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Trandafir C, Couloigner V, Chatelet F, Fauroux B, Luscan R. Lingual Tonsillectomy as Part of a DISE-Directed Multilevel Upper Airway Surgery to Treat Complex Pediatric OSA: A Safe and Appropriate Procedure. Otolaryngol Head Neck Surg 2024. [PMID: 39148289 DOI: 10.1002/ohn.947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 07/15/2024] [Accepted: 08/03/2024] [Indexed: 08/17/2024]
Abstract
OBJECTIVE To study the efficiency of lingual tonsillectomy (LT) as part of multilevel surgery in children with complex obstructive sleep apnea (OSA). To evaluate the safety and the outcomes of LT. STUDY DESIGN Retrospective case series. SETTING Pediatric tertiary care academic center. METHODS We included all children operated for LT to treat complex OSA, from January 2018 to June 2022. All patients underwent a protocolized drug-induced sleep endoscopy (DISE) followed by a coblation LT, associated with the treatment of all other obstructive sites. Patient demographics, medical history, surgery, and outcomes were reviewed. The efficiency of LT was analyzed exclusively in patients with a preoperative and postoperative sleep study. RESULTS One hundred twenty-three patients were included. Median age was 8 years (interquartile range, IQR [3-12]). Sixty-five (53%) patients had Down syndrome, 22 (18%) had a craniofacial malformation, and 8 (7%) were obese. LT was associated with adenoidectomy (n = 78, 63%), partial tonsillectomy (n = 70, 57%), inferior turbinoplasty/turbinectomy (n = 59, 48%), epiglottoplasty (n = 92, 75%), and/or expansion pharyngoplasty (n = 2, 2%). Eighty-nine patients underwent a sleep study before and after surgery. The median apnea-hypopnea index (AHI) decreased from 18 events/h (IQR [9-36]) before surgery to 3 events/h (IQR [1-5]) after surgery (P < .001) (patients with a postoperative AHI <1.5 events/h, n = 31, 35%, and an AHI <5 events/h, n = 32, 36%). Seventeen out of 30 (57%) patients could be weaned from continuous positive airway pressure after surgery. Two patients had a postoperative hemorrhage and 2 patients required a transient postoperative reintubation. CONCLUSION In children with complex OSA, LT as part of a DISE-directed multilevel upper airway surgery, was a very efficient and safe procedure.
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Affiliation(s)
- Cornelia Trandafir
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
| | - Florian Chatelet
- Faculté de Médecine, Université Paris Cité, Paris, France
- Department of Otolaryngology, AP-HP, Hôpital Lariboisière, Paris, France
| | - Brigitte Fauroux
- Pediatric Sleep and Noninvasive Ventilation Unit, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
- EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris Cité University, Paris, France
| | - Romain Luscan
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
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Linglart L, Malekzadeh-Milani S, Gaudin R, Raisky O, Bonnet D. Outcomes of coronary artery obstructions after the arterial switch operation for transposition of the great arteries. J Thorac Cardiovasc Surg 2024; 168:331-341.e4. [PMID: 38006998 DOI: 10.1016/j.jtcvs.2023.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/17/2023] [Accepted: 11/09/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVE Coronary obstruction is a rare but common complication of the arterial switch operation for transposition of the great arteries. The majority of patients remain asymptomatic and no risk factors allow targeting for reinforced surveillance. We aim to review the natural history of patients diagnosed with coronary obstruction after arterial switch operation for transposition of the great arteries and occurrence of coronary-related outcomes. METHODS We retrospectively reviewed medical records of the 102 patients diagnosed with coronary obstruction after arterial switch operation for transposition of the great arteries in our institution from 1981 to 2022. Outcomes were anti-ischemic treatment introduction, revascularization (surgical or percutaneous angioplasty), and death; investigations that motivated revascularization were also reviewed. RESULTS Twenty-eight out of 102 patients presented with myocardial ischemia during the immediate postoperative phase, 31 were diagnosed when symptomatic, and 43 were identified at the presymptomatic stage, according to our screening policy in preschool-aged children. Stenosis-related event occurrence was, respectively, 29 out of 31 and 32 out of 43 in the latter 2 subgroups. Coronary-related mortality reached 10% in patients diagnosed when symptomatic; no patients died in the presymptomatic subgroup. Of the 28 low-risk patients with no signs of ischemia at diagnosis, 10 developed obstruction warranting reintervention during follow-up. Revascularization was motivated by appearance of symptoms in patients with severe stenosis in normal coronary dispositions, and by clinical symptoms or documented silent ischemia in abnormal coronary patterns. CONCLUSIONS Occurrence of stenosis-related events remains significant in patients after arterial switch operation, underlining the importance of early diagnosis for timely intervention. Initial anatomical evaluation identifies stenotic and at-risk patients; this will require periodical function testing. Follow-up modalities can be tailored to a patient's individual anatomic characteristics.
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Affiliation(s)
- Léa Linglart
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France; Sorbonne Université, Paris, France
| | - Sophie Malekzadeh-Milani
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Régis Gaudin
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Olivier Raisky
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Damien Bonnet
- Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France; Université de Paris Cité, Paris, France.
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Preka E, Miller N, Avramescu M, Berteloot L, Vinit N, Botto N, Grapin M, Prévot M, Boistault M, Garcelon N, Taghavi K, Schrimpf C, Cohen JF, Blanc T, Boyer O. Vesico-ureteral reflux diagnosis after initial kidney abscess: Results from a Paediatric Tertiary Hospital. Acta Paediatr 2024. [PMID: 38967007 DOI: 10.1111/apa.17353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
AIMS Guidelines regarding voiding cystourethrogram (VCUG) indications following a paediatric kidney abscess are lacking. This study evaluates vesicoureteral reflux (VUR) prevalence and outcome after a first kidney abscess. METHODS This retrospective study included all children presenting to a tertiary paediatric reference centre with de-novo kidney abscesses from 2011 to 2022, diagnosed through imaging (ultrasonography or computed tomography). VCUG's clinical utility was assessed by exploring outcomes related to interventions. RESULTS Among the 17 patients (median age 9 months, IQR; 6 months-6 years), VCUG identified VUR in 7 (41%; 95% CI: 18-65%), including two with grade IV-V. Median abscess size was 19 mm (IQR; 14-27). 7/8 (88%) children with DMSA scan presented scars, including 4 with hypofunctioning (20%-44%), and one with a non-functioning kidney. Scarring on the DMSA scan was similar regardless of identified VUR. Six children had subsequent pyelonephritis. Three of the remaining 11 had grade I-III and two IV-V VUR. Surgery was required in four children overall: three for recurrent pyelonephritis and one for high-grade VUR and scars. CONCLUSION Among initial kidney abscess cases, 41% had VUR, similar to children experiencing their first uncomplicated pyelonephritis. VCUG results guided antibiotic prophylaxis but not surgical decisions. We suggest considering VCUG following recurrent pyelonephritis/kidney abscess and/or kidney scarring.
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Affiliation(s)
- Evgenia Preka
- Université Paris Cité, INSERM U970, PARCC, Paris Translational Research Centre for Organ, Transplantation, Paris, France
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | | | - Marina Avramescu
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | - Laureline Berteloot
- Imagerie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, APHP, Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | - Nicolas Vinit
- Chirurgie et Urologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France
| | - Nathalie Botto
- Chirurgie et Urologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France
| | - Mathilde Grapin
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | - Maud Prévot
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | - Margaux Boistault
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | - Nicolas Garcelon
- Data Science Platform, Imagine Institute, INSERM U1163, Université Paris Cité, Paris, France
| | - Kiarash Taghavi
- Department of Paediatric Urology, Monash Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Cécile Schrimpf
- Urgences Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, APHP, Paris, France
| | - Jérémie F Cohen
- Pédiatre Générale et Maladies Infectieuses Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France
| | - Thomas Blanc
- Chirurgie et Urologie Pédiatriques, Hôpital Universitaire Necker-Enfants Malades, APHP, Université Paris Cité, Paris, France
| | - Olivia Boyer
- Néphrologie Pédiatrique, Centre de Référence MARHEA, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris (APHP), Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
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Nguyen AT, Cotteret C, Gins C, Sarda E, Durrleman C, Mesples B, Bustamante J, Fayard C, Cisternino S, Desguerre I, Aubart M. Safety of Obinutuzumab in Children With Autoimmune Encephalitis and Early B-Cell Repopulation on Rituximab. Pediatr Neurol 2024; 156:79-84. [PMID: 38733858 DOI: 10.1016/j.pediatrneurol.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/07/2024] [Accepted: 04/12/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Rituximab (RTX) resistance or early B-cells repopulation were observed in children but only few publications reported the use of Obinutuzumab and no recommendations were made concerning the dosage for children. METHODS This study was a single-center retrospective cohort study of all the children followed-up in the Pediatric Neurology Department of Necker-Enfants malades Hospital in Paris, France, and treated with obinutuzumab, between November 1, 2019, and November 1, 2021. RESULTS A total of eight children (three females, median age 4.5 years) were treated. Seven patients presented with autoimmune encephalitis and one with myeloradiculitis. The median delay of B-cell repopulation after a course of RTX was 87 days (range 41 to 160). A switch to obinutuzumab (anti-CD20) was performed for eight children. The median duration between the first RTX infusion and obinutuzumab administration was 6.6 months. The dosage regimen for obinutuzumab was one infusion of 1000 mg/1.73 m2, that is to say 580 mg/m2 (maximum 1000 mg/infusion), by extrapolation from the adult dosage. The median delay of B-cell repopulation after one course of obinutuzumab was 230 days (range 66 to 303 days) vs 87 days after one course of RTX (P < 0.01). None of the patients presented side effects with obinutuzumab treatment. All patients had a favorable evolution at the last-follow up. Median follow-up was 1.6 years. CONCLUSIONS This study reports the use of obinutuzumab in neurological inflammatory diseases in a pediatric population. Obinutuzumab seems to have a better biological efficacy than RTX with a longer time of B-cell repopulation.
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Affiliation(s)
- Ai-Tien Nguyen
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, University of Paris Cité, AP-HP, Paris, France
| | - Camille Cotteret
- Department of Clinical Pharmacy, Necker-Enfants Malades Hospital, University of Paris Cité, AP-HP, Paris, France
| | - Clarisse Gins
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, University of Paris Cité, AP-HP, Paris, France
| | - Eugénie Sarda
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, University of Paris Cité, AP-HP, Paris, France
| | - Chloé Durrleman
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, University of Paris Cité, AP-HP, Paris, France
| | - Bettina Mesples
- Department of Pediatrics, Louis Mourier Hospital, University of Paris Cité, AP-HP, Paris, France
| | - Jacinta Bustamante
- Study Center for Primary Immunodeficiencies, Necker-Enfants Malades Hospital, University of Paris Cité, AP-HP, Paris, France; Faculty of Pharmacy, Team Blood-Brain Barrier in Brain Pathophysiology and Therapy, University of Paris Cité, INSERM UMRS 1144, Paris, France
| | - Claire Fayard
- Department of Clinical Pharmacy, Necker-Enfants Malades Hospital, University of Paris Cité, AP-HP, Paris, France
| | - Salvatore Cisternino
- Department of Clinical Pharmacy, Necker-Enfants Malades Hospital, University of Paris Cité, AP-HP, Paris, France; Faculty of Pharmacy, Team Blood-Brain Barrier in Brain Pathophysiology and Therapy, University of Paris Cité, INSERM UMRS 1144, Paris, France
| | - Isabelle Desguerre
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, University of Paris Cité, AP-HP, Paris, France
| | - Mélodie Aubart
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, University of Paris Cité, AP-HP, Paris, France; Human Genetics of Infectious Diseases, INSERM UMR 1163, University of Paris Cité, Institut Imagine, Paris, France.
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Van Coillie S, Prévot J, Sánchez-Ramón S, Lowe DM, Borg M, Autran B, Segundo G, Pecoraro A, Garcelon N, Boersma C, Silva SL, Drabwell J, Quinti I, Meyts I, Ali A, Burns SO, van Hagen M, Pergent M, Mahlaoui N. Charting a course for global progress in PIDs by 2030 - proceedings from the IPOPI global multi-stakeholders' summit (September 2023). Front Immunol 2024; 15:1430678. [PMID: 39055704 PMCID: PMC11270239 DOI: 10.3389/fimmu.2024.1430678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/13/2024] [Indexed: 07/27/2024] Open
Abstract
The International Patient Organisation for Primary Immunodeficiencies (IPOPI) held its second Global Multi-Stakeholders' Summit, an annual stimulating and forward-thinking meeting uniting experts to anticipate pivotal upcoming challenges and opportunities in the field of primary immunodeficiency (PID). The 2023 summit focused on three key identified discussion points: (i) How can immunoglobulin (Ig) therapy meet future personalized patient needs? (ii) Pandemic preparedness: what's next for public health and potential challenges for the PID community? (iii) Diagnosing PIDs in 2030: what needs to happen to diagnose better and to diagnose more? Clinician-Scientists, patient representatives and other stakeholders explored avenues to improve Ig therapy through mechanistic insights and tailored Ig preparations/products according to patient-specific needs and local exposure to infectious agents, amongst others. Urgency for pandemic preparedness was discussed, as was the threat of shortage of antibiotics and increasing antimicrobial resistance, emphasizing the need for representation of PID patients and other vulnerable populations throughout crisis and care management. Discussion also covered the complexities of PID diagnosis, addressing issues such as global diagnostic disparities, the integration of patient-reported outcome measures, and the potential of artificial intelligence to increase PID diagnosis rates and to enhance diagnostic precision. These proceedings outline the outcomes and recommendations arising from the 2023 IPOPI Global Multi-Stakeholders' Summit, offering valuable insights to inform future strategies in PID management and care. Integral to this initiative is its role in fostering collaborative efforts among stakeholders to prepare for the multiple challenges facing the global PID community.
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Affiliation(s)
- Samya Van Coillie
- International Patient Organisation for Primary Immunodeficiencies (IPOPI), Brussels, Belgium
| | - Johan Prévot
- International Patient Organisation for Primary Immunodeficiencies (IPOPI), Brussels, Belgium
| | - Silvia Sánchez-Ramón
- Department of Clinical Immunology, Health Research Institute of the Hospital Clínico San Carlos/Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IML and IdISSC), Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - David M. Lowe
- Department of Immunology, Royal Free London National Heath System (NHS) Foundation Trust, London, United Kingdom
- Institute of Immunity and Transplantation, University College London, London, United Kingdom
| | - Michael Borg
- Department of Infection Control & Sterile Services, Mater Dei Hospital, Msida, Malta
| | - Brigitte Autran
- Sorbonne-Université, Cimi-Paris, Institut national de la santé et de la recherche médicale (INSERM) U1135, centre national de la recherche scientifique (CNRS) ERL8255, Université Pierre et Marie Curie Centre de Recherche n°7 (UPMC CR7), Paris, France
| | - Gesmar Segundo
- Departamento de Pediatra, Universidade Federal de Uberlândia, Uberlandia, MG, Brazil
| | - Antonio Pecoraro
- Transfusion Medicine Unit, Azienda Sanitaria Territoriale, Ascoli Piceno, Italy
| | - Nicolas Garcelon
- Université de Paris, Imagine Institute, Data Science Platform, Institut national de la santé et de la recherche médicale Unité Mixte de Recherche (INSERM UMR) 1163, Paris, France
| | - Cornelis Boersma
- Health-Ecore B.V., Zeist, Netherlands
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
- Department of Management Sciences, Open University, Heerlen, Netherlands
| | - Susana L. Silva
- Serviço de Imunoalergologia, Unidade Local de Saúde de Santa Maria, Lisbon, Portugal
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Jose Drabwell
- International Patient Organisation for Primary Immunodeficiencies (IPOPI), Brussels, Belgium
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Isabelle Meyts
- Department of Pediatrics, University Hospitals Leuven, Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Adli Ali
- Department of Paediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, Universiti Kebangsaan Malaysia (UKM) Specialist Children’s Hospital, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Siobhan O. Burns
- Department of Immunology, Royal Free London National Heath System (NHS) Foundation Trust, London, United Kingdom
- Institute of Immunity and Transplantation, University College London, London, United Kingdom
| | - Martin van Hagen
- Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Immunology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Martine Pergent
- International Patient Organisation for Primary Immunodeficiencies (IPOPI), Brussels, Belgium
| | - Nizar Mahlaoui
- Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Enfants malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- French National Reference Center for Primary Immune Deficiencies (CEREDIH), Necker-Enfants malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Guérin J, Hennocq Q, Paternoster G, Arnaud É, Khonsari RH. Distractor position and distraction amplitude in fronto-facial monobloc advancement : A case series. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024:101942. [PMID: 38897383 DOI: 10.1016/j.jormas.2024.101942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
Fronto-facial monobloc advancement with internal distraction (FFMBA) is a central procedure in the management of faciocraniosynostoses. In techniques with internal distraction, two sets of devices are generally positioned: bilateral fronto-orbital and temporo-zygomatic distractors, using a temporal tongue and groove osteotomy design. It is believed that distractors must be positioned as parallel as possible in the horizontal and sagittal planes to avoid mechanical conflicts between the sliding bone fragments of the tongue and groove during distraction, and thus optimize the advancement amplitude. Several approaches involving surgical planification and guides for distractor positioning have thus been proposed to monitor distractor placement. To explore the need for surgical planification in distractor placement, the parallelism of the position of the 4 distractors was assessed in 19 FFMBA procedures and we correlated a set of 10 distractor angles with the degree of advancement. We report that the horizontal cut of the tongue and groove can be used as a landmark for the positioning of the lower, temporo-zygomatic, distractor in fronto-facial monobloc advancement. Other parameters (relative position of the two homolateral and the two contralateral distractors and the orientations of the vertical and horizontal cuts of the tongue and groove) do not interfere with distraction, other things being equal. Our results indicate that distractor orientation is not a critical issue in fronto-facial monobloc advancement when devices are positioned as parallel as possible based on visual monitoring.
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Affiliation(s)
- Jade Guérin
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Quentin Hennocq
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France; Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Giovanna Paternoster
- Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Éric Arnaud
- Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France; Clinique Marcel Sembat, Ramsay, Boulogne-Billancourt, France
| | - Roman Hossein Khonsari
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France; Unité fonctionnelle de chirurgie craniofaciale, Service de neurochirurgie pédiatrique, CRMR CRANIOST, Filière TeteCou, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France.
