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Kempf E, Vaterkowski M, Leprovost D, Griffon N, Ouagne D, Breant S, Serre P, Mouchet A, Rance B, Chatellier G, Bellamine A, Frank M, Guerin J, Tannier X, Livartowski A, Hilka M, Daniel C. How to Improve Cancer Patients ENrollment in Clinical Trials From rEal-Life Databases Using the Observational Medical Outcomes Partnership Oncology Extension: Results of the PENELOPE Initiative in Urologic Cancers. JCO Clin Cancer Inform 2023; 7:e2200179. [PMID: 37167578 DOI: 10.1200/cci.22.00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
PURPOSE To compare the computability of Observational Medical Outcomes Partnership (OMOP)-based queries related to prescreening of patients using two versions of the OMOP common data model (CDM; v5.3 and v5.4) and to assess the performance of the Greater Paris University Hospital (APHP) prescreening tool. MATERIALS AND METHODS We identified the prescreening information items being relevant for prescreening of patients with cancer. We randomly selected 15 academic and industry-sponsored urology phase I-IV clinical trials (CTs) launched at APHP between 2016 and 2021. The computability of the related prescreening criteria (PC) was defined by their translation rate in OMOP-compliant queries and by their execution rate on the APHP clinical data warehouse (CDW) containing data of 205,977 patients with cancer. The overall performance of the prescreening tool was assessed by the rate of true- and false-positive cases of three randomly selected CTs. RESULTS We defined a list of 15 minimal information items being relevant for patients' prescreening. We identified 83 PC of the 534 eligibility criteria from the 15 CTs. We translated 33 and 62 PC in queries on the basis of OMOP CDM v5.3 and v5.4, respectively (translation rates of 40% and 75%, respectively). Of the 33 PC translated in the v5.3 of the OMOP CDM, 19 could be executed on the APHP CDW (execution rate of 58%). Of 83 PC, the computability rate on the APHP CDW reached 23%. On the basis of three CTs, we identified 17, 32, and 63 patients as being potentially eligible for inclusion in those CTs, resulting in positive predictive values of 53%, 41%, and 21%, respectively. CONCLUSION We showed that PC could be formalized according to the OMOP CDM and that the oncology extension increased their translation rate through better representation of cancer natural history.
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Affiliation(s)
- Emmanuelle Kempf
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France
- Department of Medical Oncology, Assistance Publique Hôpitaux de Paris, Henri Mondor Teaching Hospital, Créteil, France
| | - Morgan Vaterkowski
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
- EPITA School of Engineering and Computer Science, Paris, France
| | - Damien Leprovost
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Nicolas Griffon
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - David Ouagne
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Stéphane Breant
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Patricia Serre
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Alexandre Mouchet
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Bastien Rance
- Department of Medical Informatics, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université de Paris, Paris, France
| | - Gilles Chatellier
- Department of Medical Informatics, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Université de Paris, Paris, France
| | - Ali Bellamine
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Marie Frank
- Department of Medical Information, Paris Saclay Teaching Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | | | - Xavier Tannier
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France
| | | | - Martin Hilka
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Christel Daniel
- Sorbonne Université, Inserm, Université Sorbonne Paris Nord, Laboratoire d'Informatique Médicale et d'Ingénierie des Connaissances pour la e-Santé, LIMICS, Paris, France
- Innovation and Data, Paris, IT Department, Assistance Publique Hôpitaux de Paris, Paris, France
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Ogier du Terrail J, Leopold A, Joly C, Béguier C, Andreux M, Maussion C, Schmauch B, Tramel EW, Bendjebbar E, Zaslavskiy M, Wainrib G, Milder M, Gervasoni J, Guerin J, Durand T, Livartowski A, Moutet K, Gautier C, Djafar I, Moisson AL, Marini C, Galtier M, Balazard F, Dubois R, Moreira J, Simon A, Drubay D, Lacroix-Triki M, Franchet C, Bataillon G, Heudel PE. Federated learning for predicting histological response to neoadjuvant chemotherapy in triple-negative breast cancer. Nat Med 2023; 29:135-146. [PMID: 36658418 DOI: 10.1038/s41591-022-02155-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/23/2022] [Indexed: 01/21/2023]
Abstract
Triple-negative breast cancer (TNBC) is a rare cancer, characterized by high metastatic potential and poor prognosis, and has limited treatment options. The current standard of care in nonmetastatic settings is neoadjuvant chemotherapy (NACT), but treatment efficacy varies substantially across patients. This heterogeneity is still poorly understood, partly due to the paucity of curated TNBC data. Here we investigate the use of machine learning (ML) leveraging whole-slide images and clinical information to predict, at diagnosis, the histological response to NACT for early TNBC women patients. To overcome the biases of small-scale studies while respecting data privacy, we conducted a multicentric TNBC study using federated learning, in which patient data remain secured behind hospitals' firewalls. We show that local ML models relying on whole-slide images can predict response to NACT but that collaborative training of ML models further improves performance, on par with the best current approaches in which ML models are trained using time-consuming expert annotations. Our ML model is interpretable and is sensitive to specific histological patterns. This proof of concept study, in which federated learning is applied to real-world datasets, paves the way for future biomarker discovery using unprecedentedly large datasets.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Camille Franchet
- Institut Universitaire du Cancer de Toulouse (IUCT) Oncopole, Toulouse, France
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Sebbag C, Rousset-Jablonski C, Coussy F, Ray-Coquard I, Garin C, Evrevin C, Cessot M, Labrosse J, Laot L, Darrigues L, Bobrie A, Sénéchal-Davin C, Espié M, Giacchetti S, Plu-Bureau G, Maitrot-Mantelet L, Gompel A, Santulli P, Asselain B, Hotton J, Coutant C, Guerin J, Decanter C, Mailliez A, Brain E, Dumas E, Sablone L, Seintinelles RN, Reyal F, Hamy AS. Contraception in breast cancer survivors from the FEERIC case-control study (performed on behalf of the Seintinelles research network). Breast 2022; 67:62-70. [PMID: 36630821 PMCID: PMC9982267 DOI: 10.1016/j.breast.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To compare the prevalence of contraception in breast cancer (BC) patients at risk of unintentional pregnancy (i.e. not currently pregnant or trying to get pregnant) and matched controls. STUDY DESIGN The FEERIC study (Fertility, Pregnancy, Contraception after BC in France) is a prospective, multicenter case-control study, including localized BC patients aged 18-43 years, matched for age and parity to cancer-free volunteer controls in a 1:2 ratio. Data were collected through online questionnaires completed on the Seintinelles research platform. RESULTS In a population of 1278 women at risk of unintentional pregnancy, the prevalence of contraception at study inclusion did not differ significantly between cases (340/431, 78.9%) and controls (666/847, 78.6%, p = 0.97). Contrarily, the contraceptive methods used were significantly different, with a higher proportion of copper IUD use in BC survivors (59.5% versus 25.0% in controls p < 0.001). For patients at risk of unintentional pregnancy, receiving information about chemotherapy-induced ovary damage at BC diagnosis (OR = 2.47 95%CI [ 1.39-4.37] and anti-HER2 treatment (OR = 2.46, 95% CI [ 1.14-6.16]) were significantly associated with the use of a contraception in multivariate analysis. CONCLUSION In this large French study, BC survivors had a prevalence of contraception use similar to that for matched controls, though almost one in five women at risk of unintentional pregnancy did not use contraception. Dedicated consultations at cancer care centers could further improve access to information and contraception counseling.
