Management de la qualité et de la sécurité en radiothérapie « Quel rôle pour les qualiticiens ? » : exemple au centre Alexis-Vautrin

Since 2007, the Centre Alexis-Vautrin Cancer Institute in Nancy began its safety and quality assurance management policy in the department of radiation oncology. This development induced a collaborative workflow between the quality unit and the department of radiation oncology, with a definition of the responsibilities. The quality unit provides its methodology for the quality assurance, the professionals of the radiation oncology department their expertise. In parallel, a quality referee was nominated in the radiation oncology department to implement the projects for improvement, linked with the quality assurance unit, and under the control of the radiation oncology department staff.     

Impact of Leucine Supplementation on Exercise Training Induced Anti-Cardiac Remodeling Effect in Heart Failure Mice

Leucine supplementation potentiates the effects of aerobic exercise training (AET) on skeletal muscle; however, its potential effects associated with AET on cardiac muscle have not been clarified yet. We tested whether leucine supplementation would potentiate the anti-cardiac remodeling effect of AET in a genetic model of sympathetic hyperactivity-induced heart failure in mice (α_2A/α_2CARKO). Mice were assigned to five groups: wild type mice treated with placebo and sedentary (WT, n = 11), α_2A/α_2CARKO treated with placebo and sedentary (KO, n = 9), α_2A/α_2CARKO treated with leucine and sedentary (KOL, n = 11), α_2A/α_2CARKO treated with placebo and AET (KOT, n = 12) or α_2A/α_2CARKO treated with leucine and AET (KOLT, n = 12). AET consisted of four weeks on a treadmill with 60 min sessions (six days/week, 60% of maximal speed) and administration by gavage of leucine (1.35 g/kg/day) or placebo (distilled water). The AET significantly improved exercise capacity, fractional shortening and re-established cardiomyocytes’ diameter and collagen fraction in KOT. Additionally, AET significantly prevented the proteasome hyperactivity, increased misfolded proteins and HSP27 expression. Isolated leucine supplementation displayed no effect on cardiac function and structure (KOL), however, when associated with AET (KOLT), it increased exercise tolerance to a higher degree than isolated AET (KOT) despite no additional effects on AET induced anti-cardiac remodeling. Our results provide evidence for the modest impact of leucine supplementation on cardiac structure and function in exercised heart failure mice. Leucine supplementation potentiated AET effects on exercise tolerance, which might be related to its recognized impact on skeletal muscle.     

Direct, automated detection of rifampin-resistant Mycobacterium tuberculosis by polymerase chain reaction and single-strand conformation polymorphism analysis.

A rapid screening test was recently established for the detection of mutations in the rpoB gene of Mycobacterium tuberculosis, a region identified as the locus for rifampin resistance (Rifr). The detection method involved the amplification by polymerase chain reaction (PCR) of the Rifr region and the identification of mutations by single-strand DNA conformation polymorphism analysis (SSCP) of the amplification products. Experience using two different PCR-SSCP formats for the evaluation of BACTEC cultures and sputum is presented here; the previously described manual procedure for the detection for the detection of radiolabelled amplification products and an automated SSCP by which fluorescein-labelled products were detected on a Pharmacia DNA sequencer apparatus. All 17 different Rifr mutations known to date were consistently detected. PCR-SSCP could be used for the evaluation of minimally grown cultures (BACTEC 12B medium with a growth index of < or = 100) and for direct screening of microscopically positive sputa with greater than 10 organisms per field (magnification, x250). Implementation of this technique could result in rapid detection of rifampin resistance in M. tuberculosis, a marker of multidrug-resistant tuberculosis.     

A new procedure for large scale production and freezing of lymphokine activated killer (LAK) cells to be used in adoptive immunotherapy of cancer

A new procedure for activation of peripheral blood lymphocytes (PBL) with recombinant interleukin 2 (rIL2) is described. PBL obtained by leukapheresis were subjected to NH4Cl (ACK) treatment to clear erythrocyte contamination; Ficoll separation was not performed. PBL were subsequently seeded in 10-floor multitrays (Cell FactoryTM, CF), gasified and incubated at 37 degrees C for 3-4 days in a humidified 5% CO2 atmosphere. This procedure achieved an activation (evaluated as cytotoxicity and proliferation) comparable with that obtained by culturing PBL in small flasks. Optimal activation of PBL was achieved in CF even in the presence of granulocyte contamination of up to 40%. It was also possible to freeze, thaw and recover most of the frozen cells and their cytotoxic activity. With this procedure therefore large quantities of lymphokine activated killer cells (LAK) can be easily produced to be used in adoptive immunotherapy trials.     

Conformal radiotherapy in prostate cancer: for whom and how?]

External radiotherapy is one of the modalities used to cure localized prostate carcinoma. Most of localized prostate carcinomas, specially those of the intermediate prognostic group, may benefit from escalated dose above 70 Gy at least as regard biochemical and clinical relapse free survival. 3D-CRT allows a reduction of the dose received by organs at risk and an increase of prostate dose over 70 Gy. It is on the way to become a standard. Intensity modulated radiation therapy increases dose homogeneity and reduces rectal dose. These methods necessitate rigorous procedures in reproducibility, delineation of volumes, dosimetry, daily treatment. They need also technological and human means. It is clear that localized prostate cancer is a good example for evaluation of these new radiotherapy modalities.     

Giant cell lesion of the jaw. Case report

A case is presented of a male patient affected by a giant cell lesion of the jaw, which had two recurrences in 8 years. Histologically, the lesion appeared to be composed of giant cells and mononuclear cells. Histoenzymatic study demonstrated acid phosphatase in both types of cells, and beta-glucuronidase in giant cells only. In some nuclei of giant cells, ultrastructural investigation showed filaments or microtubular structures of variable length, with irregular transverse periodicity, in addition to other expected findings. These characteristic features, found in giant cells of some giant cell tumors of the long bones, have never before been reported in a giant cell lesion of the jaw. The results are considered in order to assess the diagnosis, and the pathologic profiles of giant cell reparative granuloma, and of giant cell tumor are critically discussed.     

Traditional cardiovascular risk factors in primary Sjogren's syndrome--role of dyslipidaemia

SIR, The development of precocious atherosclerosis with itsconsequences on cardiovascular (CV) mortality in some rheumaticdiseases, such as rheumatoid arthritis (RA) and systemic lupuserythematosus (SLE), is well established [1]. Although thereis evidence that both the disorders represent an independentrisk factor for CV disease, it is thought that traditional riskfactors, including dyslipidaemia, also may contribute to acceleratedatherosclerosis in these patients [1]. Primary Sjögren'ssyndrome (SS) is a systemic autoimmune disorder characterizedby chronic inflammation of exocrine glands.