257 THPs to the coordination centre. Compliance exceeded 80% for all criteria except one (interval between first and second injection). Cumulative compliance with the five criteria was 66.9%. Major compliance failures were an inappropriate interval between the first injection and incision, and total antimicrobial prophylaxis exceeding 48 h. Cumulative compliance was 87.9% in teaching hospitals, 61.8% in general hospitals and 67.7% in private institutions (P<1 x 10(-6)). It was slightly higher when the annual number of interventions was > or =100 (69.4 versus 62.3%; P<0.02). Although the protocol for antimicrobial prophylaxis in THP was clear and easy, one-third of practices did not conform with all five standards. Knowledge of the results by the participating institutions should encourage them to set up working groups to draft care protocols for THP and other surgical interventions, in order to improve practice and perhaps reduce costs.

Importance of CD34+ cell subsets in autologous PBSC transplantation: the mulhouse experience using CD34+CD38- cells as predictive tool for hematopoietic engraftment

Over the years, various biological parameters have been proposed for predicting rapidity and long term maintenance of hematopoietic engraftment after peripheral blood stem cell transplantation (PBSCT). Determination of the graft content in CFU-GM was the only one available until the end of the eighties. But, for technical reasons, and also because it does not actually evaluate the self-renewal potential of the cell products reinfused, it has now been commonly replaced by the determination of CD34+ cell amounts, which are known to contain the pluripotent hematopoietic stem cells. However, a frequent discrepancy still exists between the number of CD34+ cells reinfused and the engraftment efficiency. We have recently demonstrated a higher accuracy of the numbers of CD34+38- cells contained in graft products to predict rapidity of trilineage engraftment, which has further been confirmed by other investigators. Furthermore, we and others, have proposed a threshold dose of 5 x 10(4) CD34+38- cells/kg b.w. below which the trilineage engraftment kinetics are significantly slower and unpredictible. This "cut-off" value also appears to be a realistic clinical tool to decide if hematopoietic growth factor(s) must be administered or not after PBSCT. Indeed, when for example, rh-G-CSF administration after transplant of CD34+38- amounts < 5 x 10(4) kg has indisputable positive effects on the rapidity of neutrophil engraftment, length of hospitalization and posttransplant costs, enough to make it fully justified in this situation, it is absolutely not the case when it is administered after reinfusion of CD34+38- cell amounts > 5 x 10(4) /kg. In this case, posttransplant rh-G-CSF administration could even result in a decrease in stem cells with self-renewal potential of the graft, which should still raise more concerns for its indiscriminate and costly use.

Role of the CD34+ 38- cells in posttransplant hematopoietic recovery

Using three different statistical tests in parallel, we showed in a preliminary study that neither mononuclear cells, CD34+ 33+ or 33- cells, nor CD34+ 38+ cells significantly correlated with engraftment kinetics following autologous blood cell transplantation (ABCT). We additionally demonstrated here, in a series of patients suffering from malignant diseases, that the graft content in CD34+ 38- cells is individually a more sensitive indicator of the earliest, as well as the latest post-ABCT trilineage hematopoietic recovery than the colony-forming units-granulocyte-macrophage and even the total CD34+ cell content. This suggests that the CD34+ 38- cell population is itself subdivided into two more subsets, one being already lineage-committed and responsible for short-term engraftment, the other containing only very primitive hematopoietic cells responsible for sustained engraftment. Strong arguments favor the probability that these subsets correspond to HLA-DR+ and DR cells, respectively. We also defined an optimal threshold value of 0.05 x 10(6) CD34+ 38- cells/kg of the patient's body weight (b.w.) above which a rapid and sustained trilineage engraftment safely occurs. In fact, infusion of lower numbers of cells seems to have a more significant impact on long-term compared to short-term neutrophil recovery and on platelet kinetics engraftment. We additionally looked for the eventual influence on engraftment time of the type of disease, and of post-ABCT administration of hematopoietic growth factors (HGF). When the type of disease appeared to have no influence on the engraftment time, posttransplant HGF administration significantly reduced the time to trilineage engraftment in patients transplanted with < 0.05 x 10(6) CD34+ 38- cells, thus justifying it in case of reinfusion of low numbers of CD34+ 38- cells. On the other hand, the administration of HGF after infusion of more than 0.05 x 10(6) CD34+ 38- cells/kg b.w. did not hasten more, or only very little, the engraftment time, thus becoming not only unprofitable for the patients but costly as well.