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Affiliation(s)
- Clara Sebbag
- Department of Medical Oncology, Institut Curie, Paris, France,Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France,Université Paris Cité, Paris, France
| | - Christine Rousset-Jablonski
- INSERM U1290 RESearch on HealthcAre PErformance (RESHAPE), University Claude Bernard Lyon 1, Lyon, France,Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Isabelle Ray-Coquard
- INSERM U1290 RESearch on HealthcAre PErformance (RESHAPE), University Claude Bernard Lyon 1, Lyon, France,Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Clémentine Garin
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France
| | - Clémence Evrevin
- Department of Medical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Marion Cessot
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Julie Labrosse
- Department of Surgical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Lucie Laot
- Department of Surgical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Lauren Darrigues
- Department of Surgical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Angélique Bobrie
- Department of Medical Oncology, Institut du cancer de Montpellier, Montpellier, France
| | | | - Marc Espié
- Sénolopole, Hôpital Saint Louis, AP-HP, Paris, France; University Paris, Paris France
| | - Sylvie Giacchetti
- Sénolopole, Hôpital Saint Louis, AP-HP, Paris, France; University Paris, Paris France
| | - Geneviève Plu-Bureau
- Department of Gynecology, Hôpital Cochin, Paris, France; University Paris, Paris France
| | | | - Anne Gompel
- Department of Gynecology, Hôpital Cochin, Paris, France; University Paris, Paris France
| | - Pietro Santulli
- Department of Gynecology, Hôpital Cochin, Paris, France; University Paris, Paris France
| | | | - Judicaël Hotton
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Charles Coutant
- Department of Surgical Oncology, Centre Georges-François Leclerc - Unicancer, Dijon, France,Clinical Research Department, Centre Georges-François Leclerc - Unicancer, Dijon, France
| | - Julien Guerin
- Data Factory, Data Office, Institut Curie, 25 rue d’Ulm, 75005 Paris, France
| | | | - Audrey Mailliez
- Department of Medical Oncology, Centre Oscar Lambert, Lille, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France
| | - Laura Sablone
- Seintinelles Research Network, 40 Rue Rémy Dumoncel, 75014, Paris, France
| | | | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France,Department of Surgical Oncology, Institut Curie, Paris, France,Seintinelles Research Network, 40 Rue Rémy Dumoncel, 75014, Paris, France,Université Paris Cité, Paris, France
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, Paris, France; Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France; Department of Surgical Oncology, Institut Curie, Paris, France; Seintinelles Research Network, 40 Rue Rémy Dumoncel, 75014, Paris, France; Université Paris Cité, Paris, France.
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Mangiardi-Veltin M, Sebbag C, Rousset-Jablonski C, Ray-Coquard I, Berkach C, Laot L, Wang Y, Abdennebi I, Labrosse J, Sautter C, Toussaint A, Sablone L, Laas E, Khallouch S, Coussy F, Santulli P, Chapron C, Bobrie A, Jacot W, Sella N, Dumas E, Sénéchal-Davin C, Espie M, Giacchetti S, Maitrot L, Plu-Bureau G, Coutant C, Guerin J, Asselain B, Fumoleau P, Rodrigues M, Decanter C, Mailliez A, Delrieu L, Lemoine A, Jouannaud C, Houdre D, Reyal F, Hamy AS. Pregnancy, fertility concerns, and fertility preservation procedures in French breast cancer survivors in the FEERIC national study (on behalf of the Seintinelles research network). Reprod Biomed Online 2022; 44:1031-1044. [DOI: 10.1016/j.rbmo.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
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5
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Hours A, Toussaint A, De Castelbajac V, Sautter C, Borghese J, Frank S, Coussy F, Laas E, Grandal B, Dumas E, Daoud E, Guerin J, Balezeau T, Feron JG, Fourchotte V, Kirova Y, Lerebours F, Pierga JY, Guillot E, Santulli P, Grynberg M, Sonigo C, Reyrat E, Soibinet-Oudot P, Reyal F, Hamy AS. Factors Associated With the Discussion of Fertility Preservation in a Cohort of 1,357 Young Breast Cancer Patients Receiving Chemotherapy. Front Oncol 2021; 11:701620. [PMID: 34650912 PMCID: PMC8507557 DOI: 10.3389/fonc.2021.701620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Female breast cancer (BC) patients exposed to gonadotoxic chemotherapy are at risk of future infertility. There is evidence of disparities in the discussion of fertility preservation for these patients. The aim of the study was to identify factors influencing the discussion of fertility preservation (FP). MATERIAL AND METHODS We analyzed consecutive BC patients treated by chemotherapy at Institut Curie from 2011-2017 and aged 18-43 years at BC diagnosis. The discussion of FP was classified in a binary manner (discussion/no discussion), based on mentions present in the patient's electronic health record (EHR) before the initiation of chemotherapy. The associations between FP discussion and the characteristics of patients/tumors and healthcare practitioners were investigated by logistic regression analysis. RESULTS The median age of the 1357 patients included in the cohort was 38.7 years, and median tumor size was 30.3 mm. The distribution of BC subtypes was as follows: 702 luminal BCs (58%), 241 triple-negative breast cancers (TNBCs) (20%), 193 HER2+/HR+ (16%) and 81 HER2+/HR- (6%). All patients received chemotherapy in a neoadjuvant (n=611, 45%) or adjuvant (n= 744, 55%) setting. A discussion of FP was mentioned for 447 patients (33%). Earlier age at diagnosis (discussion: 34.4 years versus no discussion: 40.5 years), nulliparity (discussion: 62% versus no discussion: 38%), and year of BC diagnosis were the patient characteristics significantly associated with the mention of FP discussion. Surgeons and female physicians were the most likely to mention FP during the consultation before the initiation of chemotherapy (discussion: 22% and 21%, respectively). The likelihood of FP discussion increased significantly over time, from 15% in 2011 to 45% in 2017. After multivariate analysis, FP discussion was significantly associated with younger age, number of children before BC diagnosis, physicians' gender and physicians' specialty. CONCLUSION FP discussion rates are low and are influenced by patient and physician characteristics. There is therefore room for improvement in the promotion and systematization of FP discussion.