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Simon F, Remangeon F, Loundon N, Leboulanger N, Couloigner V, Garabédian N, Denoyelle F. Pediatric Cholesteatoma Follow-Up: Residual and Recurrence in 239 Cases with Over 5-Year Hindsight. Laryngoscope 2024. [PMID: 38855882 DOI: 10.1002/lary.31567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/29/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Pediatric cholesteatoma is an aggressive disease which requires long-term evaluation to assess management strategies. The objective was to determine optimal follow-up duration in pediatric cholesteatoma to detect residual and recurrent diseases. METHODS This cohort study was set in a tertiary referral center. All consecutive patients with a minimum 5-year follow-up were included. Medical history, initial extension, surgical procedures, and follow-up were collected. The main outcome measure were Kaplan-Meier survival curves of residual and recurrence cumulative incidence. RESULTS Totally 239 ears with the first tympanoplasty between 2008 and 2014 were studied including 25% congenital. At first surgery (S1), mean age was 8.4 years and mean follow-up time 7.9 years. Mastoidectomy was performed in 69% and stapes was absent in 38% of cases. Notably, 83% (199 ears) had a second procedure (S2) of which 186 were planned. After S1, maximum cumulated incidence of residual was 45% [95%CI, 38%; 52%] at 74 months, with probability of residual of 39% at 3 years. After S2 (n = 199), maximum cumulated residual incidence was 21% [95%CI, 12%; 32%] at 62 months and 16% at 3 years. Concerning recurrence, maximum cumulated incidence after S1 (n = 239) was reached at 98 months with 21% [95%CI, 12%; 32%], 13% at 3 years and 16% at 5 years. Congenital disease had significantly less residuals after S1 (p = 0.02), but similar recurrence rate (p = 0.66) compared with acquired. CONCLUSIONS AND RELEVANCE We recommend MRI follow-up of at least 5 years after the last surgery for residual disease and clinical follow-up of at least 10 years to detect recurrence. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
- François Simon
- Université Paris Cité, Paris, France
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Remangeon
- Université Paris Cité, Paris, France
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Natalie Loundon
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Université Paris Cité, Paris, France
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Université Paris Cité, Paris, France
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Noel Garabédian
- Université Paris Cité, Paris, France
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Denoyelle
- Université Paris Cité, Paris, France
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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8
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Faviez C, Chen X, Garcelon N, Zaidan M, Billot K, Petzold F, Faour H, Douillet M, Rozet JM, Cormier-Daire V, Attié-Bitach T, Lyonnet S, Saunier S, Burgun A. Objectivizing issues in the diagnosis of complex rare diseases: lessons learned from testing existing diagnosis support systems on ciliopathies. BMC Med Inform Decis Mak 2024; 24:134. [PMID: 38789985 PMCID: PMC11127295 DOI: 10.1186/s12911-024-02538-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND There are approximately 8,000 different rare diseases that affect roughly 400 million people worldwide. Many of them suffer from delayed diagnosis. Ciliopathies are rare monogenic disorders characterized by a significant phenotypic and genetic heterogeneity that raises an important challenge for clinical diagnosis. Diagnosis support systems (DSS) applied to electronic health record (EHR) data may help identify undiagnosed patients, which is of paramount importance to improve patients' care. Our objective was to evaluate three online-accessible rare disease DSSs using phenotypes derived from EHRs for the diagnosis of ciliopathies. METHODS Two datasets of ciliopathy cases, either proven or suspected, and two datasets of controls were used to evaluate the DSSs. Patient phenotypes were automatically extracted from their EHRs and converted to Human Phenotype Ontology terms. We tested the ability of the DSSs to diagnose cases in contrast to controls based on Orphanet ontology. RESULTS A total of 79 cases and 38 controls were selected. Performances of the DSSs on ciliopathy real world data (best DSS with area under the ROC curve = 0.72) were not as good as published performances on the test set used in the DSS development phase. None of these systems obtained results which could be described as "expert-level". Patients with multisystemic symptoms were generally easier to diagnose than patients with isolated symptoms. Diseases easily confused with ciliopathy generally affected multiple organs and had overlapping phenotypes. Four challenges need to be considered to improve the performances: to make the DSSs interoperable with EHR systems, to validate the performances in real-life settings, to deal with data quality, and to leverage methods and resources for rare and complex diseases. CONCLUSION Our study provides insights into the complexities of diagnosing highly heterogenous rare diseases and offers lessons derived from evaluation existing DSSs in real-world settings. These insights are not only beneficial for ciliopathy diagnosis but also hold relevance for the enhancement of DSS for various complex rare disorders, by guiding the development of more clinically relevant rare disease DSSs, that could support early diagnosis and finally make more patients eligible for treatment.
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Affiliation(s)
- Carole Faviez
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université Paris Cité, Paris, F-75006, France.
- HeKA, Inria Paris, Paris, F-75012, France.
- Universite Paris Cite, Paris, France.
| | - Xiaoyi Chen
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université Paris Cité, Paris, F-75006, France
- HeKA, Inria Paris, Paris, F-75012, France
- Data Science Platform, Université Paris Cité, Imagine Institute, INSERM UMR 1163, Paris, F-75015, France
| | - Nicolas Garcelon
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université Paris Cité, Paris, F-75006, France
- HeKA, Inria Paris, Paris, F-75012, France
- Data Science Platform, Université Paris Cité, Imagine Institute, INSERM UMR 1163, Paris, F-75015, France
| | - Mohamad Zaidan
- Service de Néphrologie, Dialyse et Transplantation, Hôpital Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), Kremlin Bicêtre, F-94270, France
| | - Katy Billot
- Laboratory of Renal Hereditary Diseases, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, F-75015, France
| | - Friederike Petzold
- Laboratory of Renal Hereditary Diseases, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, F-75015, France
- Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
| | - Hassan Faour
- Data Science Platform, Université Paris Cité, Imagine Institute, INSERM UMR 1163, Paris, F-75015, France
| | - Maxime Douillet
- Data Science Platform, Université Paris Cité, Imagine Institute, INSERM UMR 1163, Paris, F-75015, France
| | - Jean-Michel Rozet
- Laboratory of Genetics in Ophthalmology, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, F-75015, France
| | - Valérie Cormier-Daire
- Reference Centre for Constitutional Bone Diseases, laboratory of Osteochondrodysplasia, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, F-75015, France
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades, AP-HP, Paris, F-75015, France
| | - Tania Attié-Bitach
- Service d'Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades, AP-HP, Paris, F-75015, France
| | - Stanislas Lyonnet
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades, AP-HP, Paris, F-75015, France
- Laboratory of Embryology and Genetics of Congenital Malformations, INSERM UMR 1163, Imagine Institute, Paris Cité, Paris, F-75015, France
| | - Sophie Saunier
- Laboratory of Renal Hereditary Diseases, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, F-75015, France
| | - Anita Burgun
- Centre de Recherche des Cordeliers, Sorbonne Université, INSERM, Université Paris Cité, Paris, F-75006, France
- HeKA, Inria Paris, Paris, F-75012, France
- Department of Medical Informatics, Hôpital Necker-Enfants Malades, AP-HP, Paris, F-75015, France
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9
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Bloch K, Geoffroy M, Taverne M, van de Lande L, O'Sullivan E, Liang C, Paternoster G, Moazen M, Laporte S, Khonsari RH. New diagnostic criteria for metopic ridges and trigonocephaly: a 3D geometric approach. Orphanet J Rare Dis 2024; 19:204. [PMID: 38762603 PMCID: PMC11102612 DOI: 10.1186/s13023-024-03197-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 04/29/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Trigonocephaly occurs due to the premature fusion of the metopic suture, leading to a triangular forehead and hypotelorism. This condition often requires surgical correction for morphological and functional indications. Metopic ridges also originate from premature metopic closure but are only associated with mid-frontal bulging; their surgical correction is rarely required. Differential diagnosis between these two conditions can be challenging, especially in minor trigonocephaly. METHODS Two hundred seven scans of patients with trigonocephaly (90), metopic rigdes (27), and controls (90) were collected. Geometric morphometrics were used to quantify skull and orbital morphology as well as the interfrontal angle and the cephalic index. An innovative method was developed to automatically compute the frontal curvature along the metopic suture. Different machine-learning algorithms were tested to assess the predictive power of morphological data in terms of classification. RESULTS We showed that control patients, trigonocephaly and metopic rigdes have distinctive skull and orbital shapes. The 3D frontal curvature enabled a clear discrimination between groups (sensitivity and specificity > 92%). Furthermore, we reached an accuracy of 100% in group discrimination when combining 6 univariate measures. CONCLUSION Two diagnostic tools were proposed and demonstrated to be successful in assisting differential diagnosis for patients with trigonocephaly or metopic ridges. Further clinical assessments are required to validate the practical clinical relevance of these tools.
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Affiliation(s)
- Kevin Bloch
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris, CRMR CRANIOST, Faculté de Médecine, Université Paris Cité, Paris, France
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Maya Geoffroy
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Maxime Taverne
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Lara van de Lande
- Craniofacial Unit, Great Ormond Street Hospital for Children; UCL Great Ormond Street Institute of Child Health, London, UK
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - Ce Liang
- Department of Mechanical Engineering, University College London, London, UK
| | - Giovanna Paternoster
- Service de Neurochirurgie, Hôpital Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris, CRMR CRANIOST, Paris, France
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, London, UK
| | - Sébastien Laporte
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Roman Hossein Khonsari
- Service de chirurgie maxillofaciale et chirurgie plastique, Hôpital Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris, CRMR CRANIOST, Faculté de Médecine, Université Paris Cité, Paris, France.
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France.
- Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker - Enfants malades, Assistance Publique - Hôpitaux de Paris, Paris, France.
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10
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Dupuy G, Roux CJ, Barrois R, Imbard A, Pontoizeau C, Dangles MT, Aubart M, Arnoux JB, Margoses D, Brassier A, Marbach C, Bérat CM, Sarda E, Gitiaux C, de Lonlay P, Boddaert N, Schiff M, Desguerre I. Vitamin deficiencies in children: Lessons from clinical and neuroimaging findings. Eur J Paediatr Neurol 2024; 50:6-15. [PMID: 38520815 DOI: 10.1016/j.ejpn.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND AND AIMS Water-soluble vitamins play an essential coenzyme role in the nervous system. Acquired vitamin deficiencies are easily treatable, however, without treatment, they can lead to irreversible complications. This study aimed to provide clinical, laboratory parameters and neuroimaging data on vitamin deficiencies in an attempt to facilitate early diagnosis and prompt supplementation. METHODS From July 1998 to July 2023, patients at Necker-Enfants-Malades Hospital presenting with acute neurological symptoms attributed to acquired vitamin deficiency were included. Clinical data were extracted from Dr Warehouse database. Neuroimaging, biochemical and electrophysiological data were reviewed. RESULTS Patients with vitamin B1 deficiency exhibited abnormal eye movements (n = 4/4), fluctuations in consciousness (n = 3/4), and ataxia (n = 3/4). Brain MRI showed alterations of fourth ventricle region (n = 4/4), periaqueductal region (n = 4/4), tectum (n = 3/4), and median thalami (n = 3/4). Patients with vitamin B2 deficiency presented with early onset hypotonia (n = 3/4), hyperlactatemia (n = 4/4), and hyperammonemia (n = 4/4). Plasma acylcarnitines revealed a multiple acyl-coA dehydrogenase deficiency-like profile (n = 4/4). In vitamin B12 deficiency, young children presented with developmental delay (n = 7/7) and older children with proprioceptive ataxia (n = 3/3). Brain MRI revealed atrophy (n = 7/7) and spinal MRI hyperintensity in posterior cervical columns (n = 3/3). Metabolic findings showed elevated methylmalonic acid (n = 6/7) and hyperhomocysteinemia (n = 6/7). Patients with vitamin C deficiency exhibited gait disturbances and muscle weakness (n = 2/2). CONCLUSIONS Acquired vitamin deficiencies may display reversible clinical symptoms mimicking inherited metabolic disorders. Some situations raise suspicion for diagnosis: concordant clinical presentation, suggestive neuroimaging findings, and/or biochemical evidence. Any acute neurological condition should be treated without waiting for definitive biochemical confirmation.
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Affiliation(s)
- Gabrielle Dupuy
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France; Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France.
| | - Charles-Joris Roux
- Pediatric Radiology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
| | - Rémi Barrois
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France; Pediatric Neurophysiology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
| | - Apolline Imbard
- Department of Biochemistry, Necker-Enfants-Malades Hospital, APHP, University of Paris Saclay, Paris, France
| | - Clément Pontoizeau
- Department of Biochemistry, Necker-Enfants-Malades Hospital, APHP, University of Paris Saclay, Paris, France
| | - Marie Thérèse Dangles
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
| | - Mélodie Aubart
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
| | - Jean-Baptiste Arnoux
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France
| | - Diane Margoses
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France
| | - Anaïs Brassier
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France
| | - Clothilde Marbach
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France
| | - Claire-Marine Bérat
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France
| | - Eugénie Sarda
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
| | - Cyril Gitiaux
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France; Pediatric Neurophysiology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
| | - Pascale de Lonlay
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France; INSERM U1151, Institut Necker-Enfants-Malades (INEM), Paris, France
| | - Nathalie Boddaert
- Pediatric Radiology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France; INSERM UMRS_1163, Imagine Institute, Paris, France
| | - Manuel Schiff
- Reference Center for Inborn Errors of Metabolism, Department of Pediatrics, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, G2M Network, MetabERN, Paris, France; INSERM UMRS_1163, Imagine Institute, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Necker-Enfants-Malades Hospital, APHP, University of Paris Cité, Paris, France
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11
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Hennocq Q, Garcelon N, Bongibault T, Bouygues T, Marlin S, Amiel J, Boutaud L, Douillet M, Lyonnet S, Pingault V, Picard A, Rio M, Attie-Bitach T, Khonsari RH, Roux N. Artificial intelligence-based diagnosis in fetal pathology using external ear shapes. Prenat Diagn 2024. [PMID: 38635411 DOI: 10.1002/pd.6577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/28/2024] [Accepted: 04/07/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE Here we trained an automatic phenotype assessment tool to recognize syndromic ears in two syndromes in fetuses-=CHARGE and Mandibulo-Facial Dysostosis Guion Almeida type (MFDGA)-versus controls. METHOD We trained an automatic model on all profile pictures of children diagnosed with genetically confirmed MFDGA and CHARGE syndromes, and a cohort of control patients, collected from 1981 to 2023 in Necker Hospital (Paris) with a visible external ear. The model consisted in extracting landmarks from photographs of external ears, in applying geometric morphometry methods, and in a classification step using machine learning. The approach was then tested on photographs of two groups of fetuses: controls and fetuses with CHARGE and MFDGA syndromes. RESULTS The training set contained a total of 1489 ear photographs from 526 children. The validation set contained a total of 51 ear photographs from 51 fetuses. The overall accuracy was 72.6% (58.3%-84.1%, p < 0.001), and 76.4%, 74.9%, and 86.2% respectively for CHARGE, control and MFDGA fetuses. The area under the curves were 86.8%, 87.5%, and 90.3% respectively for CHARGE, controls, and MFDGA fetuses. CONCLUSION We report the first automatic fetal ear phenotyping model, with satisfactory classification performances. Further validations are required before using this approach as a diagnostic tool.
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Affiliation(s)
- Quentin Hennocq
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Laboratoire 'Forme et Croissance Du Crâne', Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Thomas Bongibault
- Imagine Institute, INSERM UMR1163, Paris, France
- Laboratoire 'Forme et Croissance Du Crâne', Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thomas Bouygues
- Imagine Institute, INSERM UMR1163, Paris, France
- Laboratoire 'Forme et Croissance Du Crâne', Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sandrine Marlin
- Imagine Institute, INSERM UMR1163, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Jeanne Amiel
- Imagine Institute, INSERM UMR1163, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Lucile Boutaud
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | | | - Stanislas Lyonnet
- Imagine Institute, INSERM UMR1163, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Vèronique Pingault
- Imagine Institute, INSERM UMR1163, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Arnaud Picard
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Marlèe Rio
- Imagine Institute, INSERM UMR1163, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Tania Attie-Bitach
- Imagine Institute, INSERM UMR1163, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Roman H Khonsari
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
- Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Laboratoire 'Forme et Croissance Du Crâne', Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Roux
- Imagine Institute, INSERM UMR1163, Paris, France
- Faculté de Médecine, Université de Paris Cité, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France
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12
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Corbaux P, Bayle A, Besle S, Vinceneux A, Vanacker H, Ouali K, Hanvic B, Baldini C, Cassier PA, Terret C, Verlingue L. Patients' selection and trial matching in early-phase oncology clinical trials. Crit Rev Oncol Hematol 2024; 196:104307. [PMID: 38401694 DOI: 10.1016/j.critrevonc.2024.104307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Early-phase clinical trials (EPCT) represent an important part of innovations in medical oncology and a valuable therapeutic option for patients with metastatic cancers, particularly in the era of precision medicine. Nevertheless, adult patients' participation in oncology clinical trials is low, ranging from 2% to 8% worldwide, with unequal access, and up to 40% risk of early discontinuation in EPCT, mostly due to cancer-related complications. DESIGN We review the tools and initiatives to increase patients' orientation and access to early phase cancer clinical trials, and to limit early discontinuation. RESULTS New approaches to optimize the early-phase clinical trial referring process in oncology include automatic trial matching, tools to facilitate the estimation of patients' prognostic and/or to better predict patients' eligibility to clinical trials. Classical and innovative approaches should be associated to double patient recruitment, improve clinical trial enrollment experience and reduce early discontinuation rates. CONCLUSIONS Whereas EPCT are essential for patients to access the latest medical innovations in oncology, offering the appropriate trial when it is relevant for patients should increase by organizational and technological innovations. The oncologic community will need to closely monitor their performance, portability and simplicity for implementation in daily clinical practice.
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Affiliation(s)
- P Corbaux
- Medical Oncology Department, Centre Léon Bérard, Lyon, France; Medical Oncology, Institut de Cancérologie et d'Hématologie Universitaire de Saint-Étienne (ICHUSE), Centre Hospitalier Universitaire de Saint-Etienne, France
| | - A Bayle
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif F-94805, France
| | - S Besle
- Centre de Recherche en Cancérologie de Lyon (CRCL), France
| | - A Vinceneux
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - H Vanacker
- Medical Oncology Department, Centre Léon Bérard, Lyon, France; Centre de Recherche en Cancérologie de Lyon (CRCL), France
| | - K Ouali
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif F-94805, France
| | - B Hanvic
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - C Baldini
- Drug Development Department (DITEP), Gustave Roussy, Université Paris-Saclay, Villejuif F-94805, France
| | - P A Cassier
- Medical Oncology Department, Centre Léon Bérard, Lyon, France; Centre de Recherche en Cancérologie de Lyon (CRCL), France
| | - C Terret
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - L Verlingue
- Medical Oncology Department, Centre Léon Bérard, Lyon, France; Centre de Recherche en Cancérologie de Lyon (CRCL), France.