Human accessory cells have a humoral bystander effect on CAFC growing on murine feeder

Human early hematopoietic progenitors from bone marrow (BM) and leukapheresis products (LP) are highly proliferative in presence of accessory cells in standard culture on the murine FBMD-1 cell feeder with weekly addition of human interleukin-3 (HuIL-3) and granulocyte-colony stimulating factor (HuG-CSF). If however purified CD34+ cells are cultured under otherwise identical conditions, cobblestone areas (CAFC) formed by the same number of target cells are diminished by more than 1 log, as we showed previously. This suggests that mature cells are involved in growth of early progenitors. To determine whether this bystander effect is mediated by soluble growth factors, or by direct cell-to-cell contact with early progenitors, we stimulated mature plastic adherent cells separately and tested the resulting conditioned supernatant (ACS) on CAFC and colony-forming unit-granulocyte-macrophage (CFU-GM) production. In ACS-complemented standard cultures of purified CD34+ cells, the yield of CAFC was up to 1 log higher if compared to parallel cultures without ACS. Likewise, the CFU-GM production was enhanced in presence of ACS, especially in the adherent fraction of the culture. When CD34+ cell cultures were performed with ACS but without added interleukin-3 (IL-3) and granulocyte colony-stimulating factor (G-CSF), CAFC production was in the same range as if these growth factors were added alone. Addition of anti-G-CSF antibody (Ab) to ACS decreased CAFC recruitment significantly, whereas anti-IL-3 Ab had no significant effect. These findings suggest that ACS complemented with IL-3 and G-CSF replaces the accessory cells largely; this is not only due to presence of G-CSF, because ACS in combination with recombinant growth factors mounts CAFC yield higher than saturating amounts of growth factors alone do. There must be further synergizing soluble factors in the supernatant.

[Concurrent split-course chemotherapy and radiotherapy for unresectable stage III non-small cell lung cancer: preliminary results of a Phase II study]

PURPOSE

We initiated at Hospital de Mulhouse a prospective phase II study to assess a split-course concurrent radiochemotherapy in locally advanced non-small cell lung cancer.

MATERIALS AND METHODS

From March 1996 to December 1997, 28 patients were included in our study. All patients had a stage III cancer. The chemotherapy scheduled included vinorelbine (20 mg/m2/d, d1 and d5), cisplatin (20 mg/m2/d, from d1 to d5), and 5-Fluorouracil (350 mg/m2/d, from d1 to d5 by continuous infusion). The planned irradiation dose was 12.5 Gy per week with one daily fraction of 2.5 Gy from d1 to d5. Cycles were repeated every four weeks, for four cycles (50 Gy). Patients with a partial or complete response were proposed a fifth cycle.

RESULTS

Of the 28 patients of the study, only 27 were analysed; one patient had a metastatic disease at diagnosis. Major hematologic toxicity occurred in 26% of the patients. One to five cycles of chemoradiotherapy were administrated per patient (median: four). Four patients had received fewer than three cycles and their responses were not assessable. Of the 23 patients assessed, 12 responses (52%) were observed, three CR (13%) and nine PR (39%). Median follow-up was 14 months, and median survival 13.5 months. One- and two-year survival rates were respectively 63% and 14%. Local control rates was 11%, and 44% of the patients had a metastatic evolution.

CONCLUSION

Very preliminary results of this phase II study are disappointing, and quite inferior to the published results using chemoradiotherapy with conventional or hyperfractionated radiotherapy. Hematologic toxicity is restrictive. This type of chemoradiotherapy cannot be recommended.

Mature accessory cells influence long-term growth of human hematopoietic progenitors on a murine stromal cell feeder layer

A recently described long-term culture system for early human progenitor cells was established with the murine preadipocyte stromal line FBMD-1 grown in 96-well plates; cobblestone areas formed by inoculated hematopoietic cells are determined in a limiting dilution setting after five weeks' culture. To compare the capacity of cobblestone-area-forming cell (CAFC) formation by bone marrow and leukapheresis products in this system, mononuclear cells (MNC) of both origins were cultured. As related to CD34+ cell content, CAFC yields after five weeks' culture were in the same range in bone marrow and leukapheresis stemming from patients with efficient mobilization of hematopoietic cells. In purified CD34+ cell fractions, the CAFC yield per inoculated cell number was considerably higher than in MNC; however, if the CAFC number was related to the inoculated CD34+ cell number in MNC and after purification, the yield was four to eight times decreased in purified fractions. Addition of the mature cells brought the CAFC yield back up to the numbers obtained in the unseparated MNC fraction. By contrast, slightly more advanced progenitors per CAFC were found in cultures of purified hematopoietic cells from both origins than in whole MNC. The results suggest that mature human accessory cells give noticeable support to recruitment of early progenitors on this feeder but lead to lower yield of GM progenitors.