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Affiliation(s)
- Alice Hours
- Department of Surgery, Institut Curie, University Paris, Paris, France
| | - Aullene Toussaint
- Department of Surgery, Institut Curie, University Paris, Paris, France
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Victoire De Castelbajac
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
- Sénopole Hôpital Saint Louis, Assistance Publique - Hôpitaux de Paris, University Paris, Paris, France
| | - Camille Sautter
- Department of Surgery, Institut Curie, University Paris, Paris, France
| | - Julie Borghese
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Sophie Frank
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
| | - Enora Laas
- Department of Surgery, Institut Curie, University Paris, Paris, France
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
| | - Beatriz Grandal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Eric Daoud
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | | | | | | | | | - Youlia Kirova
- Department of Radiation Therapy, Institut Curie, Paris, France
| | - Florence Lerebours
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Jean-Yves Pierga
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Eugénie Guillot
- Department of Surgery, Institut Curie, University Paris, Paris, France
| | - Pietro Santulli
- Department of Obstetrics and Gynecology, Hôpital Cochin, University Paris, Paris, France
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris Sud, Assistance Publique - Hôpitaux de Paris, Clamart, France
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Jean Verdier, Bondy, France
| | - Charlotte Sonigo
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine Béclère, Hôpitaux Universitaires Paris Sud, Assistance Publique - Hôpitaux de Paris, Clamart, France
| | - Emmanuel Reyrat
- Department of Data and Informatics, Unicancer, Paris, France
| | | | - Fabien Reyal
- Department of Surgery, Institut Curie, University Paris, Paris, France
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
| | - Anne-Sophie Hamy
- Department of Surgery, Institut Curie, University Paris, Paris, France
- Department of Medical Oncology, Institut Curie, University Paris, Paris, France
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Paris, France
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Benson JC, Trejo-Lopez J, Bach SE, Schwartz J, Kaufmann TJ, Eckel L, Guerin J. Hypothalamic Pilomyxoid Astrocytoma in a Child with Lipodystrophy. AJNR Am J Neuroradiol 2021; 42:1370-1374. [PMID: 33958332 PMCID: PMC8367624 DOI: 10.3174/ajnr.a7136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 02/16/2021] [Indexed: 11/07/2022]
Abstract
Pilomyxoid astrocytoma is a rare form of pediatric CNS malignancy first classified in 2007 by the World Health Organization. The tumors are similar to pilocytic astrocytomas, sharing both some imaging and histologic traits. However, pilomyxoid astrocytomas portend a more ominous prognosis, with more aggressive local tendencies and a greater proclivity for leptomeningeal spread. Although tissue sampling is ultimately required to differentiate pilocytic astrocytomas and pilomyxoid astrocytomas, some imaging features can be used to suggest a pilomyxoid astrocytoma, including homogeneous enhancement, leptomeningeal seeding, and lack of intratumoral cysts. In this article, a case of a hypothalamic pilomyxoid astrocytoma is described, in which the presenting disorder was profound generalized lipodystrophy. The aforementioned imaging characteristics of pilomyxoid astrocytomas are reviewed, as are the pathologic features of such tumors, including their angiocentric cellular arrangement and myxoid background.
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Affiliation(s)
- J C Benson
- Department of Radiology (J.C.B., T.J.K., L.E., J.G.), Mayo Clinic, Rochester, Minnesota
| | - J Trejo-Lopez
- Department of Laboratory Medicine and Pathology (J.T.-L.), Mayo Clinic, Rochester, Minnesota
| | - S E Bach
- Department of Laboratory Medicine and Pathology (S.E.B.), OSF Healthcare, Peoria, Illinois
| | - J Schwartz
- Departments of Pediatric and Adolescent Medicine (J.S.), Mayo Clinic, Rochester, Minnesota
| | - T J Kaufmann
- Department of Radiology (J.C.B., T.J.K., L.E., J.G.), Mayo Clinic, Rochester, Minnesota
| | - L Eckel
- Department of Radiology (J.C.B., T.J.K., L.E., J.G.), Mayo Clinic, Rochester, Minnesota
| | - J Guerin
- Department of Radiology (J.C.B., T.J.K., L.E., J.G.), Mayo Clinic, Rochester, Minnesota
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7
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Nicolas M, Grandal B, Dubost E, Kassara A, Guerin J, Toussaint A, Laas E, Feron JG, Fourchotte V, Lecuru F, Girard N, Coussy F, Lavielle B, Kriegel I, Kirova Y, Pierga JY, Reyal F, Hamy AS. Breast Cancer (BC) Is a Window of Opportunity for Smoking Cessation: Results of a Retrospective Analysis of 1234 BC Survivors in Follow-Up Consultation. Cancers (Basel) 2021; 13:2423. [PMID: 34067742 PMCID: PMC8156674 DOI: 10.3390/cancers13102423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 12/24/2022] Open
Abstract
Breast cancer (BC) is the most commonly diagnosed type of cancer and the leading cause of cancer deaths in women. Smoking is the principal modifiable risk factor for cancers and has a negative influence on long-term survival. We conducted a retrospective study on consecutive BC survivors seen at follow-up consultations between 3 June and 30 October 2019 at Institut Curie, Paris, France. Smoking behaviors were evaluated prospectively via interviewer-administered questionnaires. The aim of this study was to describe smoking-related patient care at diagnosis and smoking cessation patterns in women with a history of BC. A total of 1234 patients were included in the study. Smoking status at diagnosis was missing from electronic health records in 32% of cases, including 13% of patients who smoke. Only 20% of the 197 patients currently smoking at diagnosis recalled having a discussion about smoking with a healthcare professional. Radiotherapists and surgeons were more likely to talk about complications than other practitioners. The main type of information provided was general advice to stop smoking (n = 110), followed by treatment complications (n = 48), while only five patients were referred to tobaccologists. Since diagnosis, 33% (n = 65) of the patients currently smoking had quit. Patients who quit had a lower alcohol consumption, but no other factor was associated with smoking cessation. The main motivation for tobacco withdrawal was the fear of BC relapse (63%). This study highlights room for improvement in the assessment of smoking behavior. Our data raise important perspectives for considering BC treatment and follow-up as a window of opportunity for smoking cessation.
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Affiliation(s)
- Marion Nicolas
- Faculty of Medicine, Sorbonne Université, 75006 Paris, France;
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Beatriz Grandal
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Emma Dubost
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Amyn Kassara
- Data Factory, Institut Curie, Université Paris, 75005 Paris, France; (A.K.); (J.G.)
| | - Julien Guerin
- Data Factory, Institut Curie, Université Paris, 75005 Paris, France; (A.K.); (J.G.)
| | - Aullene Toussaint
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Enora Laas
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Jean-Guillaume Feron
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Virginie Fourchotte
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Fabrice Lecuru
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Noemie Girard
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Université Paris, 75005 Paris, France; (F.C.); (B.L.); (J.-Y.P.); (A.-S.H.)
| | - Beatrice Lavielle
- Department of Medical Oncology, Institut Curie, Université Paris, 75005 Paris, France; (F.C.); (B.L.); (J.-Y.P.); (A.-S.H.)
| | - Irene Kriegel
- Department of Anesthesiology, Institut Curie, Université Paris, 75005 Paris, France;
| | - Youlia Kirova
- Department of Radiotherapy, Institut Curie, Université Paris, 75005 Paris, France;
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Université Paris, 75005 Paris, France; (F.C.); (B.L.); (J.-Y.P.); (A.-S.H.)