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13
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Faviez C, Vincent M, Garcelon N, Boyer O, Knebelmann B, Heidet L, Saunier S, Chen X, Burgun A. Performance and clinical utility of a new supervised machine-learning pipeline in detecting rare ciliopathy patients based on deep phenotyping from electronic health records and semantic similarity. Orphanet J Rare Dis 2024; 19:55. [PMID: 38336713 PMCID: PMC10858490 DOI: 10.1186/s13023-024-03063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/03/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Rare diseases affect approximately 400 million people worldwide. Many of them suffer from delayed diagnosis. Among them, NPHP1-related renal ciliopathies need to be diagnosed as early as possible as potential treatments have been recently investigated with promising results. Our objective was to develop a supervised machine learning pipeline for the detection of NPHP1 ciliopathy patients from a large number of nephrology patients using electronic health records (EHRs). METHODS AND RESULTS We designed a pipeline combining a phenotyping module re-using unstructured EHR data, a semantic similarity module to address the phenotype dependence, a feature selection step to deal with high dimensionality, an undersampling step to address the class imbalance, and a classification step with multiple train-test split for the small number of rare cases. The pipeline was applied to thirty NPHP1 patients and 7231 controls and achieved good performances (sensitivity 86% with specificity 90%). A qualitative review of the EHRs of 40 misclassified controls showed that 25% had phenotypes belonging to the ciliopathy spectrum, which demonstrates the ability of our system to detect patients with similar conditions. CONCLUSIONS Our pipeline reached very encouraging performance scores for pre-diagnosing ciliopathy patients. The identified patients could then undergo genetic testing. The same data-driven approach can be adapted to other rare diseases facing underdiagnosis challenges.
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Affiliation(s)
- Carole Faviez
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMR 1138, 75006, Paris, France.
- Inria, 75012, Paris, France.
| | - Marc Vincent
- Université Paris Cité, Imagine Institute, Data Science Platform, INSERM UMR 1163, 75015, Paris, France
| | - Nicolas Garcelon
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMR 1138, 75006, Paris, France
- Inria, 75012, Paris, France
- Université Paris Cité, Imagine Institute, Data Science Platform, INSERM UMR 1163, 75015, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, APHP-Centre, Reference Center for Inherited Renal Diseases (MARHEA), Imagine Institute, Hôpital Necker-Enfants Malades, Université Paris Cité, 75015, Paris, France
- Laboratory of Renal Hereditary Diseases, INSERM UMR 1163, Imagine Institute, Université Paris Cité, 75015, Paris, France
| | - Bertrand Knebelmann
- Nephrology and Transplantation Department, MARHEA, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Cité, 75015, Paris, France
| | - Laurence Heidet
- Department of Pediatric Nephrology, APHP-Centre, Reference Center for Inherited Renal Diseases (MARHEA), Imagine Institute, Hôpital Necker-Enfants Malades, Université Paris Cité, 75015, Paris, France
| | - Sophie Saunier
- Laboratory of Renal Hereditary Diseases, INSERM UMR 1163, Imagine Institute, Université Paris Cité, 75015, Paris, France
| | - Xiaoyi Chen
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMR 1138, 75006, Paris, France
- Inria, 75012, Paris, France
- Université Paris Cité, Imagine Institute, Data Science Platform, INSERM UMR 1163, 75015, Paris, France
| | - Anita Burgun
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMR 1138, 75006, Paris, France
- Inria, 75012, Paris, France
- Département d'informatique Médicale, Hôpital Necker-Enfants Malades, AP-HP, 75015, Paris, France
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Guérin J, Nahid A, Tassy L, Deloger M, Bocquet F, Thézenas S, Desandes E, Le Deley MC, Durando X, Jaffré A, Es-Saad I, Crochet H, Le Morvan M, Lion F, Raimbourg J, Khay O, Craynest F, Giro A, Laizet Y, Bertaut A, Joly F, Livartowski A, Heudel P. Consore: A Powerful Federated Data Mining Tool Driving a French Research Network to Accelerate Cancer Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:189. [PMID: 38397680 PMCID: PMC10887639 DOI: 10.3390/ijerph21020189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Real-world data (RWD) related to the health status and care of cancer patients reflect the ongoing medical practice, and their analysis yields essential real-world evidence. Advanced information technologies are vital for their collection, qualification, and reuse in research projects. METHODS UNICANCER, the French federation of comprehensive cancer centres, has innovated a unique research network: Consore. This potent federated tool enables the analysis of data from millions of cancer patients across eleven French hospitals. RESULTS Currently operational within eleven French cancer centres, Consore employs natural language processing to structure the therapeutic management data of approximately 1.3 million cancer patients. These data originate from their electronic medical records, encompassing about 65 million medical records. Thanks to the structured data, which are harmonized within a common data model, and its federated search tool, Consore can create patient cohorts based on patient or tumor characteristics, and treatment modalities. This ability to derive larger cohorts is particularly attractive when studying rare cancers. CONCLUSIONS Consore serves as a tremendous data mining instrument that propels French cancer centres into the big data era. With its federated technical architecture and unique shared data model, Consore facilitates compliance with regulations and acceleration of cancer research projects.
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Affiliation(s)
| | - Amine Nahid
- Coexya, 69370 Saint-Didier-au-Mont-d’Or, France; (A.N.); (F.J.)
| | - Louis Tassy
- Institut Paoli-Calmettes, 13009 Marseille, France; (L.T.); (M.L.M.)
| | - Marc Deloger
- Gustave Roussy, 94805 Villejuif, France; (M.D.); (F.L.)
| | - François Bocquet
- Data Factory & Analytics Department, Institut de Cancérologie de l’Ouest, 44805 Nantes-Angers, France (J.R.)
| | - Simon Thézenas
- Institut Régional du Cancer de Montpellier, 34090 Montpellier, France;
| | - Emmanuel Desandes
- Institut de Cancérologie de Lorraine, 54519 Nancy, France; (E.D.); (O.K.)
| | | | - Xavier Durando
- Centre Jean Perrin, 63011 Clermont Ferrand, France; (X.D.); (A.G.)
| | - Anne Jaffré
- Institut Bergonié, 33076 Bordeaux, France; (A.J.); (Y.L.)
| | - Ikram Es-Saad
- Centre Georges Francois Leclerc, 21000 Dijon, France; (I.E.-S.); (A.B.)
| | | | - Marie Le Morvan
- Institut Paoli-Calmettes, 13009 Marseille, France; (L.T.); (M.L.M.)
| | - François Lion
- Gustave Roussy, 94805 Villejuif, France; (M.D.); (F.L.)
| | - Judith Raimbourg
- Data Factory & Analytics Department, Institut de Cancérologie de l’Ouest, 44805 Nantes-Angers, France (J.R.)
| | - Oussama Khay
- Institut de Cancérologie de Lorraine, 54519 Nancy, France; (E.D.); (O.K.)
| | - Franck Craynest
- Centre Oscar Lambret, 59000 Lille, France; (M.-C.L.D.); (F.C.)
| | - Alexia Giro
- Centre Jean Perrin, 63011 Clermont Ferrand, France; (X.D.); (A.G.)
| | - Yec’han Laizet
- Institut Bergonié, 33076 Bordeaux, France; (A.J.); (Y.L.)
| | - Aurélie Bertaut
- Centre Georges Francois Leclerc, 21000 Dijon, France; (I.E.-S.); (A.B.)
| | - Frederik Joly
- Coexya, 69370 Saint-Didier-au-Mont-d’Or, France; (A.N.); (F.J.)
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Hennocq Q, Paternoster G, Collet C, Amiel J, Bongibault T, Bouygues T, Cormier-Daire V, Douillet M, Dunaway DJ, Jeelani NO, van de Lande LS, Lyonnet S, Ong J, Picard A, Rickart AJ, Rio M, Schievano S, Arnaud E, Garcelon N, Khonsari RH. AI-based diagnosis and phenotype - Genotype correlations in syndromic craniosynostoses. J Craniomaxillofac Surg 2024:S1010-5182(24)00055-6. [PMID: 39187417 DOI: 10.1016/j.jcms.2024.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/02/2024] [Indexed: 08/28/2024] Open
Abstract
Apert (AS), Crouzon (CS), Muenke (MS), Pfeiffer (PS), and Saethre Chotzen (SCS) are among the most frequently diagnosed syndromic craniosynostoses. The aims of this study were (1) to train an innovative model using artificial intelligence (AI)-based methods on two-dimensional facial frontal, lateral, and external ear photographs to assist diagnosis for syndromic craniosynostoses vs controls, and (2) to screen for genotype/phenotype correlations in AS, CS, and PS. We included retrospectively and prospectively, from 1979 to 2023, all frontal and lateral pictures of patients genetically diagnosed with AS, CS, MS, PS and SCS syndromes. After a deep learning-based preprocessing, we extracted geometric and textural features and used XGboost (eXtreme Gradient Boosting) to classify patients. The model was tested on an independent international validation set of genetically confirmed patients and non-syndromic controls. Between 1979 and 2023, we included 2228 frontal and lateral facial photographs corresponding to 541 patients. In all, 70.2% [0.593-0.797] (p < 0.001) of patients in the validation set were correctly diagnosed. Genotypes linked to a splice donor site of FGFR2 in Crouzon-Pfeiffer syndrome (CPS) caused a milder phenotype in CPS. Here we report a new method for the automatic detection of syndromic craniosynostoses using AI.
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Affiliation(s)
- Quentin Hennocq
- Imagine Institute, INSERM UMR1163, 75015, Paris, France; Département de chirurgie maxillo-faciale et chirurgie plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, 75015, Paris, France; Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France.
| | - Giovanna Paternoster
- Imagine Institute, INSERM UMR1163, 75015, Paris, France; Département de neurochirurgie, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
| | - Corinne Collet
- Département de génétique moléculaire, Hôpital Robert Debré, Université de Paris Cité, Paris, France
| | - Jeanne Amiel
- Imagine Institute, INSERM UMR1163, 75015, Paris, France; Service de médecine génomique des maladies rares, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
| | - Thomas Bongibault
- Imagine Institute, INSERM UMR1163, 75015, Paris, France; Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Thomas Bouygues
- Imagine Institute, INSERM UMR1163, 75015, Paris, France; Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France
| | - Valérie Cormier-Daire
- Imagine Institute, INSERM UMR1163, 75015, Paris, France; Service de médecine génomique des maladies rares, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
| | | | - David J Dunaway
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Nu Owase Jeelani
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Lara S van de Lande
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK; Department of Oral and Maxillofacial Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Stanislas Lyonnet
- Imagine Institute, INSERM UMR1163, 75015, Paris, France; Service de médecine génomique des maladies rares, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
| | - Juling Ong
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Arnaud Picard
- Département de chirurgie maxillo-faciale et chirurgie plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
| | - Alexander J Rickart
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Marlène Rio
- Imagine Institute, INSERM UMR1163, 75015, Paris, France; Service de médecine génomique des maladies rares, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
| | - Silvia Schievano
- UCL Great Ormond Street Institute of Child Health and Craniofacial Unit, Great Ormond Street Hospital for Children, London, UK
| | - Eric Arnaud
- Département de neurochirurgie, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, 75015, Paris, France; Clinique Marcel Sembat (Ramsay), Boulogne, France
| | | | - Roman H Khonsari
- Imagine Institute, INSERM UMR1163, 75015, Paris, France; Département de chirurgie maxillo-faciale et chirurgie plastique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, 75015, Paris, France; Laboratoire 'Forme et Croissance du Crâne', Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris Cité, Paris, France; Département de neurochirurgie, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
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Lo Barco T, Garcelon N, Neuraz A, Nabbout R. Natural history of rare diseases using natural language processing of narrative unstructured electronic health records: The example of Dravet syndrome. Epilepsia 2024; 65:350-361. [PMID: 38065926 DOI: 10.1111/epi.17855] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/31/2023]
Abstract
OBJECTIVE The increasing implementation of electronic health records allows the use of advanced text-mining methods for establishing new patient phenotypes and stratification, and for revealing outcome correlations. In this study, we aimed to explore the electronic narrative clinical reports of a cohort of patients with Dravet syndrome (DS) longitudinally followed at our center, to identify the capacity of this methodology to retrace natural history of DS during the early years. METHODS We used a document-based clinical data warehouse employing natural language processing to recognize the phenotype concepts in the narrative medical reports. We included patients with DS who have a medical report produced before the age of 2 years and a follow-up after the age of 3 years ("DS cohort," 56 individuals). We selected two control populations, a "general control cohort" (275 individuals) and a "neurological control cohort" (281 individuals), with similar characteristics in terms of gender, number of reports, and age at last report. To find concepts specifically associated with DS, we performed a phenome-wide association study using Cox regression, comparing the reports of the three cohorts. We then performed a qualitative analysis of the surviving concepts based on their median age at first appearance. RESULTS A total of 76 concepts were prevalent in the reports of children with DS. Concepts appearing during the first 2 years were mostly related with the epilepsy features at the onset of DS (convulsive and prolonged seizures triggered by fever, often requiring in-hospital care). Subsequently, concepts related to new types of seizures and to drug resistance appeared. A series of non-seizure-related concepts emerged after the age of 2-3 years, referring to the nonseizure comorbidities classically associated with DS. SIGNIFICANCE The extraction of clinical terms by narrative reports of children with DS allows outlining the known natural history of this rare disease in early childhood. This original model of "longitudinal phenotyping" could be applied to other rare and very rare conditions with poor natural history description.
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Affiliation(s)
- Tommaso Lo Barco
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Reference Center for Rare Epilepsies, Member of European Reference Network EpiCARE, Université Paris Cité, Paris, France
| | - Nicolas Garcelon
- Data Science Platform, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1163, Imagine Institute, Université Paris Cité, Paris, France
| | - Antoine Neuraz
- Data Science Platform, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1163, Imagine Institute, Université Paris Cité, Paris, France
| | - Rima Nabbout
- Department of Pediatric Neurology, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Reference Center for Rare Epilepsies, Member of European Reference Network EpiCARE, Université Paris Cité, Paris, France
- Translational Research for Neurological Disorders, Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche 1163, Imagine Institute, Université Paris Cité, Paris, France
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de Fréminville A, Saad M, Sage E, Pricopi C, Fischler M, Trillat B, Salze B, Pascreau T, Vasse M, Vallée A, Guen ML, Fessler J. Relationship Between Preoperative Inflammation Ratios Derived From Preoperative Blood Cell Count and Postoperative Pulmonary Complications in Patients Undergoing Lobectomy: A Single-Center Observational Study. J Cardiothorac Vasc Anesth 2024; 38:482-489. [PMID: 38016820 DOI: 10.1053/j.jvca.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/19/2023] [Accepted: 11/01/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE Evaluation of the association of inflammatory cell ratios, especially neutrophil-to-lymphocyte ratio (NLR), based on preoperative complete blood counts, with postoperative complications in lobectomy surgery. DESIGN This was a retrospective monocentric cohort study. SETTING The study was conducted at Foch University Hospital in Suresnes, France. PARTICIPANTS Patients having undergone a scheduled lobectomy from January 2018 to September 2021. INTERVENTIONS There were no interventions. MEASUREMENTS AND MAIN RESULTS The authors studied 208 consecutive patients. Preoperative NLR, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic inflammation index, systemic inflammation response index, and aggregate inflammation systemic index were calculated. Median and (IQR) of NLR was 2.67 (1.92-3.69). No statistically significant association was observed between any index and the occurrence of at least one major postoperative complication, which occurred in 37% of the patients. Median postoperative length of stay was 7 (5-10) days. None of the ratios was associated with prolonged length of stay (LOS), defined as a LOS above the 75th percentile. CONCLUSIONS The results suggested that simple available inflammatory ratios are not useful for the preoperative identification of patients at risk of postoperative major complications in elective lobectomy surgery.
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Affiliation(s)
- Amaury de Fréminville
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Mary Saad
- Department of Anesthesia, Institut Curie, PSL Research University, Saint Cloud, France, and PSL Research University, INSERM, Institut Curies, Saint Cloud, France
| | - Edouard Sage
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Ciprian Pricopi
- Department of Thoracic Surgery and Lung Transplantation, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Marc Fischler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France.
| | - Bernard Trillat
- Department of Information Systems, Hôpital Foch, Suresnes, France
| | - Benjamin Salze
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Tiffany Pascreau
- Department of Clinical Biology, Hôpital Foch, Suresnes, France, and Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation, Hôpital Foch, Suresnes, France
| | - Marc Vasse
- Department of Clinical Biology, Hôpital Foch, Suresnes, France, and Department of Epidemiology-Data-Biostatistics, Delegation of Clinical Research and Innovation, Hôpital Foch, Suresnes, France
| | - Alexandre Vallée
- Department of Epidemiology and Public Health, Hôpital Foch, Suresnes, France
| | - Morgan Le Guen
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
| | - Julien Fessler
- Department of Anesthesiology, Hôpital Foch, Suresnes, France, and Université Versailles-Saint-Quentin-en-Yvelines, Versailles, France
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Kuchenbuch M, Lo Barco T, Chemaly N, Chiron C, Nabbout R. Fifteen years of real-world data on the use of vigabatrin in individuals with infantile epileptic spasms syndrome. Epilepsia 2024; 65:430-444. [PMID: 37872396 DOI: 10.1111/epi.17808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE This study was undertaken to evaluate our treatment algorithm for infantile epileptic spasms syndrome (IESS) used between 2000 and 2018. We initiated vigabatrin (VGB), and steroids were added if the electroclinical response (spasms and electroencephalogram [EEG]) to VGB was not obtained or incomplete. METHODS Individuals with IESS treated with VGB were recruited from our hospital clinical data warehouse based on electronic health records (EHRs) generated since 2009 and containing relevant keywords. We confirmed the diagnosis of IESS. Clinical, EEG, imaging, and biological data were extracted from the EHRs. We analyzed factors associated with short-term response, time to response, relapse, time to relapse of spasms, and the presence of spasms at last follow-up. RESULTS We collected data from 198 individuals (female: 46.5%, IESS onset: 6 [4.5-10.3] months, follow-up: 4.6 [2.5-7.6] years, median [Q1-Q3]) including 129 (65.2%) with identifiable etiology. VGB was started 17 (5-57.5) days after IESS diagnosis. A total of 113 individuals were responders (57.1% of the cohort), 64 with VGB alone and 38 with VGB further combined with steroids (56.6% and 33.6% of responders, respectively). Among responders, 33 (29%) experienced relapses of spasms, mostly those with later onset of spasms (p = .002) and those who received VGB for <24 months after spasms cessation compared to a longer duration on VGB (45% vs. 12.8%, p = .003). At follow-up, 92 individuals were seizure-free (46.5% of the whole cohort), including 26 free of therapy (13.1%). One hundred twelve individuals (56.6%) were still receiving VGB, with a duration of 3.2 (1.75-5.7) years. SIGNIFICANCE Our sequential protocol introducing VGB then adding steroids is an effective alternative to a combined VGB-steroids approach in IESS. It avoids steroid-related adverse events, as well as those from VGB-steroid combination. According to our data, a period of 7 days seems sufficient to assess VGB response and enables the addition of steroids rapidly if needed. Continuing VGB for 2 years may balance the risk of relapse and treatment-induced adverse events.