Primordial role of CD34+ 38- cells in early and late trilineage haemopoietic engraftment after autologous blood cell transplantation

In order to better define which cell subset contained in graft products might be the most predictive of haemopoietic recovery following autologous blood cell transplantation (ABCT), the relationships between the amounts of reinfused mononuclear cells (MNC), CFU-GM, total CD34+ cells and their CD33 and CD38 subsets. and the successive stages of trilineage engraftment kinetics, were studied in 45 cancer patients, using the Spearman correlation test, a linear regression model and a log-inverse model. No relationship was found between the infused numbers of MNC, CD33+ and CD33- subsets observed and the numbers of days to reach predetermined absolute neutrophil (ANC), platelet and reticulocyte counts. The infused numbers of CFU-GM, CD34+ and CD34+ 38+ cells correlated inconstantly with haemopoietic recovery parameters. The strongest and the most constant correlations were significantly observed between the infused numbers of CD34+ 38- cells and each trilineage engraftment parameter. The log-inverse model determined a threshold dose of 0.05 x 10(6) (= 5 x 10(4)) CD34+ 38- cells/kg, below which the trilineage engraftment kinetics were significantly slower and unpredictable. Post-transplant TBI-conditioning regimens increased the low cell dose-related delay of engraftment kinetics whereas post-transplant administration of haemopoietic growth factors (HGF) seemed to abrogate this delay. This would justify clinical use of HGF only in patients transplanted with CD34+ 38- cell amounts lower than the proposed threshold value. This study suggests that the CD34+ 38- subpopulation, although essentially participating in late complete haemopoietic recovery, is also composed of committed progenitor cells involved in early trilineage engraftment.

Thyroid testing using the Cobas Core immunoassay system. A multicentre study

The random access immunoanalyzer Cobas Core and the Cobas Core Thyroid Assays were assessed as to their clinical usefulness in the analysis of different thyroid diseases. Four centres participated in this study measuring the following five thyroid tests per sample on the instrument: thyrotropin, free thyroxine, thyroxine, triiodothyronine and free triiodothyronine. The assessment was based on studies of precision and clinical samples. Within- and between-series precisions showed a mean CV over all assays of 4.3 and 6.1%, respectively. Comparison of the test results with clinical data demonstrated that the Cobas Core results are in accordance with diagnosed thyroid diseases. A good discrimination between normal and disease status and between untreated and treated status was found. Furthermore, 370 sera measured with Technicon Immuno-1 TSH and FT4 assays were compared to the respective Cobas Core EIAs). A good correlation between the assays was demonstrated.

[Epidemiology of infantile asthma in the Le Havre region]

BACKGROUND

Prevalence of asthma is influenced by environmental factors which may be different from area to area.

POPULATION AND METHODS

A cross-sectional epidemiological survey was carried out among 1,395 children attending primary schools in the city of Le Havre and the canton of Fécamp (Haute-Normandie). Questionnaires including data about the disease, family history, environmental and socio-economic factors were completed by the school physician in presence of the parents.

RESULTS

Prevalence rate of asthma calculated from 1,193 questionnaires was 7.8%. The logistic regression curves pointed out four risk factors: family history of asthma (odds ratio: 2.52) or hay fever (OR: 1.98), atopic dermatitis (OR: 3.96), and parental smoking (OR: 1.79). Sex, socioeconomic status of parents, type of housing, presence of pets in the house were not related to prevalence of asthma. Frequency of cough during the day was only significantly different between both areas.

CONCLUSIONS

The high level of school absence (21.1%) and frequency of hospitalizations for acute asthma (20.4%) should lead health professionals and educators to improve management of asthma in these areas.