| | - Fabien Reyal
- Department of Breast and Gynecological Surgery, Institut Curie, Université Paris, 75005 Paris, France; (B.G.); (E.D.); (A.T.); (E.L.); (J.-G.F.); (V.F.); (F.L.); (N.G.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Université Paris, 75005 Paris, France
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, Université Paris, 75005 Paris, France; (F.C.); (B.L.); (J.-Y.P.); (A.-S.H.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, INSERM, U932 Immunity and Cancer, Institut Curie, Université Paris, 75005 Paris, France
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8
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Grandal B, Evrevin C, Laas E, Jardin I, Rozette S, Laot L, Dumas E, Coussy F, Pierga JY, Brain E, Saule C, Stoppa-Lyonnet D, Frank S, Sénéchal C, Lae M, De Croze D, Bataillon G, Guerin J, Reyal F, Hamy AS. Impact of BRCA Mutation Status on Tumor Infiltrating Lymphocytes (TILs), Response to Treatment, and Prognosis in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy. Cancers (Basel) 2020; 12:cancers12123681. [PMID: 33302444 PMCID: PMC7764707 DOI: 10.3390/cancers12123681] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Five to 10% of breast cancers (BCs) occur in a genetic predisposition context (mainly BRCA pathogenic variant). Nevertheless, little is known about immune tumor infiltration, response to neoadjuvant chemotherapy (NAC), pathologic complete response (pCR) and adverse events according to BRCA status. MATERIAL AND METHODS Out of 1199 invasive BC patients treated with NAC between 2002 and 2012, we identified 267 patients tested for a germline BRCA pathogenic variant. We evaluated pre-NAC and post-NAC immune infiltration (TILs). Response to chemotherapy was assessed by pCR rates. Association of clinical and pathological factors with TILs, pCR and survival was assessed by univariate and multivariate analyses. RESULTS Among 1199 BC patients: 46 were BRCA-deficient and 221 BRCA-proficient or wild type (WT). At NAC completion, pCR was observed in 84/266 (31%) patients and pCR rates were significantly higher in BRCA-deficient BC (p = 0.001), and this association remained statistically significant only in the luminal BC subtype (p = 0.006). The interaction test between BC subtype and BRCA status was nearly significant (Pinteraction = 0.056). Pre and post-NAC TILs were not significantly different between BRCA-deficient and BRCA-proficient carriers; however, in the luminal BC group, post-NAC TILs were significantly higher in BRCA-deficient BC. Survival analysis were not different between BRCA-carriers and non-carriers. CONCLUSIONS BRCA mutation status is associated with higher pCR rates and post-NAC TILs in patients with luminal BC. BRCA-carriers with luminal BCs may represent a subset of patients deriving higher benefit from NAC. Second line therapies, including immunotherapy after NAC, could be of interest in non-responders to NAC.
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Affiliation(s)
- Beatriz Grandal
- Department of Surgery, Institut Curie, University Paris, 75005 Paris, France; (B.G.); (C.E.); (E.L.); (I.J.); (S.R.); (L.L.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (E.D.); (A.-S.H.)
| | - Clémence Evrevin
- Department of Surgery, Institut Curie, University Paris, 75005 Paris, France; (B.G.); (C.E.); (E.L.); (I.J.); (S.R.); (L.L.)
| | - Enora Laas
- Department of Surgery, Institut Curie, University Paris, 75005 Paris, France; (B.G.); (C.E.); (E.L.); (I.J.); (S.R.); (L.L.)
| | - Isabelle Jardin
- Department of Surgery, Institut Curie, University Paris, 75005 Paris, France; (B.G.); (C.E.); (E.L.); (I.J.); (S.R.); (L.L.)
| | - Sonia Rozette
- Department of Surgery, Institut Curie, University Paris, 75005 Paris, France; (B.G.); (C.E.); (E.L.); (I.J.); (S.R.); (L.L.)
| | - Lucie Laot
- Department of Surgery, Institut Curie, University Paris, 75005 Paris, France; (B.G.); (C.E.); (E.L.); (I.J.); (S.R.); (L.L.)
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (E.D.); (A.-S.H.)
| | - Florence Coussy
- Department of Oncology, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (F.C.); (J.-Y.P.)
| | - Jean-Yves Pierga
- Department of Oncology, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (F.C.); (J.-Y.P.)
| | - Etienne Brain
- Department of Oncology, Centre René Huguenin, Institut Curie, 35 rue Dailly, 92210 St Cloud, France;
| | - Claire Saule
- Department of Genetics, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (C.S.); (D.S.-L.); (S.F.)
| | - Dominique Stoppa-Lyonnet
- Department of Genetics, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (C.S.); (D.S.-L.); (S.F.)
| | - Sophie Frank
- Department of Genetics, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (C.S.); (D.S.-L.); (S.F.)
| | - Claire Sénéchal
- Department of Genetics, Institut Bergonié, 229 Cours de l’Argonne, 33000 Bordeaux, France;
| | - Marick Lae
- Department of Pathology, Centre René Huguenin, Institut Curie, 35 rue Dailly, 92210 St Cloud, France; (M.L.); (D.D.C.)
- Department of Pathology, Centre Henri Becquerel, INSERM U1245, UNIROUEN, University of Normandie, 76038 Rouen, France
| | - Diane De Croze
- Department of Pathology, Centre René Huguenin, Institut Curie, 35 rue Dailly, 92210 St Cloud, France; (M.L.); (D.D.C.)
| | | | - Julien Guerin
- Data Office, Institut Curie, 25 rue d’Ulm, 75005 Paris, France;
| | - Fabien Reyal
- Department of Surgery, Institut Curie, University Paris, 75005 Paris, France; (B.G.); (C.E.); (E.L.); (I.J.); (S.R.); (L.L.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (E.D.); (A.-S.H.)
- Correspondence: ; Tel.: +33-144324660; Fax: +33-153104037
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, Institut Curie, 26 rue d’Ulm, 75005 Paris, France; (E.D.); (A.-S.H.)
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9
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Simon V, Laot L, Laas E, Rozette S, Guerin J, Balezeau T, Nicolas M, Pierga JY, Coussy F, Laé M, De Croze D, Grandal B, Abecassis J, Dumas E, Lerebours F, Reyal F, Hamy AS. No Impact of Smoking Status on Breast Cancer Tumor Infiltrating Lymphocytes, Response to Neoadjuvant Chemotherapy and Prognosis. Cancers (Basel) 2020; 12:cancers12102943. [PMID: 33053866 PMCID: PMC7601636 DOI: 10.3390/cancers12102943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023] Open
Abstract
Simple Summary Tobacco use is associated with an increase in breast cancer mortality. Pathologic complete response (pCR) rate to neoadjuvant chemotherapy is influenced by tumor-infiltrating lymphocyte (TIL) levels and is associated with a better long-term survival outcome. The aim of this study was to evaluate the impact of smoking status on TIL levels, response to neoadjuvant chemotherapy and prognosis for breast cancer patients. We retrospectively assessed pre- and post-neoadjuvant chemotherapy tumor infiltrating lymphocyte (TILs) levels and pathological complete response (pCR) rates in a cohort of 956 specimens of breast cancer (BC) patients treated with neoadjuvant chemotherapy, according to their smoking status. To our knowledge, this is the largest cohort of BC patients used to study this topic so far. We found no impact of smoking status on tumor infiltrating lymphocyte levels, response to neoadjuvant chemotherapy and prognosis in the whole population and within each BC subtype. Abstract Tobacco use is associated with an increase in breast cancer (BC) mortality. Pathologic complete response (pCR) rate to neoadjuvant chemotherapy (NAC) is influenced by tumor-infiltrating lymphocyte (TIL) levels and is associated with a better long-term survival outcome. The aim of our study is to evaluate the impact of smoking status on TIL levels, response to NAC and prognosis for BC patients. We retrospectively evaluated pre- and post-NAC stromal and intra tumoral TIL levels and pCR rates on a cohort of T1-T3NxM0 BC patients treated with NAC between 2002 and 2012 at Institut Curie. Smoking status (current, ever, never smokers) was collected in clinical records. We analyzed the association between smoking status, TIL levels, pCR rates and survival outcomes among the whole population, and according to BC subtype. Nine hundred and fifty-six BC patients with available smoking status information were included in our analysis (current smokers, n = 179 (18.7%); ever smokers, n = 154 (16.1%) and never smokers, n = 623 (65.2%)). Median pre-NAC TIL levels, pCR rates, or median post-NAC TIL levels were not significantly different according to smoking status, neither in the whole population, nor in any BC subtype group. With a median follow-up of 101.4 months, relapse-free survival (RFS) and overall survival (OS) were not significantly different by smoking status. We did not find any significant effect of tobacco use on pre- and post-NAC TILs nor response to NAC. Though our data seem reassuring, BC treatment should still be considered as a window of opportunity to offer BC patients accurate smoking cessation interventions.
