Avancées thérapeutiques majeures et nouvelles perspectives en onco-hématologie

Hematology Oncology has a rich history including few crucial therapeutic innovations. These were possible because of the evolution of the cell and molecular biology allowing a better understanding of basic mechanisms of cancerogenesis. We propose here to summarize the most important therapeutic innovations since the beginning of Hematology/Oncology history. We also describe evolution of therapeutic strategies themselves. New insights and therapeutic perspectives for next future are also discussed.     

Is periodontal disease mediated by salivary BAFF in Sjögren's syndrome?

OBJECTIVE: To correlate the periodontal status of 15 patients with primary Sj?gren's syndrome (SS) with their salivary levels of BAFF. METHODS: The periodontal status of 15 patients who fulfilled the criteria for primary SS was compared with that of 15 controls with xerostomia who did not fulfill the criteria for primary SS but had similar symptoms of dry mouth. The level of BAFF was measured in paired samples of saliva and serum using in-house enzyme-linked immunosorbent assays. Periodontitis was assessed by the plaque index, the modified gingival index, the papillary bleeding index, and the periodontal pocket depth. RESULTS: Notwithstanding the better oral hygiene practices of the patients with primary SS compared with those of the xerostomia controls and the subsequent reduction of their plaque index scores, complications of periodontitis, such as bleeding, gingival hypertrophy, and periodontal pockets, were not improved. This failure to ameliorate the complications of periodontitis in patients with primary SS was associated with high levels of BAFF in their saliva compared with the levels in xerostomia controls (7.4 +/- 2.1 versus 1.0 +/- 0.4 ng/ml [P < 0.002]). The levels of BAFF in saliva did not correlate with the levels in sera but did correlate with the periodontal pocket depth (P < 0.002). CONCLUSION: These findings are similar to the bone resorption observed in patients with rheumatoid arthritis. They suggest that the known effect of B cells in periodontitis would be partly mediated by salivary BAFF in patients with primary SS.     

La mort d’un enfant : processus de deuil dans le groupe familial

The death of a child is a family cataclysm which confronts violently each of the members of the family to a loss of one of theirs, the psychic consequences of this mourning are numerous. This article is originate from the clinical experience of the authors in the care of the mourning families, analyzes the processes in the work when the death of a child comes to upset the family dynamics. It studies the specificities of the mourning of the parental side and towards (as for) the sibship and envisages the possible reorganizations for each of the members of the family. Finally, it opens tracks for modalities of care allowing to accompany these mourning families to take care of each, but also on the sibship, on the parental couple and on the family's group.     

Autonomic control of cardiovascular dynamics during weightlessness

Measuring cardiovascular dynamics is a new method of assessing the autonomic regulation of the cardiovascular system, it provides an easily-implemented non-invasive way of monitoring the effects of weightlessness on this regulatory function. The major findings of studies on cardiovascular dynamics during actual or simulated weightlessness are presented, taking into account the recent consensus on this approach. Future improvements of these studies are discussed.     

Late hemodynamic changes during a negative passive head-up tilt predict the symptomatic outcome to a nitroglycerin sensitized tilt

BACKGROUND: Sublingual nitroglycerin is advocated to sensitize the passive 70 degrees head-upright tilt test (HUTT) of patients with unexplained syncope. We hypothesized that a detailed analysis of hemodynamic responses recorded during a negative HUTT could predict the outcome to a subsequent nitroglycerin sensitized HUTT (NTG-HUTT). METHODS: Thirty-two patients (46 +/- 3 years, 17 males) with recurrent unexplained syncope but a negative HUTT were included. Heart rate, arterial blood pressure, and central hemodynamics assessed by transthoracic impedance (preejection and rapid left ventricular ejection time, slow ejection time, peak amplitude of first derivative, and cardiac index) were recorded during supine rest and 45 minutes HUTT. Changes from supine rest of the variables were retrospectively compared between patients with a negative (n = 15, NTG-HUTT(-)) and positive (n = 17, NTG-HUTT(+)) outcome to 10 minutes subsequent NTG-HUTT. RESULT: Significant differences between groups were observed during the 15th-20th minutes (Italian protocol) and during the last 5 minutes of passive HUTT (Westminster protocol). The combination of cutoff values, determined by receiver operating curves, on hemodynamic variables changes during the last 5 minutes predicted the outcome to a NTG-HUTT with a sensitivity of 76% and a specificity of 87%. The cutoff values determined during 15th-20th minutes gave an attractive sensitivity (85%) but a too weak specificity (53%) to shorten the 45 minutes passive HUTT at 20 minutes. CONCLUSION: Outcome to a NTG-HUTT can be reliably predicted by selected criteria determined from multiple hemodynamic variables recorded during a passive 70 degrees HUTT.     

Perceptual context-dependent remodeling of the forepaw map in the SI cortex of rats trained on tactile discrimination

We combined behavioral assessment of texture discrimination and electrophysiological mapping of concomitant reorganization in the forepaw representation within the SI cortex. Rats were housed in enriched (EE) or impoverished (IE) environments which have been shown to remodel the forepaw map and possibly alter discriminative abilities. In addition, animals were trained to discriminate homogeneous floorboards of invariant roughness from heterogeneous floorboards of gradually decreasing roughness contrasts during locomotion. As reported recently, differences in perceptual abilities were not related to housing conditions, but to a predilection for a floorboard type [Bourgeon S, Xerri C, Coq JO. Abilities in tactile discrimination of textures in adult rats exposed to enriched or impoverished environments. Behav Brain Res 2004;153:217-231]. Consistently, the present study shows that cortical map remodeling resulting from short-duration daily experience can prevail over changes induced by housing conditions. The relative area of glabrous skin representation was related to the discrimination performance and learning abilities in the rats (H) with a predilection for heterogeneous floorboards, i.e. in the animals performing discrimination in the most challenging perceptual context. By contrast, this cortical area was influenced by the duration of sensory experience in rats (h) with a predilection for homogeneous floorboards. Both EE condition and training to discrimination selectively decreased the sizes of the SI neurons' receptive fields (RFs) located on glabrous skin. Smaller RFs and larger cortical areas serving glabrous skin were correlated with better perceptual performances and learning abilities in the H rats only. The present study shows that representational reorganization related to tactile discrimination performances depends upon the perceptual context.