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Affiliation(s)
- Mathieu Kuchenbuch
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
- Service de Pédiatrie, Reference Center for Rare Epilepsies, member of ERN EpiCARE, Université de Lorraine, CHRU-Nancy, Nancy, France
| | - Tommaso Lo Barco
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
| | - Nicole Chemaly
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
| | - Catherine Chiron
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
| | - Rima Nabbout
- Department of Pediatric Neurology, Reference Center for Rare Epilepsies, Hôpital Necker-Enfants Malades, member of ERN EpiCARE, Paris, France
- Laboratory of Translational Research for Neurological Disorders, INSERM MR1163, Imagine Institute, Paris, France
- Université de Paris Cité, Paris, France
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Hennocq Q, Willems M, Amiel J, Arpin S, Attie-Bitach T, Bongibault T, Bouygues T, Cormier-Daire V, Corre P, Dieterich K, Douillet M, Feydy J, Galliani E, Giuliano F, Lyonnet S, Picard A, Porntaveetus T, Rio M, Rouxel F, Shotelersuk V, Toutain A, Yauy K, Geneviève D, Khonsari RH, Garcelon N. Next generation phenotyping for diagnosis and phenotype-genotype correlations in Kabuki syndrome. Sci Rep 2024; 14:2330. [PMID: 38282012 PMCID: PMC10822856 DOI: 10.1038/s41598-024-52691-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 01/30/2024] Open
Abstract
The field of dysmorphology has been changed by the use Artificial Intelligence (AI) and the development of Next Generation Phenotyping (NGP). The aim of this study was to propose a new NGP model for predicting KS (Kabuki Syndrome) on 2D facial photographs and distinguish KS1 (KS type 1, KMT2D-related) from KS2 (KS type 2, KDM6A-related). We included retrospectively and prospectively, from 1998 to 2023, all frontal and lateral pictures of patients with a molecular confirmation of KS. After automatic preprocessing, we extracted geometric and textural features. After incorporation of age, gender, and ethnicity, we used XGboost (eXtreme Gradient Boosting), a supervised machine learning classifier. The model was tested on an independent validation set. Finally, we compared the performances of our model with DeepGestalt (Face2Gene). The study included 1448 frontal and lateral facial photographs from 6 centers, corresponding to 634 patients (527 controls, 107 KS); 82 (78%) of KS patients had a variation in the KMT2D gene (KS1) and 23 (22%) in the KDM6A gene (KS2). We were able to distinguish KS from controls in the independent validation group with an accuracy of 95.8% (78.9-99.9%, p < 0.001) and distinguish KS1 from KS2 with an empirical Area Under the Curve (AUC) of 0.805 (0.729-0.880, p < 0.001). We report an automatic detection model for KS with high performances (AUC 0.993 and accuracy 95.8%). We were able to distinguish patients with KS1 from KS2, with an AUC of 0.805. These results outperform the current commercial AI-based solutions and expert clinicians.
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Affiliation(s)
- Quentin Hennocq
- Imagine Institute, INSERM UMR1163, 75015, Paris, France.
- Service de chirurgie maxillo-faciale et chirurgie plastique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Paris, France.
- Faculté de Médecine, Université de Paris Cité, 75015, Paris, France.
- Laboratoire 'Forme et Croissance du Crâne', Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.
- Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, France.
| | - Marjolaine Willems
- Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Génétique clinique, CHU Montpellier, Centre de référence anomalies du développement SOOR, INSERM U1183, Montpellier University, Montpellier, France
| | - Jeanne Amiel
- Imagine Institute, INSERM UMR1163, 75015, Paris, France
- Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphanie Arpin
- Service de Génétique, CHU Tours, UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Tania Attie-Bitach
- Imagine Institute, INSERM UMR1163, 75015, Paris, France
- Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thomas Bongibault
- Imagine Institute, INSERM UMR1163, 75015, Paris, France
- Laboratoire 'Forme et Croissance du Crâne', Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Thomas Bouygues
- Imagine Institute, INSERM UMR1163, 75015, Paris, France
- Laboratoire 'Forme et Croissance du Crâne', Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Valérie Cormier-Daire
- Imagine Institute, INSERM UMR1163, 75015, Paris, France
- Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pierre Corre
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, 44000, Nantes, France
- Nantes Université, Oniris, UnivAngers, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000, Nantes, France
| | - Klaus Dieterich
- Univ. Grenoble Alpes, Inserm, U1209, IAB, CHU Grenoble Alpes, 38000, Grenoble, France
| | | | | | - Eva Galliani
- Service de chirurgie maxillo-faciale et chirurgie plastique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Paris, France
- Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
| | | | - Stanislas Lyonnet
- Imagine Institute, INSERM UMR1163, 75015, Paris, France
- Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Arnaud Picard
- Service de chirurgie maxillo-faciale et chirurgie plastique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Paris, France
- Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
| | - Thantrira Porntaveetus
- Center of Excellence in Genomics and Precision Dentistry, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Marlène Rio
- Imagine Institute, INSERM UMR1163, 75015, Paris, France
- Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
- Service de médecine génomique des maladies rares, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Flavien Rouxel
- Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Génétique clinique, CHU Montpellier, Centre de référence anomalies du développement SOOR, INSERM U1183, Montpellier University, Montpellier, France
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Annick Toutain
- Service de Génétique, CHU Tours, UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Kevin Yauy
- Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Génétique clinique, CHU Montpellier, Centre de référence anomalies du développement SOOR, INSERM U1183, Montpellier University, Montpellier, France
| | - David Geneviève
- Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Génétique clinique, CHU Montpellier, Centre de référence anomalies du développement SOOR, INSERM U1183, Montpellier University, Montpellier, France
| | - Roman H Khonsari
- Imagine Institute, INSERM UMR1163, 75015, Paris, France
- Service de chirurgie maxillo-faciale et chirurgie plastique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Paris, France
- Faculté de Médecine, Université de Paris Cité, 75015, Paris, France
- Laboratoire 'Forme et Croissance du Crâne', Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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20
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Poirault C, Hadchouel A, Roy C, Schmartz S, Gonsard A, Garcelon N, Delacourt C, Drummond D. Inflammatory rebound and postinfectious inflammatory response in children with pleural infection: A single-center retrospective study. Pediatr Pulmonol 2024. [PMID: 38206078 DOI: 10.1002/ppul.26859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/21/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024]
Abstract
INTRODUCTION As pleural inflammation plays a central role in pleural infection (PI), corticosteroids are increasingly being considered as a potential therapy. However, the timing of treatment and the identification of patients who might benefit most remain unresolved. The aim of this study was therefore to investigate the inflammatory trajectories of children with PI. METHODS This retrospective single-center study included children aged 3 months to 17 years and 11 months hospitalized for PI due to Streptococcus pyogenes, Streptococcus pneumonia, and Staphylococcus aureus over 10 years. An inflammatory rebound was defined biologically as a reincrease in C-reactive protein (CRP) of at least 50 mg/L after an initial decrease in CRP of at least 50 mg/L. RESULTS We included 53 cases of PI, including 16 due to S. pyogenes, 27 due to S. pneumonia, and 10 due to S. aureus. An inflammatory rebound occurred in 20 patients (38%) after a median of 4.5 (3-6) days. This inflammatory rebound occurred in 9 (56%) children with S. pyogenes, 8 (30%) children with S. pneumonia, and 3 (30%) children with S. aureus. Children with an inflammatory rebound also had a higher rate of persistent fever after Day 7 and a longer length of stay (p = .01 for both). CONCLUSION We postulate that the inflammatory rebound identified in nearly 40% of our patients corresponds to an early postinfectious inflammatory response, and thus that corticosteroids may be most beneficial for children with PI if administered early (between Days 2 and 5).
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Affiliation(s)
- Clément Poirault
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Alice Hadchouel
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Charlotte Roy
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Sophie Schmartz
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Apolline Gonsard
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
| | - Nicolas Garcelon
- Université Paris Cité, Paris, France
- Institut Imagine, Paris, France
- INSERM, Centre de Recherche des Cordeliers, UMR 1138 Equipe 22, Paris, France
| | - Christophe Delacourt
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
- Université Paris Cité, Paris, France
| | - David Drummond
- Department of Pediatric Pulmonology and Allergology, University Hospital Necker-Enfants Malades, AP-HP, Paris, France
- Université Paris Cité, Paris, France
- Inserm UMR 1138, HeKA team, Centre de Recherche des Cordeliers, Paris, France
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21
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Baudouin R, Simon F, Levy R, Breton S, Alciato L, Talab E, Leboulanger N, Couloigner V, Garabedian EN, Denoyelle F. Early Magnetic Resonance Imaging to Diagnose Residual Cholesteatoma in Children and Benefit of Radiological Rereview. Otolaryngol Head Neck Surg 2023; 169:1631-1638. [PMID: 37264987 DOI: 10.1002/ohn.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 04/28/2023] [Accepted: 05/13/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Non-echo-planar diffusion-weighted (DW) magnetic resonance imaging (non-EPI MRI) is the appropriate sequence to detect residual cholesteatoma. In the child, MRI may be clinically useful to determine the timing of the second-look procedure. The aim of this paper was to retrospectively evaluate the performance of early MRI (before the 18th postoperative month) in detecting residual cholesteatoma in children after review by experienced specialized neuroradiologists. STUDY DESIGN Retrospective study. SETTING One university center comparative cohort. METHODS All patients who had a 2-staged procedure for cholesteatoma with an MRI before the second stage from 2010 to 2020 were included and analyzed. Three pediatric neuroradiologists reviewed all the images blinded to the surgical result. RESULTS N = 141 cholesteatoma events (140 children) were included with a mean age at MRI of 10 (±4) years old. Non-EPI MRIs were performed 10.7 (±3.8) months after the first-stage surgery and 2.2 (±2.6) months before the second-stage procedure. Non-EPI MRI had a 0.57 sensitivity (SE) and 0.83 specificity (SP). MRI was reviewed in 112 cases. The diagnosis was corrected in 17 cases (15.1%) (3 true positives, 7 false negatives, and 7 false positives). SE = 0.63 (p = 0.1) and SP = 0.92 (p = 0.08) after rereading. CONCLUSION Early MRI's SE is poor but SP is excellent after rereading. Evidence does not support the use of early non-EPI MRI to modify the surgical strategy or to postpone the second look. If performed, early non-EPI MRI should be read by specialized experienced radiologists with all 3 sequences (T1, T2, and non-EPI DW) and apparent diffusion coefficient calculation, especially in cases of otitis media with effusion.
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Affiliation(s)
- Robin Baudouin
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - François Simon
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Raphaël Levy
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Sylvain Breton
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
- Department of Radiology, Paris Imagerie 114, Paris, France
| | - Lauranne Alciato
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Elsa Talab
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Radiology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Vincent Couloigner
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Erea-Noël Garabedian
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | - Françoise Denoyelle
- Faculté de Médecine, Université Paris-Cité, Paris, France
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
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Aoust L, Berteloot L, Drabent P, Garcelon N, Bodemer C, Molina TJ, Bader-Meunier B, Hadchouel A. Unclassifiable interstitial lung disease and autoimmunity: Towards IPAF in children? Pediatr Pulmonol 2023; 58:3303-3313. [PMID: 37701997 DOI: 10.1002/ppul.26660] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 07/14/2023] [Accepted: 08/19/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Interstitial pneumonia with autoimmune features (IPAF) has been defined for adults with interstitial lung disease (ILD) and autoimmunity who do not meet the criteria for a specific connective tissue disease (CTD). We aimed to determine whether IPAF criteria could apply to children. METHODS We retrospectively studied patients with ILD and autoimmunity followed at Necker Hospital between 2008 and 2019. Children were classified according to specific CTD and IPAF criteria. The epidemiology and course of the disease were studied according to the final diagnosis. RESULTS Among 27 patients, 6 fulfilled the criteria for IPAF and represented 4.5% of all patients with ILD during the study period. Other diagnoses included juvenile dermatomyositis (30%), overlap syndromes (19%), systemic lupus erythematosus (15%), systemic sclerosis (7%), mixed CTD (4%), and rheumatoid arthritis (4%). IPAF patients were more frequently boys versus CTD-ILD patients (67% vs. 14%, p = .02). Two patients had severe respiratory distress that led to death for one of them. The course was favorable for the others, with a good response to steroids. The course tended to be more favorable for IPAF patients than for those with CTD-ILD (0% lung fibrosis in the IPAF group vs. 43% in the CTD-ILD group, p = .07). CONCLUSION We confirmed the existence of IPAF in children. Its prevalence was lower than in adults but comparable to that found for other pediatric series. Boys were more highly represented than in CTD-ILD. The course was favorable for most cases. Larger and more prospective studies are needed to confirm these results.
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Affiliation(s)
- Laura Aoust
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Pneumologie Pédiatrique, Centre de Référence pour les Maladies Respiratoires Rares de l'Enfant, Paris, France
| | - Laureline Berteloot
- Institut Imagine, INSERM UMRS 1163, Paris, France
- AP-HP, Service d'Imagerie Pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Philippe Drabent
- AP-HP, Hôpitaux Universitaires Necker-Enfants Malades et Robert Debré, Service d'Anatomie Pathologique, Paris, France
| | - Nicolas Garcelon
- Imagine Institute, Data Science Platform, INSERM UMR 1163, Université de Paris, Paris, France
| | - Christine Bodemer
- APHP, Hôpital Universitaire Necker-Enfants Malades, Service de Dermatologie Pédiatrique, Paris, France
- Université Paris Cité, Paris, France
| | - Thierry Jo Molina
- Institut Imagine, INSERM UMRS 1163, Paris, France
- AP-HP, Hôpitaux Universitaires Necker-Enfants Malades et Robert Debré, Service d'Anatomie Pathologique, Paris, France
- Université Paris Cité, Paris, France
| | - Brigitte Bader-Meunier
- APHP, Hôpital Universitaire Necker-Enfants Malades, Service d'Immunologie et Rhumatologie Pédiatriques, Paris, France
- Center for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), Paris Cité University, Paris, France
- Laboratory of Immunogenetics of Paediatric Autoimmunity, Imagine Institute, INSERM U1163, Paris Cité University, Paris, France
| | - Alice Hadchouel
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Pneumologie Pédiatrique, Centre de Référence pour les Maladies Respiratoires Rares de l'Enfant, Paris, France
- Université Paris Cité, Paris, France
- INSERM U1151, Institut Necker Enfants Malades, Paris, France
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23
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Beauvais M, Taam RA, Neuraz A, Le Bourgeois M, Delacourt C, Faour H, Garcelon N, Lezmi G. Hyperventilation syndrome in children with asthma. J Asthma 2023; 60:1987-1996. [PMID: 37092722 DOI: 10.1080/02770903.2023.2206903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Hyperventilation syndrome (HVS) may be associated with asthma. In the absence of a gold standard diagnosis for children, its impact on asthma has been rarely assessed. OBJECTIVE To assess the impact of HVS on the symptoms and lung function of children with asthma and determine the diagnostic value of the Nijmegen questionnaire in comparison to a hyperventilation test (HVT). METHODS Data from asthmatic children followed in the department of Pediatric Pulmonology of Necker Hospital and explored for HVS were retrospectively analyzed. HVS was diagnosed by a positive HVT. Asthma exacerbations, control and lung function were assessed in children with or without a positive HVT. The sensitivity and specificity of the Nijmegen questionnaire were determined relative to the positivity of a HVT. The Nijmegen questionnaire threshold was ≥23. RESULTS Data from 112 asthmatic children, median age 13.9 years [11.6-16], were analyzed. Twenty-eight children (25%) had mild or moderate asthma and 84 (75%) severe asthma. The HVT was performed on 108 children and was negative for 34 (31.5%) and positive for 74 (68.5%). The number of asthma exacerbations in the past 12 months, Asthma Control Test (ACT) score, and lung function did not differ between children with a positive HVT and a negative HVT. The Nijmegen questionnaire was administered to 103 children. Its sensitivity was 56.3% and specificity 56.3%. CONCLUSION The symptoms and lung function of adolescents with asthma are not affected by the presence of HVS. The sensitivity and specificity of the Nijmegen questionnaire are low.
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Affiliation(s)
- Manon Beauvais
- Department of Pediatric Pneumology and Allergology, Necker-Enfants Malades Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Rola Abou Taam
- Department of Pediatric Pneumology and Allergology, Necker-Enfants Malades Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Antoine Neuraz
- Data Science Platform, INSERM UMR 1163, Université de Paris Cité, Imagine Institute, Paris, France
| | - Muriel Le Bourgeois
- Department of Pediatric Pneumology and Allergology, Necker-Enfants Malades Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Christophe Delacourt
- Department of Pediatric Pneumology and Allergology, Necker-Enfants Malades Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Hassan Faour
- Data Science Platform, INSERM UMR 1163, Université de Paris Cité, Imagine Institute, Paris, France
| | - Nicolas Garcelon
- Data Science Platform, INSERM UMR 1163, Université de Paris Cité, Imagine Institute, Paris, France
| | - Guillaume Lezmi
- Department of Pediatric Pneumology and Allergology, Necker-Enfants Malades Hospital, AP-HP, Université Paris Cité, Paris, France
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24
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Gueiderikh A, Ung M, Lazarovici J, Danu A, Ghez D, Saleh K, Dragani M, Noël N, Bigenwald C, Willekens C, Ribrag V, Michot JM, Martin V. Incidence, characteristics, management and outcome of patients with follicular lymphoma with tumor epidural compression, a study on 22 cases. Cancer Radiother 2023; 27:370-375. [PMID: 37156711 DOI: 10.1016/j.canrad.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/30/2023] [Accepted: 04/15/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE Follicular lymphoma (FL) is one of the most common lymphoma. Occasionally, FL is associated with tumoral epidural compression and management of these patients remain poorly codified. This study aims to report incidence, clinical characteristics, management and outcomes of patients with FL and tumoral epidural compression. MATERIAL AND METHODS Observational, retrospective cohort study of adult patients with FL and epidural tumor compression, treated in a French Institute over the last 20 years (2000-2021). RESULTS Between 2000 and 2021, 1382 patients with FL were followed by the haematological department. Of them, 22 (1.6%) patients (16 men and 6 women) had follicular lymphoma with epidural tumor compression. At epidural tumor compression occurrence, 8/22 (36%) patients had a neurological clinical deficit (motor, sensory or sphincter function) and 14/22 (64%) had tumor pain. All patients were treated with immuno-chemotherapy; the main regimen being used was R-CHOP plus high dose IV methotrexate in 16/22 (73%) patients. Radiotherapy for tumor epidural compression was performed in 19/22 (86%) patients. With a median follow-up of 60 months (range=[1-216]), 5 year local tumor relapse free survival was achieved in 65% (95% CI 47-90%) of patients. The median PFS was of 36 months (95% CI 24-NA) and 5 years OS estimate was 79% (95% CI 62-100%). Two patients developed a relapse at a second epidural site. CONCLUSION FL with tumoral epidural compression reached 1.6% of all FL patients. Management based on immuno-chemotherapy with radiotherapy appeared to produce comparable outcomes with the general FL population.