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Affiliation(s)
- Vanille Simon
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
| | - Lucie Laot
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
| | - Enora Laas
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
| | - Sonia Rozette
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
| | - Julien Guerin
- Data Factory, Data Office, Institut Curie, 25 rue d’Ulm, 75005 Paris, France; (J.G.); (T.B.)
| | - Thomas Balezeau
- Data Factory, Data Office, Institut Curie, 25 rue d’Ulm, 75005 Paris, France; (J.G.); (T.B.)
| | - Marion Nicolas
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
| | - Marick Laé
- Department of Tumor Biology, Institut Curie, 75005 Paris, France; (M.L.); (D.D.C.)
| | - Diane De Croze
- Department of Tumor Biology, Institut Curie, 75005 Paris, France; (M.L.); (D.D.C.)
| | - Beatriz Grandal
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
| | - Judith Abecassis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
| | - Florence Lerebours
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
| | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
- Correspondence: ; Tel.: +33-144-324-087 or +33-615-271-980
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
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10
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Labrosse J, Lam T, Sebbag C, Benque M, Abdennebi I, Merckelbagh H, Osdoit M, Priour M, Guerin J, Balezeau T, Grandal B, Coussy F, Bobrie A, Ferrer L, Laas E, Feron JG, Reyal F, Hamy AS. Text Mining in Electronic Medical Records Enables Quick and Efficient Identification of Pregnancy Cases Occurring After Breast Cancer. JCO Clin Cancer Inform 2020; 3:1-12. [PMID: 31626565 DOI: 10.1200/cci.19.00031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To apply text mining (TM) technology on electronic medical records (EMRs) of patients with breast cancer (BC) to retrieve the occurrence of a pregnancy after BC diagnosis and compare its performance to manual curation. MATERIALS AND METHODS The training cohort (Cohort A) comprised 344 patients with BC age ≤ 40 years old treated at Institut Curie between 2005 and 2007. Manual curation consisted in manually reviewing each EMR to retrieve pregnancies. TM consisted of first applying a keyword filter ("accouch*" or "enceinte," French terms for "deliver*" and "pregnant," respectively) to select a subset of EMRs, and, second, checking manually EMRs to confirm the pregnancy. Then, we applied our TM algorithm on an independent cohort of patients with BC treated between 2008 and 2012 (Cohort B). RESULTS In Cohort A, 36 pregnancies were identified among 344 patients (10.5%; 2,829 person-years of EMR). Thirty were identified by manual review versus 35 by TM. TM resulted in a lower percentage of manual checking (26.7% v 100%, respectively) and substantial time gains (time to identify a pregnancy: 13 minutes for TM v 244 minutes for manual curation, respectively). Presence of any of the two TM filters showed excellent sensitivity (97%) and negative predictive value (100%). In Cohort B, 67 pregnancies were identified among 1,226 patients (5.5%; 7,349 person-years of EMR). Similarly, for Cohort B, TM spared 904 (73.7%) EMRs from manual review and quickly generated a cohort of 67 pregnancies after BC. Incidence rate of pregnancy after BC was 0.01 pregnancy per person-year of EMR in both cohorts. CONCLUSION TM is highly efficient to quickly identify rare events and is a promising tool to improve rapidity, efficiency, and costs of medical research.
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Affiliation(s)
| | - Thanh Lam
- Geneva University Hospitals, Geneva, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | - Loïc Ferrer
- Institut Curie, U900, Hôpital René Huguenin, Saint-Cloud, France
| | | | | | - Fabien Reyal
- Paris 5 Research University, INSERM U932, Institut Curie, Paris, France
| | - Anne-Sophie Hamy
- Paris 5 Research University, INSERM U932, Institut Curie, Paris, France
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11
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Benson JC, Diehn F, Passe T, Guerin J, Silvera VM, Carlson ML, Lane J. The Forgotten Second Window: A Pictorial Review of Round Window Pathologies. AJNR Am J Neuroradiol 2019; 41:192-199. [PMID: 31831467 DOI: 10.3174/ajnr.a6356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/02/2019] [Indexed: 12/26/2022]
Abstract
The round window serves to decompress acoustic energy that enters the cochlea via stapes movement against the oval window. Any inward motion of the oval window via stapes vibration leads to outward motion of the round window. Occlusion of the round window is a cause of conductive hearing loss because it increases the resistance to sound energy and consequently dampens energy propagation. Because the round window niche is not adequately evaluated by otoscopy and may be incompletely exposed during an operation, otologic surgeons may not always correctly identify associated pathology. Thus, radiologists play an essential role in the identification and classification of diseases affecting the round window. The purpose of this review is to highlight the developmental, acquired, neoplastic, and iatrogenic range of pathologies that can be encountered in round window dysfunction.
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Affiliation(s)
- J C Benson
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - F Diehn
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - T Passe
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - J Guerin
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - V M Silvera
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
| | - M L Carlson
- Otolaryngology-Head and Neck Surgery (M.L.C.), Mayo Clinic, Rochester, Minnesota
| | - J Lane
- From the Departments of Neuroradiology (J.C.B., F.D., T.P., J.G., V.M.S., J.L.)
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12
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Hamy AS, Derosa L, Valdelièvre C, Yonekura S, Opolon P, Priour M, Guerin J, Pierga JY, Asselain B, De Croze D, Pinheiro A, Lae M, Talagrand LS, Laas E, Darrigues L, Grandal B, Marangoni E, Montaudon E, Kroemer G, Zitvogel L, Reyal F. Comedications influence immune infiltration and pathological response to neoadjuvant chemotherapy in breast cancer. Oncoimmunology 2019; 9:1677427. [PMID: 32002287 PMCID: PMC6959439 DOI: 10.1080/2162402x.2019.1677427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/18/2019] [Accepted: 10/04/2019] [Indexed: 12/22/2022] Open
Abstract
Immunosurveillance plays an important role in breast cancer (BC) prognosis and progression, and can be geared by immunogenic chemotherapy. In a cohort of 1023 BC patients treated with neoadjuvant chemotherapy (NAC), 40% of the individuals took comedications mostly linked to aging and comorbidities. We systematically analyzed the off-target effects of 1178 concurrent comedications (classified according to the Anatomical Therapeutic Chemical (ATC) Classification System) on the density of tumor-infiltrating lymphocytes (TILs) and pathological complete responses (pCR). At level 1 of the ATC system, the main anatomical classes of drugs were those targeting the nervous system (class N, 39.1%), cardiovascular disorders (class C, 26.6%), alimentary and metabolism (class A, 16.9%), or hormonal preparations (class H, 6.5%). At level 2, the most frequent therapeutic classes were psycholeptics (N05), analgesics (N02), and psychoanaleptics (N06). Pre-NAC TIL density in triple-negative BC (TNBC) was influenced by medications from class H, N, and A, while TIL density in HER2+ BC was associated with the use of class C. Psycholeptics (N05) and agents acting on the renin-angiotensin system (C09) were independently associated with pCR in the whole population of BC or TNBC, and in HER2-positive BC, respectively. Importantly, level 3 hypnotics (N05C) alone were able to reduce tumor growth in BC bearing mice and increased the anti-cancer activity of cyclophosphamide in a T cell-dependent manner. These findings prompt for further exploration of drugs interactions in cancer, and for prospective drug-repositioning strategies to improve the efficacy of NAC in BC.
