The new Luminex model FlexMap 3D is progressively replacing the previous Luminex generation in HLA laboratories for the detection and identification of anti-HLA antibodies. FlexMap 3D Luminex promises a higher degree of sensitivity, which may lead to greater mean fluorescence intensities, depending on the anti-HLA beads kit supplier. Given that anti-HLA antibodies and potential donor specific antibodies monitoring rely on MFI variations, all kits routinely used and especially Single Antigen Beads assays must be compared. In the HLA Laboratory at Toulouse Hospital, we compared the two Luminex generations using LABScreen Mix, Panel Reactive Antibody and LABScreen Single Antigen from One Lambda and Lifecodes ID from Werfen suppliers. LABScreen Mix, Panel Reactive Antibodies and Single Antigen gave the same results with both Luminex platforms. It should be noted that a divider was applied to all results obtained with FlexMap 3D when using One Lambda kits, which enabled us to obtain comparable MFI. Lifecodes ID also showed a strong correlation with both Luminex instruments, but no divider was applied and higher MFI were attained on FlexMap 3D. Serial dilutions of two monoclonal antibodies also illustrated that MFI achieved with Single Antigen from Werfen on FlexMap 3D Luminex were closer to One Lambda values. All MFI obtained with One Lambda were virtually identical when using Labscan 200 or FlexMap 3D, allowing the switch to the new Luminex platform to be made without issue. MFI gained with Werfen was higher with FlexMap 3D Luminex, which increases sensitivity, and may facilitate MFI comparisons between the two suppliers.
OBJECTIVE:Chronic wounds, such as venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs), remain a major healthcare challenge, particularly in France, where their management is complex and resource-intensive. Technology lipido-colloid nano-oligosaccharide factor (TLC-NOSF) dressings have demonstrated the ability to modulate the wound microenvironment, inhibit excessive matrix metalloproteinase activity and accelerate healing. Despite strong evidence and national recommendations, their use in routine practice remains limited. The STARTLIFE study aimed to generate additional real-life evidence on the effectiveness of TLC-NOSF dressings in VLUs and DFUs across diverse care settings. METHOD:STARTLIFE was a prospective, multicentre, non-interventional French observational study. TLC-NOSF dressings (UrgoStart Plus Border/Pad, UrgoStart Contact, Laboratoires Urgo, France) were used according to clinical practice. The primary endpoint was complete healing within 12 weeks; secondary outcomes included wound healing progression and dressing performance. RESULTS:From June 2022-July 2024, 229 VLUs and 138 DFUs were included at 53 French sites. Among patients with VLUs, 44.5% achieved complete healing after 72 days, with a median healing time of 60 days. In patients with DFUs, 36.8% achieved complete closure after 78 days, with a median healing time of 64 days. Earlier initiation of TLC-NOSF treatment was associated with better outcomes in both groups. Both patient and clinician satisfaction with comfort and efficacy were high. CONCLUSION:The findings of the STARTLIFE study provide real-life evidence demonstrating the effectiveness, safety and high acceptability of TLC-NOSF dressings in the management of VLUs and DFUs when associated with appropriate standard of care. The diverse range of TLC-NOSF dressings supports personalised wound care and reinforces its use as a first-line intervention throughout the healing process.
Introduction Transthyretin cardiomyopathy (ATTR-CM) and aortic stenosis (AS) are two frequently associated pathologies. The diagnosis of ATTR-CM can be made by performing a cardiac amyloid radionuclide imaging (CARI) with a computed tomography (CT) scan to localize the signal, which allows to see aortic valve calcifications (AVC). Objective To determine whether AVC on the CT scan performed at the time of the CARI for the diagnosis of ATTR-CM were predictive of AS and had an impact on prognosis. Method Consecutive patients referred to nuclear medicine and diagnosed with ATTR-CM on bone scintigraphy after exclusion of monoclonal gammopathy were included. Patients with a history of aortic valve replacement were excluded. CT images performed for signal localization were reviewed for the presence of aortic calcifications. In the presence of calcifications, a calcium score was calculated from axial slices using a threshold of 130 Hounsfield units. Calcium score results were compared with aortic valve hemodynamic parameters assessed by transthoracic echocardiography to classify patients according to the presence and severity of AS. A three-stage visual score was developed to assess the extent of aortic valve calcifications (score 0: absence or spotty calcification; score 1:<50% of annulus circumference; score 2:≥50%). Receiver operating characteristic (ROC) analysis and Cox proportional hazards models were used for statistical analysis. Results Two hundred and sixty-three patients were included. Aortic calcifications based on visual score>0 were present in 153 (58%) patients. Among them, the median calcium score was 430 [200–1140]. A cut-off calcium score≥380 predicted AS with an area under the ROC curve of 0.93 (P<0.0001), sensitivity 91%, specificity 81%. For severe AS, a threshold≥1690 yielded an AUC of 0.98 (P<0.0001), allowing a sensitivity of 94% and a specificity of 96%. A visual score of 2 predicted severe AS with 94% sensitivity and 90% specificity. Both the aortic valve calcium score and visual score were independent predictors of all-cause mortality during follow-up (Fig. 1). Conclusion Aortic calcifications on CT scan of bone scintigraphy are found in almost two-thirds of patients with ATTR-CM. Assessed using both a semi-quantitative visual score and a calcium score, they are strong predictors of AS severity and mortality. A calcium score≥1690 and visual score 2 reliably identify severe AS.
Intermittent catheterisation (IC) is practised by patients with a variety of conditions that can affect bladder function, including spinal cord injury (SCI) and multiple sclerosis (MS). EMJ interviewed a multidisciplinary panel of HCPs involved in the care of patients using IC, including functional urologists, SCI experts, and continence nurses, to discuss benefits and limitations of polyvinylpyrrolidone (PVP) catheter coatings, which are widely used to reduce friction during catheterisation. Interviewees highlighted the value of hydrophilicity as an important catheter property conferred by PVP coatings, but also acknowledged concerns about adhesion of catheter coatings to the urethral mucosa, resulting in damage to the urothelium and deposition of PVP residues. The panel also discussed evolving catheter technology and alternative approaches to conferring hydrophilic surface properties without requiring application of coating material. Expert perspectives, based on extensive collective clinical experience combined with evaluation of scientific evidence from preclinical studies investigating the performance of PVP catheter coatings in vitro and ex vivo, were offered by Michael Kennelly, Atrium Health Wake Forest School of Medicine, Charlotte, North Carolina, USA; Xavier Gamé, Toulouse University Hospital, France; Stefania Musco, Careggi University Hospital, Florence, Italy; Todd Linsenmeyer, Kessler Institute for Rehabilitation, West Orange, New Jersey, USA; Andrei Krassioukov, University of British Columbia, Vancouver, Canada; Angie Rantell, King’s College Hospital NHS Foundation Trust and Brunel University, London, UK; Diane Newman, University of Pennsylvania, Philadelphia, USA; Piet Eelen, National Multiple Sclerosis Center Melsbroek, Steenokkerzeel, Belgium; and Ased Ali, Mid Yorkshire Teaching NHS Trust, Yorkshire and Convatec Ltd., Flintshire, Wales, UK.