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Affiliation(s)
- A Gueiderikh
- Radiation therapy department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - M Ung
- Radiation therapy department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - J Lazarovici
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - A Danu
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - D Ghez
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - K Saleh
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - M Dragani
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - N Noël
- Internal medicine department, hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - C Bigenwald
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - C Willekens
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - V Ribrag
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - J-M Michot
- Hematology department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
| | - V Martin
- Radiation therapy department, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France
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Ndoudi Likoho B, Berthaud R, Dossier C, Delbet JD, Boyer O, Baudouin V, Alison M, Biran V, Hurtaud MF, Hogan J, Kwon T, Couderc A. Renal vein thrombosis in neonates: a case series of diagnosis, treatment and childhood kidney function follow-up. Pediatr Nephrol 2023; 38:3055-3063. [PMID: 36988695 DOI: 10.1007/s00467-023-05918-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Neonatal renal vein thrombosis (NRVT) is a rare condition with little data available. METHODS We retrospectively analyzed newborns diagnosed with NRVT admitted to 3 pediatric nephrology units in Paris from 2005 to 2020. RESULTS Twenty-seven patients were analyzed (male = 59%). The median age at diagnosis was 2.5 days (1 - 4.5). Diagnosis was suspected based on at least one of the three cardinal signs of renal vein thrombosis in 93%: flank mass (67%), hematuria (67%) and thrombocytopenia (70%). In all patients, diagnosis was confirmed by ultrasound. All patients had at least one known perinatal risk factor. A prothrombotic risk factor was found in 13 patients (48%). NRVT was unilateral in 70%, involving the left renal vein in 58%. Among 25 treated patients, 19 (76%) received low molecular weight heparin (LMWH) as initial therapy, 2 (8%) received unfractionated heparin and 4 (16%) received fibrinolysis. Median duration of treatment was 8 weeks (4 - 12). Bleeding occurred significantly more often with fibrinolysis than with LMWH/supportive therapy (3 of 4: 75% vs 0 of 4: 0%, p = 0.05). Clot resolution in patients treated with fibrinolysis did not differ significantly from those treated with LMWH/supportive therapy. After a median follow-up of 5.7 years (3 years - 9.9 years), pathological kidney features were observed in 73% of the patients (19 of 26), kidney atrophy in 18 (69%), hypertension in 2 (8%), chronic kidney disease (CKD) in 1 (4%) and proteinuria in 2 (8%). CONCLUSIONS NRVT remains a challenging condition, which still requires further study because of its associated morbidity. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Bellaure Ndoudi Likoho
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France.
| | - Romain Berthaud
- Department of Pediatric Nephrology, Necker-Enfants-Malades University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Claire Dossier
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Jean-Daniel Delbet
- Department of Pediatric Nephrology, Trousseau University Hospital, Assistance Publique - Hôpitaux de Paris, and Sorbonne University, Paris, France
| | - Olivia Boyer
- Department of Pediatric Nephrology, Necker-Enfants-Malades University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Véronique Baudouin
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Marianne Alison
- Department of Pediatric Radiology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Valérie Biran
- Neonatal Intensive Care Unit, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Marie-Françoise Hurtaud
- Biological Hematology Department, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Julien Hogan
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Theresa Kwon
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
| | - Anne Couderc
- Department of Pediatric Nephrology, Robert Debré University Hospital, Assistance Publique - Hôpitaux de Paris, and University of Paris, Paris, France
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Massard-Combe P, Debs A, De Tienda M, Pejin Z, Gaume M, Pannier S. Radiographic evaluation of ulnar deformity in patients with hereditary multiple osteochondroma and its relationship with radial head dislocation. Orthop Traumatol Surg Res 2023; 109:103591. [PMID: 36905956 DOI: 10.1016/j.otsr.2023.103591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 12/20/2022] [Accepted: 01/02/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION In patients who have hereditary multiple osteochondroma (HMO), progressive deformity of the forearm skeleton may lead to radial head dislocation. The latter is permanent, painful and causes weakness. HYPOTHESIS There is a relationship between the amount of ulnar deformity and the presence of radial head dislocation in patients with HMO. MATERIALS AND METHODS This was a cross-sectional radiographic study comprising an analysis of anterior-posterior (AP) and lateral x-rays of 110 forearms in children having a mean age of 8 years and 4 months who were followed for HMO between 1961 and 2014. Four factors reflecting on the ulnar deformity in the coronal plane were investigated on the AP view and three factors in the sagittal plane were investigated on the lateral view to identify any relationship between ulnar deformity and radial head dislocation. The forearms were separated into two groups: with radial head dislocation (26 cases) and without radial head dislocation (84 cases). RESULTS Ulnar bowing, intramedullary angle of ulnar bowing, tangent ulnar angle and overall ulnar angle were significantly higher in the group of children who had a radial head dislocation (0.05 vs 0.03, p<.001; 161 vs 167, p<001; 156 vs 162, p<001; 50 vs 30, p<.001) in univariate and multivariate analyses. DISCUSSION Ulnar deformity, evaluated using the method described here, is more often associated with radial head dislocation than other previously published radiological parameters. This provides new insight on this phenomenon and may help to determine which factors are associated with radial head dislocation and how to prevent it. CONCLUSION Ulnar bowing in the context of HMO, especially when evaluated on AP radiographs, is significantly associated with radial head dislocation. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Philippe Massard-Combe
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France.
| | - Alexandre Debs
- Service de santé publique du Pr. Carrat, Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - Marine De Tienda
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | - Zagorka Pejin
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | - Mathilde Gaume
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
| | - Stéphanie Pannier
- Service chirurgie orthopédique, Hôpital Necker - Université Paris Cité, 149 Rue de Sèvres, 75015 Paris, France
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Guida L, Benichi S, Bourgeois M, Paternoster G, James S, De Saint Denis T, Dangouloff Ros V, Beccaria K, Blauwblomme T. The Management of Hydrocephalus in Midline Posterior Fossa Cystic Collections: Surgical Outcome From a Retrospective Single-Center Case Series of 54 Consecutive Pediatric Patients. Neurosurgery 2023; 93:576-585. [PMID: 36921245 DOI: 10.1227/neu.0000000000002450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/13/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Hydrocephalus frequently occurs with midline posterior fossa cystic collections. The classification of this heterogeneous group of developmental anomalies, including Dandy-Walker malformation, persisting Blake's pouch, retrocerebellar arachnoid cysts, and mega cisterna magna, is subject of debate. The absence of diagnostic criteria is confusing regarding the ideal management of PFCC-related hydrocephalus. OBJECTIVE To decipher the surgical strategy for the treatment of children with PFCC-related hydrocephalus through a retrospective analysis of the surgical outcome driven by their clinical and radiological presentation. METHODS This study enrolled patients operated of symptomatic PFCC-related hydrocephalus. Clinical and MRI features were examined, as well as the surgical outcome. Unbiased subgroup classification of the patients was performed with multiple component analysis as a function of imaging characteristics and hierarchical clustering on principal component. Outcome was assessed with binomial logistic regression and Kaplan-Meier analysis. RESULTS Fifty-four patients were included between 2007 and 2021. Multiple component analysis suggested that cerebellar and vermian hypoplasia, vermian rotation, basal-tentorial angle, and fastigial angle were strongly correlated. Hierarchical clustering and the distribution of the patients in the bidimensional plot showed the clear segregation of 3 major clusters, which correlated with the radiological diagnosis ( P < .01). Binomial logistic regression and survival analysis showed that endoscopic third ventriculostomy was an effective treatment for patients with persisting Blake's pouch, while failing to control hydrocephalus in most of patients with Dandy-Walker malformation. CONCLUSION Preoperative MRI in patients with PFCC-related hydrocephalus is essential to better define the diagnosis. The choice of treatment strategy notably relies on correct radiological diagnosis.
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Affiliation(s)
- Lelio Guida
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
- Université de Paris Cité, Paris , France
| | - Sandro Benichi
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
- Université de Paris Cité, Paris , France
| | - Marie Bourgeois
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
| | - Giovanna Paternoster
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
| | - Syril James
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
| | | | - Volodia Dangouloff Ros
- Department of Pediatric Radiology, APHP, Hôpital Necker Enfants Malades, Paris , France
- Université Paris Cité, UMR 1163, Institut Imagine, Paris , France
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
- Université de Paris Cité, Paris , France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, APHP, Hôpital Necker Enfants Malades, Paris , France
- Université de Paris Cité, Paris , France
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Hennocq Q, Bongibault T, Marlin S, Amiel J, Attie-Bitach T, Baujat G, Boutaud L, Carpentier G, Corre P, Denoyelle F, Djate Delbrah F, Douillet M, Galliani E, Kamolvisit W, Lyonnet S, Milea D, Pingault V, Porntaveetus T, Touzet-Roumazeille S, Willems M, Picard A, Rio M, Garcelon N, Khonsari RH. AI-based diagnosis in mandibulofacial dysostosis with microcephaly using external ear shapes. Front Pediatr 2023; 11:1171277. [PMID: 37664547 PMCID: PMC10469912 DOI: 10.3389/fped.2023.1171277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/26/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Mandibulo-Facial Dysostosis with Microcephaly (MFDM) is a rare disease with a broad spectrum of symptoms, characterized by zygomatic and mandibular hypoplasia, microcephaly, and ear abnormalities. Here, we aimed at describing the external ear phenotype of MFDM patients, and train an Artificial Intelligence (AI)-based model to differentiate MFDM ears from non-syndromic control ears (binary classification), and from ears of the main differential diagnoses of this condition (multi-class classification): Treacher Collins (TC), Nager (NAFD) and CHARGE syndromes. Methods The training set contained 1,592 ear photographs, corresponding to 550 patients. We extracted 48 patients completely independent of the training set, with only one photograph per ear per patient. After a CNN-(Convolutional Neural Network) based ear detection, the images were automatically landmarked. Generalized Procrustes Analysis was then performed, along with a dimension reduction using PCA (Principal Component Analysis). The principal components were used as inputs in an eXtreme Gradient Boosting (XGBoost) model, optimized using a 5-fold cross-validation. Finally, the model was tested on an independent validation set. Results We trained the model on 1,592 ear photographs, corresponding to 1,296 control ears, 105 MFDM, 33 NAFD, 70 TC and 88 CHARGE syndrome ears. The model detected MFDM with an accuracy of 0.969 [0.838-0.999] (p < 0.001) and an AUC (Area Under the Curve) of 0.975 within controls (binary classification). Balanced accuracies were 0.811 [0.648-0.920] (p = 0.002) in a first multiclass design (MFDM vs. controls and differential diagnoses) and 0.813 [0.544-0.960] (p = 0.003) in a second multiclass design (MFDM vs. differential diagnoses). Conclusion This is the first AI-based syndrome detection model in dysmorphology based on the external ear, opening promising clinical applications both for local care and referral, and for expert centers.
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Affiliation(s)
- Quentin Hennocq
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
- Laboratoire ‘Forme et Croissance du Crâne’, Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Thomas Bongibault
- Imagine Institute, INSERM UMR1163, Paris, France
- Laboratoire ‘Forme et Croissance du Crâne’, Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Sandrine Marlin
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Jeanne Amiel
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Tania Attie-Bitach
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Geneviève Baujat
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Lucile Boutaud
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Georges Carpentier
- CHU Lille, Inserm, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008-Controlled Drug Delivery Systems and Biomaterial, Université de Lille, Lille, France
| | - Pierre Corre
- Department of Oral and Maxillofacial Surgery, INSERM U1229—Regenerative Medicine and Skeleton RMeS, Nantes, France
- Department of Oral and Maxillofacial Surgery, Nantes University, CHU Nantes, Nantes, France
| | - Françoise Denoyelle
- Department of Paediatric Otolaryngology, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
| | | | | | - Eva Galliani
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Wuttichart Kamolvisit
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Genomics and Precision Dentistry, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Stanislas Lyonnet
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Dan Milea
- Duke-NUS Medical School Singapore, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore
| | - Véronique Pingault
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Thantrira Porntaveetus
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Genomics and Precision Dentistry, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Sandrine Touzet-Roumazeille
- CHU Lille, Inserm, Service de Chirurgie Maxillo-Faciale et Stomatologie, U1008-Controlled Drug Delivery Systems and Biomaterial, Université de Lille, Lille, France
| | - Marjolaine Willems
- Département de Génétique Clinique, CHRU de Montpellier, Hôpital Arnaud de Villeneuve, Institute for Neurosciences of Montpellier, INSERM, Univ Montpellier, Montpellier, France
| | - Arnaud Picard
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Marlène Rio
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Médecine Génomique des Maladies Rares, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | | | - Roman H. Khonsari
- Imagine Institute, INSERM UMR1163, Paris, France
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker—Enfants Malades, Assistance Publique—Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
- Laboratoire ‘Forme et Croissance du Crâne’, Faculté de Médecine, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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Durrleman C, Grevent D, Aubart M, Kossorotoff M, Roux CJ, Kaminska A, Rio M, Barcia G, Boddaert N, Munnich A, Nabbout R, Desguerre I. Clinical and radiological description of 120 pediatric stroke-like episodes. Eur J Neurol 2023; 30:2051-2061. [PMID: 37046408 DOI: 10.1111/ene.15821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND AND PURPOSE Stroke-like episodes (SLEs) are defined as acute onset of neurological symptoms mimicking a stroke and radiological lesions non-congruent to vascular territory. We aimed to analyze the acute clinical and radiological features of SLEs to determine their pathophysiology. METHODS We performed a monocenter retrospective analysis of 120 SLEs in 60 children over a 20-year period. Inclusion criteria were compatible clinical symptoms and stroke-like lesions on brain magnetic resonance imaging (MRI; performed for all 120 events) with focal hyperintensity on diffusion-weighted imaging in a non-vascular territory. RESULTS Three groups were identified: children with mitochondrial diseases (n = 22) involving mitochondrial DNA mutations (55%) or nuclear DNA mutations (45%); those with other metabolic diseases or epilepsy disorders (n = 22); and those in whom no etiology was found despite extensive investigations (n = 16). Age at first SLE was younger in the group with metabolic or epilepsy disorders (18 months vs. 128 months; p < 0.0001) and an infectious trigger was more frequent (69% vs. 20%; p = 0.0001). Seizures occurred in 75% of episodes, revealing 50% episodes of SLEs and mainly leading to status epilepticus (90%). Of the 120 MRI scans confirming the diagnosis, 28 were performed within a short and strict 48-h period and were further analyzed to better understand the underlying mechanisms. The scans showed primary cortical hyperintensity (n = 28/28) with decreased apparent diffusion coefficient in 52% of cases. Systematic hyperperfusion was found on spin labeling sequences when available (n = 18/18). CONCLUSION Clinical and radiological results support the existence of a vicious circle based on two main mechanisms: energy deficit and neuronal hyperexcitability at the origin of SLE.
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Affiliation(s)
- Chloe Durrleman
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - David Grevent
- Pediatric Imaging Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
- Lumiere Platform, Université Paris Cité, Paris, France
| | - Melodie Aubart
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Charles-Joris Roux
- Pediatric Imaging Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Anna Kaminska
- Neurophysiology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Marlene Rio
- Genetic Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Giulia Barcia
- Genetic Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Nathalie Boddaert
- Pediatric Imaging Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
- Lumiere Platform, Université Paris Cité, Paris, France
| | - Arnold Munnich
- Genetic Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Rima Nabbout
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
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30
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Kaspar M, Liman L, Morbach C, Dietrich G, Seidlmayer LK, Puppe F, Störk S. Querying a Clinical Data Warehouse for Combinations of Clinical and Imaging Data. J Digit Imaging 2023; 36:715-724. [PMID: 36417023 PMCID: PMC10039164 DOI: 10.1007/s10278-022-00727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022] Open
Abstract
This study aims to show the feasibility and benefit of single queries in a research data warehouse combining data from a hospital's clinical and imaging systems. We used a comprehensive integration of a production picture archiving and communication system (PACS) with a clinical data warehouse (CDW) for research to create a system that allows data from both domains to be queried jointly with a single query. To achieve this, we mapped the DICOM information model to the extended entity-attribute-value (EAV) data model of a CDW, which allows data linkage and query constraints on multiple levels: the patient, the encounter, a document, and a group level. Accordingly, we have integrated DICOM metadata directly into CDW and linked it to existing clinical data. We included data collected in 2016 and 2017 from the Department of Internal Medicine in this analysis for two query inquiries from researchers targeting research about a disease and in radiology. We obtained quantitative information about the current availability of combinations of clinical and imaging data using a single multilevel query compiled for each query inquiry. We compared these multilevel query results to results that linked data at a single level, resulting in a quantitative representation of results that was up to 112% and 573% higher. An EAV data model can be extended to store data from clinical systems and PACS on multiple levels to enable combined querying with a single query to quickly display actual frequency data.
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Affiliation(s)
- Mathias Kaspar
- Department of Health Services Research, Carl Von Ossietzky University of Oldenburg, Campus Haarentor, V4/1/129, Ammerländer Heerstraße 140, 26129, Oldenburg, Germany.