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Affiliation(s)
- Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, U932, Immunity and Cancer, Institut Curie, PSL Research University, Paris, France.,Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Lisa Derosa
- Gustave Roussy Cancer Campus (GRCC), Villejuif, France.,Institut National de la Santé Et de la Recherche Medicale (INSERM), Equipe Labellisée-Ligue Nationale contre le Cancer, Villejuif, France.,Univ. Paris-Sud, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | | | - Satoru Yonekura
- Gustave Roussy Cancer Campus (GRCC), Villejuif, France.,Institut National de la Santé Et de la Recherche Medicale (INSERM), Equipe Labellisée-Ligue Nationale contre le Cancer, Villejuif, France.,Univ. Paris-Sud, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Paule Opolon
- Gustave Roussy Cancer Campus (GRCC), Villejuif, France.,Institut National de la Santé Et de la Recherche Medicale (INSERM), Equipe Labellisée-Ligue Nationale contre le Cancer, Villejuif, France.,Univ. Paris-Sud, Université Paris-Saclay, Gustave Roussy, Villejuif, France
| | - Maël Priour
- Informatics Department, Institut Curie, Paris, France
| | - Julien Guerin
- Informatics Department, Institut Curie, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | | | | | - Alice Pinheiro
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, U932, Immunity and Cancer, Institut Curie, PSL Research University, Paris, France
| | - Marick Lae
- Tumor Biology, Institut Curie, Paris, France
| | | | - Enora Laas
- Department of Surgery, Institut Curie, Paris, France
| | | | | | - Elisabetta Marangoni
- Preclinical investigation laboratory, Translational Research Department, Institut Curie, PSL Research University, Paris
| | - Elodie Montaudon
- Preclinical investigation laboratory, Translational Research Department, Institut Curie, PSL Research University, Paris
| | - Guido Kroemer
- Equipe 11 labellisée par la Ligue contre le Cancer, Centre de Recherche des Cordeliers, Paris, France.,Cell Biology and Metabolomics platforms, Villejuif, France.,INSERM, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France.,Université Pierre et Marie Curie, Paris, France.,Pôle de Biologie, Hôpital Européen Georges Pompidou, AP-HP, Paris, France.,Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden
| | - Laurence Zitvogel
- Gustave Roussy Cancer Campus (GRCC), Villejuif, France.,Institut National de la Santé Et de la Recherche Medicale (INSERM), Equipe Labellisée-Ligue Nationale contre le Cancer, Villejuif, France.,Univ. Paris-Sud, Université Paris-Saclay, Gustave Roussy, Villejuif, France.,Center of Clinical Investigations in Biotherapies of Cancer (CICBT), Gustave Roussy and Institut Curie, France
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, U932, Immunity and Cancer, Institut Curie, PSL Research University, Paris, France.,Department of Surgery, Institut Curie, Paris, France.,Sorbonne Paris Cité, Université Paris Descartes, Paris, France
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Hamy-Petit AS, Toussaint A, Sautter C, Coussy F, Donnadieu A, Rouzier R, Saule C, Frank S, Bensen A, Grynberg M, Scarabin-Carre V, Santulli P, Balezeau T, Guerin J, Reyrat E, Jamain C, Hours A, Lecourt A, Reyal F. Abstract P6-16-02: Fertility preservation in young breast cancer patients: Real life data on 1390 patients treated in the Institut Curie. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-16-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Adverse effects of chemotherapy on fertility are a critical concern for young breast cancer (BC) patients. Fertility preservation (FP) is currently offered to BC patients, though literature data concerning reproductive outcomes are scarce. Also, very few data are available on whether these procedures are associated with delay to treatment, or whether they impact oncologic outcomes. The objective of our study is to evaluate: (i) efficacy of FP procedures in terms of stored material and pregnancy rates, (ii) safety regarding time from BC diagnosis to chemotherapy, and oncologic outcomes in a large real-life cohort of BC patients.
Methods: We retrospectively analyzed medical charts of all consecutive patients aged between 18 and 43 diagnosed with invasive BC between 01/01/2011 and 30/09/2017 and treated with chemotherapy at Institut Curie (Paris and Saint Cloud). Baseline factors (antral follicle count (AFC), AMH), details on fertility preservation procedures, and results (number of frozen oocytes and embryos) were retrieved in 3 academic hospitals (Jean Verdier, Antoine Béclère and Cochin). All medical charts were reviewed in March 2018 to assess time from diagnosis to surgery / chemotherapy, pregnancy outcomes, recurrence and survival. We compared time from first consultation to start of chemotherapy (time diagnosis-to-CT) in case of neoadjuvant chemotherapy (NAC between patients who had or who did not have PF.
Results: On 1.390 patients identified, 622 had NAC, 768 had adjuvant CT. Median age at diagnosis was 38.8 y.o. 136 were BRCA mutated.
- 264 patients (19%) underwent a FP procedure: In Vitro Maturation (IVM) (58%, n=154); ovarian stimulation protocol (STIM) (31%, n=82); others (10%, n=28). The mean number of oocytes preserved was 5 [0-36] and was not different between IMV and STIM.
- Delays from diagnosis to CT were not different in patients who had FP than those who did not, neither in patients with NAC (no FP: 24.1 days VS FP: 22.8, p=0.24) nor in patients with adjuvant CT (no FP: 70.6 days VS FP : 66.8, p=0.11).
- 39 patients had at least one pregnancy: 28 spontaneous, 6 without information, and 5 from oocyte/embryo donation. The pregnancy rate was higher in patients in FP group (n=16 ; 6%) than in no FP group (n=23 ; 2%). 3 reused material : 2 without pregnancy and one had a miscarriage.
- About oncologic outcomes, 90 patients underwent relapse (6,4%), and this rate was not significantly different in the 2 groups (n=12, 4,5% VS n=78, 6.9%).
- Patients with BRCA mutation (BRCAm) had lower AMH (2.9 VS 4.1 ng/mL ; p = 0,03) and antral follicle count (17.6 VS 24 ; p = 0.01). However, there was no difference on the stored material, and pregnancy rate was higher than in patients with no mutation or unkwnown status (7.6 VS 2.6% ; p = 0,01).
Conclusion: Pregnancy rate was higher in patients with FP, however majority of pregnancies was spontaneous, and no live birth was observed after material reuse. FP procedures were not associated with delay to treatment. Though bias cannot be excluded, preliminary data do not show an adverse impact of FP on oncologic outcome. Further follow-up is needed.
Citation Format: Hamy-Petit A-S, Toussaint A, Sautter C, Coussy F, Donnadieu A, Rouzier R, Saule C, Frank S, Bensen A, Grynberg M, Scarabin-Carre V, Santulli P, Balezeau T, Guerin J, Reyrat E, Jamain C, Hours A, Lecourt A, Reyal F. Fertility preservation in young breast cancer patients: Real life data on 1390 patients treated in the Institut Curie [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-02.