[Licit and illicit drug consumption in the school environment. Results of a cross-sectional epidemiologic survey carried out among 663 high school students in Le Havre]

A cross-sectional epidemiologic study was undertaken in 1988 in the city of Le Havre, in order to study the licit and illicit drug consumption of adolescents attending high schools. The regular consumption of alcohol was higher in boys (9.2% vs 5.8%) whereas girls smoked more (16.4% vs 12.5%). In the group (4.2%) of every day drinkers, cider was the first alcoholic beverage used. One of 5 adolescents had been drunk at least once in 6 months, those over 15 years of age being involved twice as often as the youngest (28.2% vs 14.1%). The use of neuropsychotropic drugs was independent of sex, age and performance in school. Typological classification according to patterns of alcohol and drug consumption identified 4 groups of adolescents: the excessive consumers (3.6%), the moderate (25.6%), the abstainers (58.1%) and the consumers of psychotropic drugs (12.7%). The distribution of adolescents into these classes was influenced by age and, to a lesser extent, by school performance.

[Consumption of legal and illegal drugs by school students from the region of Doubs]

Two surveys were carried out among high school students from the Doubs region in 1982 and 1985. Their objective was to determine how legal and illegal drugs were used and their importance among the target population. Alcohol was found to be more common among the male population and its consumption remained stable during the 1982-1985 period. The use of tobacco, however, increased dramatically, especially among females attending vocational schools. The surveys also revealed that the age at which smoking was attempted for the first time has lowered, family and school environment playing an important role. Of those students who smoked, 69% had parents and a close friend who smoked, whereas 16% had none in their immediate environment who smoked. It was noted that young girls used more often psycho-active medicines than boys. A noticeable increase in their use became evident especially in vocational schools. Of those students questioned, 43% of junior high school students, 10.3% of vocational school students and 14.8% of senior high school students, stated that they used illegal drugs and that their accessibility permitted a wide use of these products. Whatever the age or sex the following associations were the most significant: drugs-tobacco, drugs-alcohol, tobacco-alcohol. Health education must therefore make the promotion of preventive strategies, concerning legal and illegal drugs, a priority in the education of adolescents.

[A cooperative program for the prevention of domestic accidents in children at the department of the Doubs. II. Educative aspects and evaluation]

Effective prevention of domestic accidents in children includes regimental and/or legislative action, information for parents and education of the children. The latter two strategies have been applied in the deparment of the Doubs in a cooperative health promotion program. Preschool and kindergarten structures were chosen and the pedagogical project involved acquainting the children with the idea of danger by use of a kit prepared by the "Comité Français d'Education pour la Santé" (French Committee for health education). This study was set up in two stages: "experimental" in 2 schools (1983-1984) and "operational" in 40 schools (1984-1985). In order to evaluate it, the population was divided into a control group and an experimental group. A total of 5,720 tests were carried out among 520 children. 494 parents and 82 teachers answered the questionnaires sent to them. The teachers were generally very positive about the effectiveness of education about dangers and the teaching activities which could be employed: discovery of environment, awareness of body, a.s.o. The changes in attitude were real and enduring among children. The parents changed their behavior significantly concerning the storing of poisonous products (medicines and household cleaning products), which allows to feel that this program can be effective in terms of risk reduction.

[Cooperative program for domestic accidents of children in the department of Doubs. Epidemiological aspects]

This work presents the results of a survey carried out among 818 families in the department of the Doubs. Each family had a child between one and 6 years of age. Its aim was to come as close as possible to exploring morbidity in accidents by questioning parents about the accidents which took place a month before the investigation, and to study the influence of certain psychosocial factors on this pathology, for example the attitude of parents confronted with risks. The annual accident morbidity rate was 1,056 accidents per 1,000 children. In other words, each child has, on the average, one accident per year. Even though no significant difference between town and country has been noted, serious accidents occurred more frequently in rural areas. This may be explained by the way dangerous products are stored (medicines, household cleaning and agricultural products), looser parental surveillance (predominance at games outside home), as well as the fact that children are more often in the kitchen when they are indoors, which is potentially the most dangerous room. Classical notions of disturbing events occurring prior to the accident (divorce, moving, a.s.o.) and children who are "repeat offenders" have also been noticed. The examination of parental attitude in dealing with the possibility of accidents (instructive, lax or repressive) did not allow us to demonstrate in any significant way the influence of these attitudes on accidental morbidity. On the other hand the so-called "instructive" parents are the ones who best put away the poisonous products. There is therefore, an encouraging connection between attitude and behavior.