- Comprehensive Heart Failure Center and Department of Internal Medicine I, University and University Hospital Würzburg, Würzburg, Germany.
| | - Leon Liman
- Chair of Computer Science VI, University of Würzburg, Würzburg, Germany
| | - Caroline Morbach
- Comprehensive Heart Failure Center and Department of Internal Medicine I, University and University Hospital Würzburg, Würzburg, Germany
| | - Georg Dietrich
- Chair of Computer Science VI, University of Würzburg, Würzburg, Germany
| | | | - Frank Puppe
- Chair of Computer Science VI, University of Würzburg, Würzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center and Department of Internal Medicine I, University and University Hospital Würzburg, Würzburg, Germany
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Goetz V, Yang DD, Abid H, Roux CJ, Levy R, Kossorotoff M, Desguerre I, Angoulvant F, Aubart M. Neurological features related to influenza virus in the pediatric population: a 3-year monocentric retrospective study. Eur J Pediatr 2023:10.1007/s00431-023-04901-9. [PMID: 36947244 DOI: 10.1007/s00431-023-04901-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/23/2023]
Abstract
Influenza virus is generally characterized by fever, myalgia, and respiratory symptoms. Neurological entities have already been described, such as acute necrotizing encephalitis (ANE). We aimed to highlight the non-exceptional nature and explore the clinical spectrum and evolution of neurological features related to influenza virus in children. This monocentric observational study included patients under 18 years old, positive for influenza virus, between January 2017 and April 2019 in a pediatric university hospital. Patients were classified into two groups: those with or without a previous significant neurological or metabolic disorder. Two hundred eighty-nine children were identified with influenza infection. Thirty seven had a neurological manifestation: 14 patients who had previous significant neurological or metabolic disorder and 23 patients with no medical history. We identified several clinical patterns: 22 patients had seizures, 7 behavior disorders, 5 disturbances of consciousness, and 3 motor deficits. Four were diagnosed with a known influenza-associated neurological syndrome: 1 ANE, 1 cytotoxic lesion of the corpus callosum, 1 hemiconvulsion-hemiplegia-epilepsia syndrome, and 1 recurrent encephalitis in the context of a RANBP2 mutation. The neurological outcome was favorable in most cases. None of the patients with previous significant disorder retained sequalae or had a recurrence. Two patients had a fatal outcome, and both had a predisposing disorder. CONCLUSION Various neurological manifestations can be associated with influenza virus. Certain entities led to a poor prognosis, but in most cases, symptoms improved within a few days. The severity of the neurological manifestations correlated with previous neurological or metabolic disorders. WHAT IS KNOWN • Influenza viruses are well known pathogens with a seasonal epidemic evolution, particularly affecting children. These viruses cause acute fever with respiratory symptoms, associated with myalgia and headaches. Neurological presentation in influenza-virus infection is a well-established possibility as influenza virus is considered to be responsible for 27 to 36% of childhood encephalitis. Some specific and severe entity as acute necrotizing encephalitis, cytotoxic lesion of the corpus callosum, or Hemiconvulsion-hemiplegia-epilepsy syndrome are well described. WHAT IS NEW • In a French monocentric cohort of 37 children with influenza-related neurologic manifestations, the majority of these manifestations, including seizure, drowsiness, motor deficiency, hallucination… are self limiting and do not lead to after-effects. In rare cases (4/37), they may reveal severe encephalitis requiring rapid and appropriate treatment. Otherwise, comparison of a group of 14 children with underlying neurological or metabolic disorder with a group of 23 children free of any significant disorder show that the severity of the neurological manifestations was largely related to previous neurological or metabolic disorders highlighting the importance of vaccination in this population.
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Affiliation(s)
- Violette Goetz
- Pediatric Neurology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - David-Dawei Yang
- Pediatric Emergency Department, Necker-Enfants alades Hospital, APHP, Université de Paris Citém, Paris, France
| | - Hanene Abid
- Virology Laboratory, Necker-Enfants alades Hospital, APHP, Université de Paris Citém, Paris, France
| | - Charles-Joris Roux
- Paediatric Radiology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - Raphael Levy
- Paediatric Radiology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - Isabelle Desguerre
- Pediatric Neurology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France
| | - François Angoulvant
- Pediatric Emergency Department, Necker-Enfants alades Hospital, APHP, Université de Paris Citém, Paris, France.
- INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France.
| | - Mélodie Aubart
- Pediatric Neurology Department, Necker-Enfants malades Hospital, APHP, Université de Paris Cité, Paris, France.
- INSERM U1163 Institut HU Imagine, Laboratory of Human Genetics of Infectious Disease, Paris, France.
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He T, Belouali A, Patricoski J, Lehmann H, Ball R, Anagnostou V, Kreimeyer K, Botsis T. Trends and opportunities in computable clinical phenotyping: A scoping review. J Biomed Inform 2023; 140:104335. [PMID: 36933631 DOI: 10.1016/j.jbi.2023.104335] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023]
Abstract
Identifying patient cohorts meeting the criteria of specific phenotypes is essential in biomedicine and particularly timely in precision medicine. Many research groups deliver pipelines that automatically retrieve and analyze data elements from one or more sources to automate this task and deliver high-performing computable phenotypes. We applied a systematic approach based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a thorough scoping review on computable clinical phenotyping. Five databases were searched using a query that combined the concepts of automation, clinical context, and phenotyping. Subsequently, four reviewers screened 7960 records (after removing over 4000 duplicates) and selected 139 that satisfied the inclusion criteria. This dataset was analyzed to extract information on target use cases, data-related topics, phenotyping methodologies, evaluation strategies, and portability of developed solutions. Most studies supported patient cohort selection without discussing the application to specific use cases, such as precision medicine. Electronic Health Records were the primary source in 87.1 % (N = 121) of all studies, and International Classification of Diseases codes were heavily used in 55.4 % (N = 77) of all studies, however, only 25.9 % (N = 36) of the records described compliance with a common data model. In terms of the presented methods, traditional Machine Learning (ML) was the dominant method, often combined with natural language processing and other approaches, while external validation and portability of computable phenotypes were pursued in many cases. These findings revealed that defining target use cases precisely, moving away from sole ML strategies, and evaluating the proposed solutions in the real setting are essential opportunities for future work. There is also momentum and an emerging need for computable phenotyping to support clinical and epidemiological research and precision medicine.
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Affiliation(s)
- Ting He
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Anas Belouali
- Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jessica Patricoski
- Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Harold Lehmann
- Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Robert Ball
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US FDA, Silver Spring, MD, USA
| | - Valsamo Anagnostou
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kory Kreimeyer
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Taxiarchis Botsis
- Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Biomedical Informatics and Data Science Section, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Léguillon R, Gosselin L, Carnoy C, Pressat-Laffouilhere T, Letord C, Dahamna B, Darmoni SJ, Grosjean J. Integrating a new knowledge organisation system for monoclonal antibodies for therapeutic use authorised in Europe into HeTOP terminology-ontology server. J Biomed Inform 2023; 140:104325. [PMID: 36870586 DOI: 10.1016/j.jbi.2023.104325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 02/06/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023]
Abstract
Monoclonal antibodies (MAs) are increasingly used in the therapeutic arsenal. Clinical Data Warehouses (CDWs) offer unprecedented opportunities for research on real-word data. The objective of this work is to develop a knowledge organization system on MAs for therapeutic use (MATUs) applicable in Europe to query CDWs from a multi-terminology server (HeTOP). After expert consensus, three main health thesauri were selected: the MeSH thesaurus, the National Cancer Institute thesaurus (NCIt) and the SNOMED CT. These thesauri contain 1,723 MAs concepts, but only 99 (5.7 %) are identified as MATUs. The knowledge organisation system proposed in this article is a six-level hierarchical system according to their main therapeutic target. It includes 193 different concepts organised in a cross lingual terminology server, which will allow the inclusion of semantic extensions. Ninety nine (51.3 %) MATUs concepts and 94 (48.7 %) hierarchical concepts composed the knowledge organisation system. Two separates groups (an expert group and a validation group) carried out the selection, creation and validation processes. Queries identify, for unstructured data, 83 out of 99 (83.8 %) MATUs corresponding to 45,262 patients, 347,035 hospital stays and 427,544 health documents, and for structured data, 61 out of 99 (61.6 %) MATUs corresponding to 9,218 patients, 59,643 hospital stays and 104,737 hospital prescriptions. The volume of data in the CDW demonstrated the potential for using these data in clinical research, although not all MATUs are present in the CDW (16 missing for unstructured data and 38 for structured data). The knowledge organisation system proposed here improves the understanding of MATUs, the quality of queries and helps clinical researchers retrieve relevant medical information. The use of this model in CDW allows for the rapid identification of a large number of patients and health documents, either directly by a MATU of interest (e.g. Rituximab) but also by searching for parent concepts (e.g. Anti-CD20 Monoclonal Antibody).
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Affiliation(s)
- Romain Léguillon
- Department of Digital Health, Rouen University Hospital, Rouen, France; Department of Pharmacy, Rouen University Hospital, Rouen, France; Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France.
| | - Laura Gosselin
- Department of Digital Health, Rouen University Hospital, Rouen, France; Department of Pharmacy, Rouen University Hospital, Rouen, France
| | - Christophe Carnoy
- Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France; GIVRE, Univ-Lille, France
| | - Thibaut Pressat-Laffouilhere
- Clinique Ambroise Paré, groupe ELSAN Department of medical information, 387 Rte de Saint-Simon, F-31100 Toulouse, France
| | - Catherine Letord
- Department of Digital Health, Rouen University Hospital, Rouen, France; Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
| | - Badisse Dahamna
- Department of Digital Health, Rouen University Hospital, Rouen, France; Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
| | - Stéfan J Darmoni
- Department of Digital Health, Rouen University Hospital, Rouen, France; Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
| | - Julien Grosjean
- Department of Digital Health, Rouen University Hospital, Rouen, France; Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances en e-Santé (LIMICS), U1142, INSERM, Sorbonne Université, Paris, France
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Hennocq Q, Bongibault T, Bizière M, Delassus O, Douillet M, Cormier-Daire V, Amiel J, Lyonnet S, Marlin S, Rio M, Picard A, Khonsari RH, Garcelon N. An automatic facial landmarking for children with rare diseases. Am J Med Genet A 2023; 191:1210-1221. [PMID: 36714960 DOI: 10.1002/ajmg.a.63126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/31/2023]
Abstract
Two to three thousand syndromes modify facial features: their screening requires the eye of an expert in dysmorphology. A widely used tool in shape characterization is geometric morphometrics based on landmarks, which are precise and reproducible anatomical points. Landmark positioning is user dependent and time consuming. Many automatic landmarking tools are currently available but do not work for children, because they have mainly been trained using photographic databases of healthy adults. Here, we developed a method for building an automatic landmarking pipeline for frontal and lateral facial photographs as well as photographs of external ears. We evaluated the algorithm on patients diagnosed with Treacher Collins (TC) syndrome as it is the most frequent mandibulofacial dysostosis in humans and is clinically recognizable although highly variable in severity. We extracted photographs from the photographic database of the maxillofacial surgery and plastic surgery department of Hôpital Necker-Enfants Malades in Paris, France with the diagnosis of TC syndrome. The control group was built from children admitted for craniofacial trauma or skin lesions. After testing two methods of object detection by bounding boxes, a Haar Cascade-based tool and a Faster Region-based Convolutional Neural Network (Faster R-CNN)-based tool, we evaluated three different automatic annotation algorithms: the patch-based active appearance model (AAM), the holistic AAM, and the constrained local model (CLM). The final error corresponding to the distance between the points placed by automatic annotation and those placed by manual annotation was reported. We included, respectively, 1664, 2044, and 1375 manually annotated frontal, profile, and ear photographs. Object recognition was optimized with the Faster R-CNN-based detector. The best annotation model was the patch-based AAM (p < 0.001 for frontal faces, p = 0.082 for profile faces and p < 0.001 for ears). This automatic annotation model resulted in the same classification performance as manually annotated data. Pretraining on public photographs did not improve the performance of the model. We defined a pipeline to create automatic annotation models adapted to faces with congenital anomalies, an essential prerequisite for research in dysmorphology.
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Affiliation(s)
- Quentin Hennocq
- Imagine Institute, INSERM UMR 1163, Paris, France.,Département de chirurgie maxillo-faciale et chirurgie plastique pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
| | | | | | | | | | - Valérie Cormier-Daire
- Fédération de médecine génomique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Jeanne Amiel
- Fédération de médecine génomique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Stanislas Lyonnet
- Fédération de médecine génomique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Sandrine Marlin
- Fédération de médecine génomique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Marlène Rio
- Fédération de médecine génomique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Arnaud Picard
- Département de chirurgie maxillo-faciale et chirurgie plastique pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
| | - Roman Hossein Khonsari
- Département de chirurgie maxillo-faciale et chirurgie plastique pédiatrique, Hôpital Necker - Enfants Malades, Assistance Publique - Hôpitaux de Paris, Centre de Référence des Malformations Rares de la Face et de la Cavité Buccale MAFACE, Filière Maladies Rares TeteCou, Faculté de Médecine, Université de Paris Cité, Paris, France
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Lovis C, Mageau A, Mékinian A, Tannier X, Carrat F. Construction of Cohorts of Similar Patients From Automatic Extraction of Medical Concepts: Phenotype Extraction Study. JMIR Med Inform 2022; 10:e42379. [PMID: 36534446 PMCID: PMC9808583 DOI: 10.2196/42379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/17/2022] [Accepted: 10/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Reliable and interpretable automatic extraction of clinical phenotypes from large electronic medical record databases remains a challenge, especially in a language other than English. OBJECTIVE We aimed to provide an automated end-to-end extraction of cohorts of similar patients from electronic health records for systemic diseases. METHODS Our multistep algorithm includes a named-entity recognition step, a multilabel classification using medical subject headings ontology, and the computation of patient similarity. A selection of cohorts of similar patients on a priori annotated phenotypes was performed. Six phenotypes were selected for their clinical significance: P1, osteoporosis; P2, nephritis in systemic erythematosus lupus; P3, interstitial lung disease in systemic sclerosis; P4, lung infection; P5, obstetric antiphospholipid syndrome; and P6, Takayasu arteritis. We used a training set of 151 clinical notes and an independent validation set of 256 clinical notes, with annotated phenotypes, both extracted from the Assistance Publique-Hôpitaux de Paris data warehouse. We evaluated the precision of the 3 patients closest to the index patient for each phenotype with precision-at-3 and recall and average precision. RESULTS For P1-P4, the precision-at-3 ranged from 0.85 (95% CI 0.75-0.95) to 0.99 (95% CI 0.98-1), the recall ranged from 0.53 (95% CI 0.50-0.55) to 0.83 (95% CI 0.81-0.84), and the average precision ranged from 0.58 (95% CI 0.54-0.62) to 0.88 (95% CI 0.85-0.90). P5-P6 phenotypes could not be analyzed due to the limited number of phenotypes. CONCLUSIONS Using a method close to clinical reasoning, we built a scalable and interpretable end-to-end algorithm for extracting cohorts of similar patients.
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Affiliation(s)
| | - Arthur Mageau
- Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1137 Infection Antimicrobials Modelling Evolution, Team Decision Sciences in Infectious Diseases, Université Paris Cité, Paris, France
| | - Arsène Mékinian
- Service de Médecine Interne, Inflammation-Immunopathology-Biotherapy Department, Hôpital Saint-Antoine, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Xavier Tannier
- Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, Institut National de la Santé et de la Recherche Médicale, Université Sorbonne, Paris, France
| | - Fabrice Carrat
- Institute Pierre Louis Epidemiology and Public Health, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Paris, France.,Public Health Department, Hopital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
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Nguyen AT, Cotteret C, Durrleman C, Barnerias C, Hully M, Gitiaux C, Mesples B, Bustamante J, Chhun S, Fayard C, Cisternino S, Treluyer JM, Desguerre I, Aubart M. Indications and Safety of Rituximab in Pediatric Neurology: A 10-Year Retrospective Study. Pediatr Neurol 2022; 137:41-48. [PMID: 36228496 DOI: 10.1016/j.pediatrneurol.2022.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 08/06/2022] [Accepted: 08/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND RTX is used off-label in several neurological inflammatory diseases in adults children patients. We conducted a study to assess indications and safety of rituximab (RTX) for children and to identify risk factors for early B-cell repopulation. METHODS A single-center retrospective study of children treated with RTX for a neurological disease between May 31, 2010, and May 31, 2020, was performed. RESULTS A total of 77 children (median age, 8.9 years) were included. RTX was mostly used as second-line therapy in all groups of diseases (68%). Median dose was 1500 mg/m2 for each patient. There were 13 clinical relapses (17%), 5 when B-cell depletion was complete. Adverse events were present in 6% of the cases. The factors influencing early B-cell repopulation were the recent infusion of intravenous Ig (P < 0.01) and the administration of less than 1500 mg/m2 during the first RTX treatment (P = 0.04). The median time to B-cell repopulation seemed to be shorter (160 vs 186 days) when patients had plasmapheresis even when a 48-hour delay was observed with RTX infusions. CONCLUSIONS This study confirms the good tolerance of RTX in the treatment of specific neurological disorders in a pediatric population. It also highlights risk factors for early B-cell repopulation and underlines the importance of B-cell monitoring.
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Affiliation(s)
- Ai Tien Nguyen
- Department of Pediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Camille Cotteret
- Department of Clinical Pharmacy, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Chloé Durrleman
- Department of Pediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Christine Barnerias
- Department of Pediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Marie Hully
- Department of Pediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Cyril Gitiaux
- Department of Pediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Bettina Mesples
- Department of Pediatrics, Louis Mourier Hospital, University of Paris, AP-HP, Paris, France
| | - Jacinta Bustamante
- Study Center for Primary Immunodeficiencies, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France; Human Genetics of Infectious Diseases, INSERM UMR 1163, University of Paris, Institut Imagine, Paris, France
| | - Stéphanie Chhun
- Laboratory of Immunology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Claire Fayard
- Department of Clinical Pharmacy, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Salvatore Cisternino
- Department of Clinical Pharmacy, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Jean-Marc Treluyer
- Clinical Research Unit, Necker-Enfants maladies Hospital, University of Paris, AP-HP, Paris, France
| | - Isabelle Desguerre
- Department of Pediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France
| | - Mélodie Aubart
- Department of Pediatric Neurology, Necker-Enfants malades Hospital, University of Paris, AP-HP, Paris, France; Human Genetics of Infectious Diseases, INSERM UMR 1163, University of Paris, Institut Imagine, Paris, France.