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Affiliation(s)
- A-S Hamy-Petit
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - A Toussaint
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - C Sautter
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - F Coussy
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - A Donnadieu
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - R Rouzier
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - C Saule
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - S Frank
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - A Bensen
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - M Grynberg
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - V Scarabin-Carre
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - P Santulli
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - T Balezeau
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - J Guerin
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - E Reyrat
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - C Jamain
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - A Hours
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - A Lecourt
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
| | - F Reyal
- Curie Institute, Paris, France; Antoine Beclere Hospital, Clamart, France; Port Royal Hospital, Paris, France; Unicancer Federation, Paris, France
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14
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Abstract
The range of foods featuring lactic acid bacteria (LAB) with potential associated health benefits has expanded over the years from traditional dairy products to meat, cereals, vegetables and fruits, chocolate, etc. All these new carriers need to be compared for their efficacy to protect, carry, and deliver LAB, but because of their profusion and the diversity of methods this remains difficult. This review points out the advantages and disadvantages of the main food matrix types, and an additional distinction between dairy and nondairy foods is made. The food matrix impact on LAB viability during food manufacturing, storage, and digestion is also discussed. The authors propose an ideal hypothetical food matrix that includes structural and physicochemical characteristics such as pH, water activity, and buffering capacities, all of which need to be taken into account when performing LAB food matrix design. Guidelines are finally provided to optimize food matrix design in terms of effective LAB delivery.
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Affiliation(s)
- F Gomand
- LIBio, Université de Lorraine, F-54000 Nancy, France;
| | - F Borges
- LIBio, Université de Lorraine, F-54000 Nancy, France;
| | - J Burgain
- LIBio, Université de Lorraine, F-54000 Nancy, France;
| | - J Guerin
- LIBio, Université de Lorraine, F-54000 Nancy, France;
| | | | - C Gaiani
- LIBio, Université de Lorraine, F-54000 Nancy, France;
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15
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Gomand F, Borges F, Salim D, Burgain J, Guerin J, Gaiani C. High-throughput screening approach to evaluate the adhesive properties of bacteria to milk biomolecules. Food Hydrocoll 2018. [DOI: 10.1016/j.foodhyd.2018.06.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Hamy AS, Val de Lièvre C, Laas E, Darrigues L, Priour M, Guerin J, Balezeau T, Livartowski A, Pierga JY, Escalup L, Asselain B, Rouzier R, Lae M, Decroze D, Pinheiro A, Laurent C, Reyal F. Abstract P3-06-11: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-06-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- A-S Hamy
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - C Val de Lièvre
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - E Laas
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - L Darrigues
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - M Priour
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - J Guerin
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - T Balezeau
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - A Livartowski
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - J-Y Pierga
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - L Escalup
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - B Asselain
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - R Rouzier
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - M Lae
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - D Decroze
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - A Pinheiro
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - C Laurent
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
| | - F Reyal
- Institut Curie, Paris, France; U932, Immunity and Cancer, INSERM, Institut Curie, Paris, France; Institut Curie, Paris, France
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17
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Hamy-Petit AS, Lam GT, Laas E, Darrigues L, Balezeau T, Guerin J, Livartowski A, Sadacca B, Pierga JY, Vincent-Salomon A, Bidard FC, Lerebours F, Brain E, Becette V, Rouzier R, Lae M, Reyal F. Abstract P2-03-04: Lymphovascular invasion in breast carcinoma following neodjuvant chemotherapy is a strong prognosis factor. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-03-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose : Lymphovascular invasion (LVI) is a poor prognosis factor in breast cancer (BC), but data on its value in the neoadjuvant setting is scarce. This study evaluates the relationships between post-NAC LVI and prognosis in BC.
Methods: We identified 1197 patients with primary BC receiving NAC +/- trastuzumab between 2002 and 2011. Information on LVI in post-NAC surgical specimen was retrieved from review of medical charts. Univariate and multivariate analyses were performed to assess the association of clinical, pathological factors with disease free survival (DFS) and overall survival (OS) was assessed using a cox proportional hazard model.
Results: On 1197 tumors, 528 were luminal (44.1%), 375 were triple negative breast cancer (TNBC) (31.3%) and 294 were HER2-positive (24.6%). On post-NAC surgical specimens, LVI was present in 302 (25.2%), absent in 531 (44.4%), and was not mentionned in 364 cases (30.4%). The presence of post-NAC LVI was associated with an impaired DFS (HR=2.17, 95 CI [1.65 - 2.86], p<0.001) and the magnitude of this impact varied by BC subtype (p-value for interaction=0.02), (luminal BC: HR=1.75, p=0.006; TNBC : HR=2.77, p<0.001 ; HER2-positive BC : HR=5.12, p<0.001).
Table 1 Univariate analysis and multivariate analysis on DFS (whole population) Univariate Multivariate VariableClassHRClpHRCIpAge< 451 0.35 45-550.82[0.62 - 1.08] >550.87[0.64 - 1.19] Menopausal statuspremenopausal1.04[0.81 - 1.34]0.75 postmenopausal1 BMI class19-251 < 191.24[0.75 - 2.05]0.41 > 251.36[1.06 - 1.75]0.01 Tumor sizeT1-T21 T31.77[1.38 - 2.27]<0.011.77[ 1.32 - 2.38 ]<0.001Clinical nodal statusN01 N1-N2-N31.35[1.05 - 1.72]0.021.43[ 1.07 - 1.91 ]0.016HistologyDuctal1 Other1.24[0.87 - 1.78]0.24 GradeGrade I-II1 III1.24[0.87 - 1.78]0.07 Ki 67<201 >201.54[1.06 - 2.22]0.02 Mitotic index≤221 >221.18[0.9 - 1.53]0.23 DCIS componentno1 yes1.33[0.88 - 2.01]0.18 Pre-NAC LVIno1 yes1.35[0.88 - 2.01]0.09 ER statusnegative1 positive0.72[0.56 - 0.91]<0.01 PR statusnegative1 positive0.66[0.51 - 0.85]<0.01 HER2 statusnegative1 positive0.84[0.62 - 1.14]0.26 BC subtypeluminal1 TNBC1.53[1.17 - 2]<0.012.67[ 1.93 - 3.69 ]<0.001 HER20.99[0.72 - 1.38]0.971.25[ 0.82 - 1.88 ]0.299Post NAC parametersPost-NAC LVI (breast)no1 yes2.17[1.65 - 2.86]<0.012.3[ 1.72 - 3.08 ]<0.001pCRNo pCR1 pCR0,4[0.27 - 0.59]<0.01 Pathological nodal involvement0 1-31.48[1.11 - 1.97]<0.01 ≥4 N+3.13[2.34 - 4.19]<0.01 RCB class01 10.97[0.36 - 2.64]0.96 22.88[1.69 - 4.89]<0.01 35.21[3.01 - 9.02]<0.01 ER: oestrogene receptor PR: progesteron receptor RCB: residual cancer burden
Post-NAC LVI was an independent predictor of poor DFS, that overwhelmed the prognostic impact of pathological complete response in all 3 BC subtypes. Post-NAC LVI was also an independent predictor of poor OS in the whole cohort and in all BC subtypes.
Table 1 resumes univariate and multivariate analysis on DFS in whole population.
Conclusion: Post-NAC LVI is a strong independent prognostic factor associated with poor DFS and OS, that (i) should be systematically mentioned in pathological reports following NAC and (ii) could be used to select high risk patients candidates to second line trials in the post-neoadjuvant window.
