Annales de biologie clinique最新文献

Clinical biology plays a crucial role in healthcare. However, this specialty is facing a loss in attractiveness in medical studies. What is driving this decline in interest? Based on insights from the "Livre Blanc de la Formation en Biologie Médicale", written and validated by two unions representing laboratory medicine residents in France, and the insight of young clinical biologists, this article delves into young biologists' perspectives on their profession, through the eyes of the "New Generation in Clinical Biology" task force of the French Clinical Biology Society (SFBC). We explore key challenges our field will have to overcome for the new generation. At the same time, we shed light on their aspirations: modernizing missions, promoting research, and expanding career opportunities. Finally, we propose concrete solutions to revitalize the field and ensure a stronger integration of young professionals into the healthcare system.

Metformin is the first-line oral drug prescribed in type 2 diabetes. The main severe side effect of this drug is metformin associated lactic acidosis (MALA), which generally occurs accidentally and rarely in patients with renal failure. We present here a case of voluntary self-poisoning with metformin and antiretroviral therapy drugs. On admission, the patient showed lactic acidosis with a pH of 7.19 (normal ranges: 7.38-7.42) and lactates at 9.40 mmol/L (normal ranges: 0.50-2.20 mmol/L). Metformin and antiretroviral therapy intoxication was confirmed by detecting these drugs with high performance liquid chromatography coupled with diode array detector (HPLC-PDA) and a another HPLC with mass spectrometry (HPLC-MS) then by a metformin dosage at 814 mg/L (therapeutic ranges: 1-2 mg/L). During hospitalization, liver dysfunctionned, contributing to an altered lactate elimination. Therefore, lactic acidosis increased as the patient's state worsened. Therapeutics were inefficient, leading to patient's death 30 hours after presentation. This observation illustrates a rare case of voluntary intoxication with a high dose of metformin and its unusual association with antiretroviral therapy drugs, that could increase lactic acidosis and cause liver failure.

A 41-year-old woman presented to the emergency room for long-term dysphagia, with a loss of eight kilos in two months. Myositis or inflammatory myopathies were suspected. A marked increase in troponin T concentration was observed.

Nosocomial infections (NI) are a major concern of healthcare professionals. To propose targeted awareness-raising campaigns, we put in place NI monitoring of laboratory data. The positive bacteriological results after 48 hours hospitalisation are subject of a report via the Infection Control Team, to the physician corresponding in the department, for the clinical validation of diagnostic of NI. At hospital level and specialty activity, we measured NI incidence rates for 1 000 hospital days and for 100 admissions every month since October 1, 2016. Results were then declined by specialties and by infected anatomical site and investigation allowed to describe the microbial flora responsible for these infections. The request began in october 2016. Average results were stable over the year despite monthly fluctuations. For 2023, incidence rates are IAS 2,8 for 1 000 JH and IAS 1,2 for 100 admissions. The detail of the results is transmitted to the physicians and is the subject of internal communications. They will be allowed to follow up more closely with the NI epidemiology and propose targeted corrective measures as appropriate.

Polycythemia, characterized by an abnormal increase in red blood cells, can manifest as primary polycythemia (PV) or secondary polycythemia, often due to conditions like obstructive sleep apnea (OSA) and high-altitude polycythemia (HAP). Understanding the molecular mechanisms underlying these conditions is crucial for developing targeted therapies. Transcriptome analysis was performed to identify differentially expressed genes (DEGs), significant modules, and immune cell infiltration. We identified 370 DEGs and four significant gene co-expression modules closely related to HAP. Modules were associated with neutrophil migration, glycoprotein metabolism, UDP-N-acetylglucosamine synthesis, and red pulp cells. These modules showed the same directions of change in OSA but were reversed when treated with continuous positive airway pressure therapy. Comparison with GWAS showed that overlapping genes were related to oxygen transport in the DEGs. PRDM1 and NCOA1, NFE2 were identified as key transcription factors. Noca1 knockout mice showed elevated levels of red blood cell count (RBC), hemoglobin (HGB), and hematocrit (HCT). Lomustine and hydralazine emerged as potential candidate drugs for treating polycythemia. Abdominal breathing training for three months improved symptoms and reduced RBC, HGB, and HCT in 33 HAP patients. These findings elucidate HAP's molecular mechanisms and suggest new therapeutic directions.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by loss of B cell tolerance to self antigens resulting in the production of a wide variety of auto antibodies. The objective of this study was the assessment of serum free light chains (FLC) assay in patients with SLE. In this study, 156 patients (142 women and 14 men, mean age 35.6 years) and 60 healthy subjects (55 women and 5 men, mean age 36.4 years) were included. The kappa (κ) and lambda (λ) FLC were measured by turbidimetry method. The analysis of our results showed that the FLC rates κ and λ were significantly higher in patients compared to controls (44.52 vs. 8,55 mg/L, P = 0.0001 for FLC κ and 33.43 vs. 12,99 mg/L, P = 0.0001 for FLC λ). In addition, significant associations were noted between the increase in FLC κ, λ and disease activity (P = 0.006 and P = 0.008 respectively), as well as with the presence of lupus nephritis (P = 0.044 and p = 0.045). The increase of the serum FLC during SLE could be a useful marker for assessing the disease activity and the risk of lupus nephritis.

Available data on the potential use of thrombin generation (TG) assays in clinical practice is promising but larger studies involving several centers are needed to confirm this added-value for clinical purposes. The objective of this evaluation was to assess the analytical performances of the ST Genesia using STG-ThromboScreen, STG-BleedScreen, and STG-DrugScreen reagents across three centers to support its use in multicenter studies. Repeatability and reproducibility have been evaluated using commercial plasmas and quality control (QC) samples. Accuracy was assessed by calculating QC biases from the manufacturer's assigned values. Frozen plasma samples from healthy donors and patients having thrombophilia, hemorrhagic disorders, or taking anticoagulants allowed the comparison of TG parameters between the analyzers from two French centers. Repeatability and reproducibility CVs were respectively below 5% and 10% whatever the reagent and the sample used. The later fell under 6% after normalization. Mean biases between observed and assigned QC values provided by the manufacturer were less than 5% for most TG parameters. We found a good agreement for all TG parameters between the two evaluating centers. Relative bias was below 5% for all combination of parameters and reagents except for Peak height (+14.2%), ETP (+7.3%), and ETP inhibition (-12.0%) using STG-ThromboScreen. We found satisfactory repeatability, reproducibility, accuracy, and inter-laboratory variability for TG parameters using the three available reagents across three centers, supporting the use of ST Genesia in multicenter clinical trials.

The "Emergency Biology" working group of the French Society of Clinical Biology (SFBC) presents in this article its recommendations for the application of article L6211-18 of the Public Health Code, when the analytical phase of a medical biology examination cannot be carried out in a medical laboratory within a time frame compatible with the patient's state of health. A proposal for a list of examinations that may be carried out outside the laboratory (point-of-care testing - POCT) is made, by associating the elements justifying this delocalization: clinical contexts concerned and maximum time limits for carrying out the examination in these contexts if the examination is carried out within the LBM. These recommendations are to be adapted within the framework of local clinic biological agreements.