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Fouquet G, Rossignol J, Ricard L, Guillem F, Couronné L, Asnafi V, Vavasseur M, Parisot M, Garcelon N, Rieux-Laucat F, Mekinian A, Hermine O. BLNK mutation associated with T-cell LGL leukemia and autoimmune diseases: Case report in hematology. Front Med (Lausanne) 2022; 9:997161. [DOI: 10.3389/fmed.2022.997161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 10/11/2022] [Indexed: 11/17/2022] Open
Abstract
We present the case of a female patient with a heterozygous somatic BLNK mutation, a T-cell LGL (large granular lymphocyte) leukemia, and multiple autoimmune diseases. Although this mutation seems uncommon especially in this kind of clinical observation, it could represent a new mechanism for autoimmune diseases associated with LGL leukemia. The patient developed several autoimmune diseases: pure red blood cell apalsia, thyroiditis, oophoritis, and alopecia areata. She also presented a T-cell LGL leukemia which required treatment with corticosteroids and cyclophosphamide, with good efficacy. Interestingly, she had no notable infectious history. The erythroblastopenia also resolved, the alopecia evolves by flare-ups, and the patient is still under hormonal supplementation for thyroiditis and oophoritis. We wanted to try to understand the unusual clinical picture presented by this patient. We therefore performed whole-genome sequencing, identifying a heterozygous somatic BLNK mutation. Her total gamma globulin level was slightly decreased. Regarding the lymphocyte subpopulations, she presented a B-cell deficiency with increased autoreactive B-cells and a CD4+ and Treg deficiency. This B-cell deficiency persisted after complete remission of erythroblastopenia and LGL leukemia. We propose that the persistent B-cell deficiency linked to the BLNK mutation can explain her clinical phenotype.
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Pouliquen G, Fillon L, Dangouloff-Ros V, Kuchenbuch M, Bar C, Chemaly N, Levy R, Roux CJ, Saitovitch A, Boisgontier J, Nabbout R, Boddaert N. Arterial Spin-Labeling Perfusion Imaging in the Early Stage of Sturge-Weber Syndrome. AJNR Am J Neuroradiol 2022; 43:1516-1522. [PMID: 36137664 PMCID: PMC9575527 DOI: 10.3174/ajnr.a7643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/27/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Sturge-Weber syndrome is a rare congenital neuro-oculo-cutaneous disorder. Although the principal mechanism of Sturge-Weber syndrome is characterized by a leptomeningeal vascular malformation, few data regarding perfusion abnormalities of the brain parenchyma are available. Therefore, the aim of this study was to assess the diagnostic performance of arterial spin-labeling perfusion imaging in the early stage of Sturge-Weber syndrome before 1 year of age until 3.5 years of age. We hypothesized that a leptomeningeal vascular malformation has very early hypoperfusion compared with controls with healthy brains. MATERIALS AND METHODS We compared the CBF using arterial spin-labeling perfusion imaging performed at 3T MR imaging in the brain parenchymal regions juxtaposing the leptomeningeal vascular malformation in patients with Sturge-Weber syndrome (n = 16; 3.5 years of age or younger) with the corresponding areas in age-matched controls with healthy brains (n = 58). The analysis was performed following two complementary methods: a whole-brain voxel-based analysis and a visual ROI analysis focused on brain territory of the leptomeningeal vascular malformation. RESULTS Whole-brain voxel-based comparison revealed a significant unilateral decrease in CBF localized in the affected cortices of patients with Sturge-Weber syndrome (P < .001). CBF values within the ROIs in patients with Sturge-Weber syndrome were lower than those in controls (in the whole cohort: median, 25 mL/100g/min, versus 44 mL/100g/min; P < .001). This finding was also observed in the group younger than 1 year of age, emphasizing the high sensitivity of arterial spin-labeling in this age window in which the diagnosis is difficult. CONCLUSIONS Arterial spin-labeling perfusion imaging in the early stage of Sturge-Weber syndrome can help to diagnose the disease by depicting a cortical hypoperfusion juxtaposing the leptomeningeal vascular malformation.
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Affiliation(s)
- G Pouliquen
- From the Department of Pediatric Radiology (G.P., V.D.-R., R.L., C.-J.R., N.B.)
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - L Fillon
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - V Dangouloff-Ros
- From the Department of Pediatric Radiology (G.P., V.D.-R., R.L., C.-J.R., N.B.)
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - M Kuchenbuch
- Centre de Reference Epilepsies Rares (M.K., C.B., N.C., R.N.), Department of Pediatric Neurology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - C Bar
- Centre de Reference Epilepsies Rares (M.K., C.B., N.C., R.N.), Department of Pediatric Neurology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - N Chemaly
- Centre de Reference Epilepsies Rares (M.K., C.B., N.C., R.N.), Department of Pediatric Neurology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - R Levy
- From the Department of Pediatric Radiology (G.P., V.D.-R., R.L., C.-J.R., N.B.)
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - C-J Roux
- From the Department of Pediatric Radiology (G.P., V.D.-R., R.L., C.-J.R., N.B.)
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - A Saitovitch
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - J Boisgontier
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
| | - R Nabbout
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
- Centre de Reference Epilepsies Rares (M.K., C.B., N.C., R.N.), Department of Pediatric Neurology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - N Boddaert
- From the Department of Pediatric Radiology (G.P., V.D.-R., R.L., C.-J.R., N.B.)
- Imagine Institute for Genetic Diseases (G.P., L.F., V.D.-R., R.L., C.-J.R., A.S., J.B., R.N., N.B.), L'Institut National de la Santé et de la Recherche Médicale U1163, Paris, France
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Friedlander L, Vincent M, Berdal A, Cormier-Daire V, Lyonnet S, Garcelon N. Consideration of oral health in rare disease expertise centres: a retrospective study on 39 rare diseases using text mining extraction method. Orphanet J Rare Dis 2022; 17:317. [PMID: 35987771 PMCID: PMC9392290 DOI: 10.1186/s13023-022-02467-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Around 8000 rare diseases are currently defined. In the context of individual vulnerability and more specifically the one induced by rare diseases, ensuring oral health is a particularly important issue. The objective of the study is to evaluate the pattern of oral health care course for patients with any rare genetic disease. Description of oral phenotypic signs—which predict a theoretical dental health care course—and effective orientation into an oral healthcare were evaluated.
Materials and methods We set up a retrospective cohort study to describe the consideration of patient oral health and potential orientation to an oral health care course who have at least been seen once between 1 January 2017 and 1 January 2020 in Necker Enfants Malades Hospital. We recruited patients from this study using the data warehouse, Dr Warehouse® (DrWH), from Necker-Enfants Malades Hospital.
Results The study sample included 39 rare diseases, 2712 patients, with 54.7% girls and 45.3% boys. In the sample studied, 27.9% of patients had an acquisition delay or a pervasive developmental disorder. Among the patient files studied, oral and dental phenotypic signs were described for 18.40% of the patients, and an orientation in an oral healthcare was made in 15.60% of patients. The overall "network" effect was significantly associated with description of phenotypic signs (corrected p = 1.44e−77) and orientation to an oral healthcare (corrected p = 23.58e−44). Taking the Defiscience network (rare diseases of cerebral development and intellectual disability) as a reference for the odd ratio analysis, OSCAR, TETECOU, FILNEMUS, FIMARAD, MHEMO networks stand out from the other networks for their significantly higher consideration of oral phenotypic signs and orientation in an oral healthcare.
Conclusion To our knowledge, no study has explored the management of oral health in so many rare diseases. The expected benefits of this study are, among others, a better understanding, and a better knowledge of the oral care, or at least of the consideration of oral care, in patients with rare diseases. Moreover, with the will to improve the knowledge on genetic diseases, oral heath must have a major place in the deep patient phenotyping. Therefore, interdisciplinary consultations with health professionals from different fields are crucial.
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40
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Fouquet G, Rossignol J, Garcelon N, Hermine O, Côté F, Coman T. Targeting Serotonin With Common Antidepressants Induces Rapid Recovery From Cytopenia. Stem Cells Transl Med 2022; 11:927-931. [PMID: 35946826 PMCID: PMC9492259 DOI: 10.1093/stcltm/szac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/12/2022] [Indexed: 11/12/2022] Open
Abstract
The hematopoietic system uses several, yet undiscovered, factors to adapt to stresses such as chemotherapy, infections, or bleeding. Serotonin is commonly known as a neurotransmitter but is also produced and used in peripheral organs. In particular, we have shown that serotonin synthesized in the bone marrow is necessary for erythroid progenitors' survival and proliferation. Serotonin levels can be increased by FDA approved antidepressants called selective serotonin reuptake inhibitors (SSRI). In this work, we report a previously unknown role of SSRI in the recovery of cytopenia, after autologous hematopoietic stem cell transplantation in patients and after sub-lethal irradiation in mice. We also observed an unexpected cooperation between SSRI and G-CSF on the improvement of the 3 hematopoietic lineages. Of note, SSRI do not seem to affect blood cells production in the absence of stress-induced hematopoiesis. We propose that the serotonergic system could be a valuable therapeutic target in stress-induced cytopenia, especially as a rescue after radiation or chemotherapy.
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Affiliation(s)
- Guillemette Fouquet
- Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France.,Hématologie, Hôpital Necker, APHP, Paris, France.,Hématologie, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France.,INSERM U1016, Institut Cochin, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Paris, France
| | - Julien Rossignol
- Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France.,Hématologie, Hôpital Necker, APHP, Paris, France
| | - Nicolas Garcelon
- Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France
| | - Olivier Hermine
- Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France.,Hématologie, Hôpital Necker, APHP, Paris, France
| | - Francine Côté
- Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France.,INSERM U1016, Institut Cochin, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Paris, France
| | - Tereza Coman
- Institut Imagine, INSERM U1163, Université Paris Cité, Paris, France.,INSERM U1016, Institut Cochin, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, Paris, France.,Hématologie, Institut Gustave Roussy, Villejuif, France
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41
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Lãzãrescu AM, Benichi S, Blauwblomme T, Beccaria K, Bourgeois M, Roux CJ, Vergnaud E, Montmayeur J, Meyer P, Cohen JF, Chalumeau M, Blangis F, Orliaguet G. Abusive Head Trauma in Infants During the COVID-19 Pandemic in the Paris Metropolitan Area. JAMA Netw Open 2022; 5:e2226182. [PMID: 36040743 PMCID: PMC9428740 DOI: 10.1001/jamanetworkopen.2022.26182] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/02/2022] [Indexed: 12/17/2022] Open
Abstract
Importance The COVID-19 pandemic and the containment and mitigation measures taken were feared to be associated with increased child abuse. Objective To investigate the trend of abusive head trauma (AHT) incidence and severity in infants during the COVID-19 pandemic. Design, Setting, and Participants In a time-series analysis of a longitudinal, population-based, cohort study, all consecutive cases of AHT in infants younger than 12 months old referred between January 2017 and December 2021 to Necker Hospital for Sick Children, the single regional pediatric neurosurgery center for the Paris metropolitan area, were included. AHT was defined as 1 or more subdural hemorrhage and a positive multidisciplinary evaluation after a social, clinical, biological, and radiological workup. Data were analyzed from January to March 2022. Main Outcomes and Measures The primary outcome was the monthly incidence of AHT, which was analyzed using Poisson regression modeling. Secondary outcomes included mortality and severe morbidity and were studied with logistic and linear regressions. The monthly incidence of neurosurgical interventions for hydrocephalus was used as a control series. Results Among the 99 included infants with AHT (median [IQR] age, 4 [3-6] months; 64 boys [65%]), 86 of 99 (87%) had bridging vein thrombosis, 74 of 99 (75%) had retinal hemorrhages, 23 of 72 (32%) had fractures, 26 of 99 (26%) had status epilepticus, 20 of 99 (20%) had skin injuries, 53 of 99 (54%) underwent neurosurgical interventions, and 13 of 99 (13%) died. Compared with the prepandemic period (2017-2019), AHT incidence was stable in 2020 (adjusted incidence rate ratio, 1.02; 95% CI, 0.59-1.77) and then significantly increased in 2021 (adjusted incidence rate ratio, 1.92; 95% CI, 1.23-2.99). The severity of AHT worsened in 2021 in terms of mortality (odds ratio 9.39; 95% CI, 1.88-47.00). Other secondary outcomes and the control series were not significantly modified. Conclusions and Relevance In this cohort study, a marked increase in AHT incidence and severity occurred during the COVID-19 pandemic in the Paris metropolitan area. These results suggest the need for clinical awareness and preventive actions.
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Affiliation(s)
- Alina-Marilena Lãzãrescu
- Department of Pediatric Anesthesia and Intensive Care, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Sandro Benichi
- Department of Pediatric Neurosurgery, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Kévin Beccaria
- Department of Pediatric Neurosurgery, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Marie Bourgeois
- Department of Pediatric Neurosurgery, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Charles-Joris Roux
- Department of Pediatric Radiology, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Estelle Vergnaud
- Department of Pediatric Anesthesia and Intensive Care, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Juliette Montmayeur
- Department of Pediatric Anesthesia and Intensive Care, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Philippe Meyer
- Department of Pediatric Anesthesia and Intensive Care, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Jérémie F. Cohen
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, Université Paris Cité, Institut National de la Santé et de la Recherche Medicale, Paris, France
- Child Protection Unit, Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Martin Chalumeau
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, Université Paris Cité, Institut National de la Santé et de la Recherche Medicale, Paris, France
- Child Protection Unit, Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Flora Blangis
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and Statistics, Université Paris Cité, Institut National de la Santé et de la Recherche Medicale, Paris, France
- Child Protection Unit, Department of General Pediatrics and Pediatric Infectious Diseases, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
| | - Gilles Orliaguet
- Department of Pediatric Anesthesia and Intensive Care, Assistance Publique–Hôpitaux de Paris, Necker-Enfants Malades Hospital, Université Paris Cité, Paris, France
- Unit EA7323 Evaluation of Therapeutics and Pharmacology in Perinatality and Pediatrics, Université Paris Cité, Paris, France
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Yang DD, Rio M, Michot C, Boddaert N, Yacoub W, Garcelon N, Thierry B, Bonnet D, Rondeau S, Herve D, Guey S, Angoulvant F, Cormier-Daire V. Natural history of Myhre syndrome. Orphanet J Rare Dis 2022; 17:304. [PMID: 35907855 PMCID: PMC9338657 DOI: 10.1186/s13023-022-02447-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Myhre syndrome (MS) is a rare genetic disease characterized by skeletal disorders, facial features and joint limitation, caused by a gain of function mutation in SMAD4 gene. The natural history of MS remains incompletely understood.
Methods We recruited in a longitudinal retrospective study patients with molecular confirmed MS from the French reference center for rare skeletal dysplasia. We described natural history by chaining data from medical reports, clinical data warehouse, medical imaging and photographies.
Results We included 12 patients. The median age was 22 years old (y/o). Intrauterine and postnatal growth retardation were consistently reported. In preschool age, neurodevelopment disorders were reported in 80% of children. Specifics facial and skeletal features, thickened skin and joint limitation occured mainly in school age children. The adolescence was marked by the occurrence of pulmonary arterial hypertension (PAH) and vascular stenosis. We reported for the first time recurrent strokes from the age of 26 y/o, caused by a moyamoya syndrome in one patient. Two patients died at late adolescence and in their 20 s respectively from PAH crises and mesenteric ischemia. Conclusion Myhre syndrome is a progressive disease with severe multisystemic impairement and life-threathning complication requiring multidisciplinary monitoring.
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Affiliation(s)
- David Dawei Yang
- Centre de Recherche Des Cordeliers, INSERM UMRS 1138 Team 22, Université de Paris, 75006, Paris, France.,Pediatric Emergency Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Marlene Rio
- Université de Paris, Institut IMAGINE, Developmental Brain Disorders Laboratory, INSERM UMR1163, 75015, Paris, France.,Departement of Medical Genetics, AP-HP, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Caroline Michot
- Departement of Medical Genetics, AP-HP, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France.,Université de Paris, Institut IMAGINE, Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR1163, 75015, Paris, France
| | - Nathalie Boddaert
- Paediatric Radiology Department, AP-HP, Hôpital Universitaire Necker Enfants Malades, 75015, Paris, France.,Université de Paris, Institut IMAGINE, INSERM1163, 75015, Paris, France
| | - Wael Yacoub
- Paediatric Radiology Department, AP-HP, Hôpital Universitaire Necker Enfants Malades, 75015, Paris, France.,Université de Paris, Institut IMAGINE, INSERM1163, 75015, Paris, France
| | - Nicolas Garcelon
- Centre de Recherche Des Cordeliers, INSERM UMRS 1138 Team 22, Université de Paris, 75006, Paris, France.,Université de Paris, Institut IMAGINE, Data Science Platform, INSERM UMR1163, 75015, Paris, France
| | - Briac Thierry
- Department of Pediatric Otolaryngology-Head and Neck Surgery, AP-HP, Hôpital Universitaire Necker - Enfants Malades, 75015, Paris, France.,Université de Paris, Human Immunology, Pathophysiology, Immunotherapy/HIPI/INSERM UMR976, Stem Cell Biotechnologies, 75010, Paris, France
| | - Damien Bonnet
- Université de Paris, Institut IMAGINE, INSERM1163, 75015, Paris, France.,M3C-Paediatric Cardiology, AP-HP, Hôpital Universitaire Necker Enfants Malades, 75015, Paris, France
| | - Sophie Rondeau
- Departement of Medical Genetics, AP-HP, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France.,Université de Paris, Institut IMAGINE, Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR1163, 75015, Paris, France
| | - Dominique Herve
- Department of Neurology, AP-HP Nord, Referral Center for Rare Vascular Diseases of the Brain and Retina (CERVCO), DHU NeuroVasc, INSERM U 1161, 75010, Paris, France
| | - Stephanie Guey
- Department of Neurology, AP-HP, Hôpital Lariboisière, UMR-S1161, 75010, Paris, France
| | - Francois Angoulvant
- Centre de Recherche Des Cordeliers, INSERM UMRS 1138 Team 22, Université de Paris, 75006, Paris, France.,Pediatric Emergency Department, AP-HP, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France
| | - Valerie Cormier-Daire
- Departement of Medical Genetics, AP-HP, Hôpital Universitaire Necker-Enfants Malades, 75015, Paris, France. .,Université de Paris, Institut IMAGINE, Molecular and Physiopathological Bases of Osteochondrodysplasia, INSERM UMR1163, 75015, Paris, France.
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Chen X, Faviez C, Vincent M, Briseño-Roa L, Faour H, Annereau JP, Lyonnet S, Zaidan M, Saunier S, Garcelon N, Burgun A. Patient-Patient Similarity-Based Screening of a Clinical Data Warehouse to Support Ciliopathy Diagnosis. Front Pharmacol 2022; 13:786710. [PMID: 35401179 PMCID: PMC8993144 DOI: 10.3389/fphar.2022.786710] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022] Open
Abstract
A timely diagnosis is a key challenge for many rare diseases. As an expanding group of rare and severe monogenic disorders with a broad spectrum of clinical manifestations, ciliopathies, notably renal ciliopathies, suffer from important underdiagnosis issues. Our objective is to develop an approach for screening large-scale clinical data warehouses and detecting patients with similar clinical manifestations to those from diagnosed ciliopathy patients. We expect that the top-ranked similar patients will benefit from genetic testing for an early diagnosis. The dependence and relatedness between phenotypes were taken into account in our similarity model through medical concept embedding. The relevance of each phenotype to each patient was also considered by adjusted aggregation of phenotype similarity into patient similarity. A ranking model based on the best-subtype-average similarity was proposed to address the phenotypic overlapping and heterogeneity of ciliopathies. Our results showed that using less than one-tenth of learning sources, our language and center specific embedding provided comparable or better performances than other existing medical concept embeddings. Combined with the best-subtype-average ranking model, our patient-patient similarity-based screening approach was demonstrated effective in two large scale unbalanced datasets containing approximately 10,000 and 60,000 controls with kidney manifestations in the clinical data warehouse (about 2 and 0.4% of prevalence, respectively). Our approach will offer the opportunity to identify candidate patients who could go through genetic testing for ciliopathy. Earlier diagnosis, before irreversible end-stage kidney disease, will enable these patients to benefit from appropriate follow-up and novel treatments that could alleviate kidney dysfunction.
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Affiliation(s)
- Xiaoyi Chen
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,HeKA, Inria, Paris, France.,Data Science Platform, Imagine Institute, Université de Paris, INSERM UMR 1163, Paris, France
| | - Carole Faviez
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,HeKA, Inria, Paris, France
| | - Marc Vincent
- Data Science Platform, Imagine Institute, Université de Paris, INSERM UMR 1163, Paris, France
| | | | - Hassan Faour
- Data Science Platform, Imagine Institute, Université de Paris, INSERM UMR 1163, Paris, France
| | | | | | - Mohamad Zaidan
- Service de Néphrologie, Hôpital Universitaire Bicêtre, Kremlin Bicêtre, France
| | - Sophie Saunier
- Laboratory of Renal Hereditary Diseases, Imagine Institute, Université de Paris, INSERM UMR 1163, Paris, France
| | - Nicolas Garcelon
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,HeKA, Inria, Paris, France.,Data Science Platform, Imagine Institute, Université de Paris, INSERM UMR 1163, Paris, France
| | - Anita Burgun
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France.,HeKA, Inria, Paris, France.,Department of Medical Informatics, Hôpital Necker-Enfant Malades, AP-HP, Paris, France
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44
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Goetz V, Yang DD, Lacaille F, Pelosi M, Angoulvant F, Brassier A, Arnoux JB, Schiff M, Heilbronner C, Salvador E, Debray D, Oualha M, Renolleau S, Girard M, de Lonlay P. What are the clues for an inherited metabolic disorder in Reye syndrome? A single Centre study of 58 children. Mol Genet Metab 2022; 135:320-326. [PMID: 35221207 DOI: 10.1016/j.ymgme.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/26/2022] [Accepted: 02/08/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Reye Syndrome is an acute encephalopathy with increased liver enzymes and blood ammonia, without jaundice. The prevalence of an underlying inherited metabolic disorder (IMD) is unclear, nor the clinical or biological factors directing toward this diagnosis. Our aims were to define these clues in a large series of patients. PATIENTS AND METHODS We retrospectively studied all patients with Reye admitted in our institution from 1995. We defined 3 groups: Group 1 with a confirmed IMD, Group 2 considered as free of IMD, Group 3 unclassified. Statistical analysis compared patients in Groups 1 and 2, to find criteria for a diagnosis of IMD. RESULTS Fifty-eight children were included; 41 (71%) had a confirmed IMD, 12 (20%) were free of IMD, and 5 remained unclassified. IMDs included Urea Cycle Disorders (51%), Fatty-Acid Oxidation Disorders (24%), ketogenesis defects (5%), other mitochondrial energy metabolism defects (10%), NBAS mutation (7%), Glycosylation Disorders (2%). In Group 2, the trigger was a viral infection, or a drug, deferasirox in three children. Univariate analysis showed that onset before 2 years-old, recurrent Reye and the association with rhabdomyolysis were significantly associated with IMD. Blood ammonia was a poor discriminating marker. All children were admitted into the intensive care unit, 23% needed continuous venovenous hemodialysis and one died from brain oedema. CONCLUSION Metabolic tests should be performed early in all cases of Reye, regardless of triggers. As they can be inconclusive, we suggest to systematically go to Next-Generation Sequencing study. These children should be transferred early to a specialized unit.
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Affiliation(s)
- Violette Goetz
- Reference Centre of Inherited Metabolic Diseases, Necker-Enfants malades Hospital, APHP, Filière G2M, Metab ERN, Université de Paris, Paris, France.
| | - David Dawei Yang
- Hopitaux de Paris, Pediatric Emergency Department, Necker-Enfants malades Hospital, Université de Paris, Paris, France
| | - Florence Lacaille
- Gastroenterology-Hepatology-Nutrition Unit, Reference Center for Rare Paediatric Liver Diseases, Necker-Enfants malades Hospital, APHP, Filière Filfoie, Université de Paris, Paris, France
| | - Michele Pelosi
- Reference Centre of Inherited Metabolic Diseases, Necker-Enfants malades Hospital, APHP, Filière G2M, Metab ERN, Université de Paris, Paris, France
| | - François Angoulvant
- Hopitaux de Paris, Pediatric Emergency Department, Necker-Enfants malades Hospital, Université de Paris, Paris, France
| | - Anais Brassier
- Reference Centre of Inherited Metabolic Diseases, Necker-Enfants malades Hospital, APHP, Filière G2M, Metab ERN, Université de Paris, Paris, France
| | - Jean-Baptiste Arnoux
- Reference Centre of Inherited Metabolic Diseases, Necker-Enfants malades Hospital, APHP, Filière G2M, Metab ERN, Université de Paris, Paris, France
| | - Manuel Schiff
- Reference Centre of Inherited Metabolic Diseases, Necker-Enfants malades Hospital, APHP, Filière G2M, Metab ERN, Université de Paris, Paris, France; Inserm UMR-S1163, Institut Imagine, Paris, France
| | - Claire Heilbronner
- Pediatric intensive Care Unit, Necker-Enfants malades Hospital, APHP, Université de Paris, Paris, France
| | - Elodie Salvador
- Pediatric intensive Care Unit, Necker-Enfants malades Hospital, APHP, Université de Paris, Paris, France
| | - Dominique Debray
- Pediatric hepatology unit, Reference Center for Rare Paediatric Liver Diseases, Necker-Enfants malades Hospital, APHP, Filière Filfoie, Université de Paris, Paris, France
| | - Mehdi Oualha
- Pediatric intensive Care Unit, Necker-Enfants malades Hospital, APHP, Université de Paris, Paris, France
| | - Sylvain Renolleau
- Pediatric intensive Care Unit, Necker-Enfants malades Hospital, APHP, Université de Paris, Paris, France
| | - Muriel Girard
- Pediatric hepatology unit, Reference Center for Rare Paediatric Liver Diseases, Necker-Enfants malades Hospital, APHP, Filière Filfoie, Université de Paris, Paris, France
| | - Pascale de Lonlay
- Reference Centre of Inherited Metabolic Diseases, Necker-Enfants malades Hospital, APHP, Filière G2M, Metab ERN, Université de Paris, Paris, France
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Pressat-Laffouilhère T, Balayé P, Dahamna B, Lelong R, Billey K, Darmoni SJ, Grosjean J. Evaluation of Doc'EDS: a French semantic search tool to query health documents from a clinical data warehouse. BMC Med Inform Decis Mak 2022; 22:34. [PMID: 35135538 PMCID: PMC8822768 DOI: 10.1186/s12911-022-01762-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unstructured data from electronic health records represent a wealth of information. Doc'EDS is a pre-screening tool based on textual and semantic analysis. The Doc'EDS system provides a graphic user interface to search documents in French. The aim of this study was to present the Doc'EDS tool and to provide a formal evaluation of its semantic features. METHODS Doc'EDS is a search tool built on top of the clinical data warehouse developed at Rouen University Hospital. This tool is a multilevel search engine combining structured and unstructured data. It also provides basic analytical features and semantic utilities. A formal evaluation was conducted to measure the impact of Natural Language Processing algorithms. RESULTS Approximately 18.1 million narrative documents are stored in Doc'EDS. The formal evaluation was conducted in 5000 clinical concepts that were manually collected. The F-measures of negative concepts and hypothetical concepts were respectively 0.89 and 0.57. CONCLUSION In this formal evaluation, we have shown that Doc'EDS is able to deal with language subtleties to enhance an advanced full text search in French health documents. The Doc'EDS tool is currently used on a daily basis to help researchers to identify patient cohorts thanks to unstructured data.
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Affiliation(s)
- Thibaut Pressat-Laffouilhère
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France.,LITIS EA4108, Rouen University, Normandy, France
| | - Pierre Balayé
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France
| | - Badisse Dahamna
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France.,LIMICS U1142 INSERM, Sorbonne Université & Sorbonne Paris Nord, Paris, France
| | - Romain Lelong
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France.,LIMICS U1142 INSERM, Sorbonne Université & Sorbonne Paris Nord, Paris, France
| | - Kévin Billey
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France.,LITIS EA4108, Rouen University, Normandy, France
| | - Stéfan J Darmoni
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France.,LIMICS U1142 INSERM, Sorbonne Université & Sorbonne Paris Nord, Paris, France
| | - Julien Grosjean
- Department of Biomedical Informatics, Rouen University Hospital, Normandy, France. .,LIMICS U1142 INSERM, Sorbonne Université & Sorbonne Paris Nord, Paris, France.
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The prediction of hospital length of stay using unstructured data. BMC Med Inform Decis Mak 2021; 21:351. [PMID: 34922532 PMCID: PMC8684269 DOI: 10.1186/s12911-021-01722-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to assess the performance improvement for machine learning-based hospital length of stay (LOS) predictions when clinical signs written in text are accounted for and compared to the traditional approach of solely considering structured information such as age, gender and major ICD diagnosis.
Methods This study was an observational retrospective cohort study and analyzed patient stays admitted between 1 January to 24 September 2019. For each stay, a patient was admitted through the Emergency Department (ED) and stayed for more than two days in the subsequent service. LOS was predicted using two random forest models. The first included unstructured text extracted from electronic health records (EHRs). A word-embedding algorithm based on UMLS terminology with exact matching restricted to patient-centric affirmation sentences was used to assess the EHR data. The second model was primarily based on structured data in the form of diagnoses coded from the International Classification of Disease 10th Edition (ICD-10) and triage codes (CCMU/GEMSA classifications). Variables common to both models were: age, gender, zip/postal code, LOS in the ED, recent visit flag, assigned patient ward after the ED stay and short-term ED activity. Models were trained on 80% of data and performance was evaluated by accuracy on the remaining 20% test data.
Results The model using unstructured data had a 75.0% accuracy compared to 74.1% for the model containing structured data. The two models produced a similar prediction in 86.6% of cases. In a secondary analysis restricted to intensive care patients, the accuracy of both models was also similar (76.3% vs 75.0%).
Conclusions LOS prediction using unstructured data had similar accuracy to using structured data and can be considered of use to accurately model LOS. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01722-4.
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Lee KS, Shin DG, Hwang JH, Kim R, Han CH, Yoo J. Construction of a bone marrow report registry using a clinical data warehouse. Int J Lab Hematol 2021; 44:e140-e144. [PMID: 34889526 DOI: 10.1111/ijlh.13781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Kwang Seob Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong-Gyo Shin
- Medical Record Service Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jin-Hee Hwang
- Medical Record Service Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ranhee Kim
- Medical Record Service Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chang Hoon Han
- Division of Biomedical Informatics, Departments of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jongha Yoo
- Division of Biomedical Informatics, Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Use of IOOG Classification to Categorize Middle Ear Surgery in Children: Evaluation After 5 Months of Use in 119 Consecutive Pediatric Middle Ear Surgeries. Otol Neurotol 2021; 43:e220-e223. [PMID: 34772885 DOI: 10.1097/mao.0000000000003415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION SAMEO-ATO classification is an international consensual tool published in 2018. In order to evaluate the ease of use and reliability of this classification in pediatric otologic surgery, a retrospective study was conducted in our tertiary referral center. METHOD We began to use IOOG classification in September 2018, after a 15-day testing period. In this monocentric retrospective study, we reviewed the classification and the operative charts of all the pediatric middle ear surgeries after the first 5 months of use. Each classification was carefully re-checked by a junior and senior surgeon. In parallel, all the surgeons involved received a questionnaire to evaluate the ease of use, with a score from 1 (very difficult) to 5 (very easy). RESULTS From September 2018 to February 2019, the tool was used for 119 pediatric surgeries, involving 13 surgeons. The indications for surgery were tympanic membrane perforations (28/119, 23.5%), retraction pockets (36/119, 30.3%), cholesteatoma first procedures (13/119, 10.9%), cholesteatoma revision procedures (41/119, 34.5%) and temporal bone fracture (1/119, 0.8%). All surgical procedures performed could be classified with the ATO-SAMEO classification. We found misclassification in 29/119 cases (24%), 79% of which concerning ATO items. Of the 8 SAMEO-ATO categories in 119 surgeries, the error rate was 4.5% (49/952). Surgeons reported a mean score of use of 4 (quite easy). CONCLUSION The easy-to-use SAMEO-ATO classification is well suited for pediatric otology and to the categorization of surgical procedures. However, in a multi-user context, misclassifications were observed in up to a quarter of cases during the first months of use. Carefully anticipated explanations and guidelines given to surgeons should ensure an optimal quality of rating.
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Veroul E, Amaddeo A, Leboulanger N, Gelin M, Denoyelle F, Thierry B, Fauroux B, Luscan R. Noninvasive Respiratory Support as an Alternative to Tracheostomy in Severe Laryngomalacia. Laryngoscope 2021; 132:1861-1868. [PMID: 34713900 DOI: 10.1002/lary.29928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To analyze the role of noninvasive respiratory support (NRS) as an alternative to tracheostomy in the management of severe laryngomalacia. STUDY DESIGN We conducted a monocentric retrospective study in a tertiary pediatric care center. METHODS All children under the age of 3 years with severe laryngomalacia, treated between January 2014 and December 2019, were included. Patient demographics, medical history, nutrition, surgery, NRS, and outcome were reviewed. Predictors for NRS were analyzed. RESULTS One hundred and eighty-eight patients were included. Mean age was 4 ± 5 months and mean weight was 4,925 ± 1,933 g. An endoscopic bilateral supraglottoplasty was performed in 183 (97%) patients and successful in 159 (87%). NRS was initiated in 29 (15%) patients at a mean age of 3 ± 2 months (1-11 months): 15 (52%) patients were treated with NRS after surgical failure, 9 (31%) were treated with NRS initiated prior to surgery because of abnormal overnight gas exchange, and 5 (17%) were treated exclusively with NRS due to comorbidities contraindicating an endoscopic procedure. NRS was successfully performed in all patients with a mean duration of 6 ± 11 months. No patient required a tracheostomy. Univariate analysis identified the following predictors of NRS: neonatal respiratory distress (P = .003), neurological comorbidity (P < .001), associated laryngeal abnormality (P < .001), cardiac surgery (P = .039), surgical endoscopic revision (P = .007), and nutritional support (P < .001). CONCLUSION NRS is a safe procedure, which may avoid a tracheostomy in severe laryngomalacia, in particular, in case of endoscopic surgery failure, respiratory failure before surgery, and/or severe co-morbidity. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Elina Veroul
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Alessandro Amaddeo
- Faculté de Médecine, Université de Paris, Paris, France.,Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Nicolas Leboulanger
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France.,Institut Mondor pour la Recherche Biomédicale, INSERM U955 Team 13, Creteil, France
| | - Matthieu Gelin
- Université de Paris, Human Immunology Pathophysiology Immunotherapy (HIPI), CytoMorpho Lab, INSERM CEA UMR976, Paris, France
| | - Françoise Denoyelle
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Briac Thierry
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
| | - Brigitte Fauroux
- Faculté de Médecine, Université de Paris, Paris, France.,EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Université de Paris, Paris, France
| | - Romain Luscan
- Faculté de Médecine, Université de Paris, Paris, France.,Department of Pediatric Otolaryngology, AP-HP, Hôpital Necker - Enfants Malades, Paris, France
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Thulium LASER for endoscopic closure of tracheoesophageal fistula in esophageal atresia's spectrum: An appropriate tool? J Pediatr Surg 2021; 56:1752-1756. [PMID: 33199056 DOI: 10.1016/j.jpedsurg.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/28/2020] [Accepted: 10/09/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To report our experience with endoscopic Thulium LASER for treatment of recurrent TEF after EA surgery, and for H-Type fistulas. METHODS A retrospective chart review of consecutive patients undergoing standardized endoscopic closure as first line therapy of recurrent tracheoesophageal fistula (RTEF) and H-type fistula using Thulium LASER, from 2013 to 2019, in a pediatric tertiary care center. Control endoscopic procedure was systematically performed. If persistence of the TEF was noted an external approach was performed. Patient demographics, medical history, symptoms, TEF type, treatment modalities, complications and outcomes were collected. RESULTS Eleven patients with tracheoesophageal fistula were included: six RTEF after primary repair of esophageal atresia and five H-type fistulas. The average age at endoscopic treatment was 19 months (SD 23 months, range 13 days-63 months). Closure of the fistula after single endoscopic procedure with Thulium LASER was obtained in 3 RTEF (50%) and 1 H-type fistula (20%). Six patients with failure of endoscopic treatment were cured after a single external procedure without any complications. One child, treated for H-type fistula, presented a severe complication of Thulium LASER treatment. Median follow-up after last repair was 24 months (range: 14-72 months). All fistulas were successfully treated. CONCLUSIONS In H-Type fistula, success rate of Thulium LASER is only 20% and thus should not be used. In contrast, in RTEF, success rate of 50% is achieved, avoiding as many open procedures, and Thulium LASER could be considered as first line treatment. In any case, open surgery is safe and efficient and can be considered as a first-line treatment for H-type fistulas, and as a salvage treatment for endoscopic treatment failures. LEVELS OF EVIDENCE Level IV.
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