Citation Format: Hamy-Petit A-S, Lam G-T, Laas E, Darrigues L, Balezeau T, Guerin J, Livartowski A, Sadacca B, Pierga J-Y, Vincent-Salomon A, Bidard F-C, Lerebours F, Brain E, Becette V, Rouzier R, Lae M, Reyal F. Lymphovascular invasion in breast carcinoma following neodjuvant chemotherapy is a strong prognosis factor [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-03-04.
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Affiliation(s)
- A-S Hamy-Petit
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - G-T Lam
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - E Laas
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - L Darrigues
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - T Balezeau
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - J Guerin
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - A Livartowski
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - B Sadacca
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - J-Y Pierga
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - A Vincent-Salomon
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - F-C Bidard
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - F Lerebours
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - E Brain
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - V Becette
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - R Rouzier
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - M Lae
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
| | - F Reyal
- Institut Curie, Paris, France; Geneva University Hospitals, Geneva, Switzerland
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18
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Lin F, Feighery C, Guerin J, O'Byrne H, Jackson J. Enzyme-linked immunosorbent assay for β2-glycoprotein I quantitation: the importance of variability in the plastic support. Br J Biomed Sci 2018; 60:165-8. [PMID: 14560796 DOI: 10.1080/09674845.2003.11978046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F Lin
- Department of Biological Sciences, Dublin Institute of Technology, Republic of Ireland
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19
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Hamy AS, Lam GT, Laas E, Darrigues L, Balezeau T, Guerin J, Livartowski A, Sadacca B, Pierga JY, Vincent-Salomon A, Coussy F, Becette V, Bonsang-Kitzis H, Rouzier R, Feron JG, Benchimol G, Laé M, Reyal F. Lymphovascular invasion after neoadjuvant chemotherapy is strongly associated with poor prognosis in breast carcinoma. Breast Cancer Res Treat 2018; 169:295-304. [PMID: 29374852 DOI: 10.1007/s10549-017-4610-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 12/06/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE Few studies evaluated the prognostic value of the presence of lymphovascular invasion (LVI) after neoadjuvant chemotherapy (NAC) for breast cancer (BC). METHODS The association between LVI and survival was evaluated in a cohort of BC patients treated by NAC between 2002 and 2011. Five post-NAC prognostic scores (ypAJCC, RCB, CPS, CPS + EG and Neo-Bioscore) were evaluated and compared with or without the addition of LVI. RESULTS Out of 1033 tumors, LVI was present on surgical specimens in 29.2% and absent in 70.8% of the cases. Post-NAC LVI was associated with impaired disease-free survival (DFS) (HR 2.54; 95% CI 1.96-3.31; P < 0.001), and the magnitude of this effect depended on BC subtype (Pinteraction = 0.003), (luminal BC: HR 1.83; P = 0.003; triple negative BC: HR 3.73; P < 0.001; HER2-positive BC: HR 6.21; P < 0.001). Post-NAC LVI was an independent predictor of local relapse, distant metastasis, and overall survival; and increased the accuracy of all five post-NAC prognostic scoring systems. CONCLUSIONS Post-NAC LVI is a strong independent prognostic factor that: (i) should be systematically reported in pathology reports; (ii) should be used as stratification factor after NAC to propose inclusion in second-line trials or adjuvant treatment; (iii) should be included in post-NAC scoring systems.
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Affiliation(s)
- Anne-Sophie Hamy
- Translational Research Department, INSERM, U932, Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut Curie, PSL Research University, 26, rue d'Ulm, 75248, Paris, France
| | - Giang-Thanh Lam
- Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France.,Department of Gynecology and Obstetrics, Geneva University Hospitals, 30 bd de la Cluse, 1205, Geneva, Switzerland
| | - Enora Laas
- Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Lauren Darrigues
- Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Thomas Balezeau
- Department of Medical Informatics and Data, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Julien Guerin
- Department of Medical Informatics and Data, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Alain Livartowski
- Department of Medical Informatics and Data, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France.,Department of Medical Oncology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Benjamin Sadacca
- Translational Research Department, INSERM, U932, Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut Curie, PSL Research University, 26, rue d'Ulm, 75248, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Anne Vincent-Salomon
- Department of Pathology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Florence Coussy
- Department of Medical Oncology, Hôpital René Huguenin, 35, rue Dailly, 92210, Saint-Cloud, France
| | - Veronique Becette
- Department of Pathology, Hôpital René Huguenin, 35, rue Dailly, 92210, Saint-Cloud, France
| | - Hélène Bonsang-Kitzis
- Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Roman Rouzier
- Department of Surgery, Hôpital René Huguenin, 35, rue Dailly, 92210, Saint-Cloud, France.,Equipe d'Accueil 7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, University Versailles-Saint-Quentin, 2 av de la source de la Bièvre, 78180, Montigny-Le-Bretonneux, France
| | - Jean-Guillaume Feron
- Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Gabriel Benchimol
- Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Marick Laé
- Department of Pathology, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France
| | - Fabien Reyal
- Translational Research Department, INSERM, U932, Immunity and Cancer, Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut Curie, PSL Research University, 26, rue d'Ulm, 75248, Paris, France. .,Department of Surgery, Institut Curie, PSL Research University, 26 rue d'Ulm, 75248, Paris, France.
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20
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Guerin J, Sim R, Yu BB, Ferluga J, Feighery C, Jackson J. Heterogeneous Recognition of beta 2-glycoprotein I by Antibodies from Antiphospholipid Syndrome Patients. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1614031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryBeta 2-glycoprotein I plays a pivotal role in the binding of antiphospholipid antibodies to phospholipid in patients with antiphospholipid syndrome. In this study the nature of the epitopes on beta 2-glycoprotein I (β2-GPI) recognised by sera from antiphospholipid syndrome (APS) patients (n = 15) was investigated and compared to rabbit polyclonal and mouse monoclonal anti-β2-GPI antibodies. β2-GPI was only recognised when bound to a high affinity binding support. The antigenic epitope on β2-GPI recognised by all APS patients was also dependent on disulphide bond integrity. Digestion of β2-GPI with elastase rapidly destroyed the epitope(s) on β2-GPI recognised by antibodies in 91% of APS patients. The main cleavage occurred at tryptophan316-lysine317 in the fifth domain. Digestion with staphylococcal V8 protease resulted in a 50% reduction in antibody binding in 81% of patients and the cleavage sites mainly involved the first domain of the molecule. There was considerable variability in the recognition of six different species of β2-GPI by serum from APS patients. The epitopes on β2-GPI bound by APS sera appear conformationally determined in all patients but are quite heterogeneous in the regions of β2-GPI that are recognised.
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21
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Kalina P, Guerin J. Pediatric Head and Neck Radiology: Selected Cases. J Pediatr Neuroradiol 2016. [DOI: 10.1055/s-0036-1593546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- P. Kalina
- Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, United States
| | - J. Guerin
- Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, United States
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22
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Darrouzet V, Soulie D, Siddiqui SA, Guerin J, Caille JM, Bebear JP. Contribution of 3D-MRI in the Management of Acoustic Neurinomas. Skull Base Surg 2015. [DOI: 10.1159/000429977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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23
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Darrouzet V, Siddiqui SA, Guerin J, Bebear JP. The Widened Retrolabyrinthine Approach in Surgery of Tumors of the Cerebellopontine Angle. Skull Base Surg 2015. [DOI: 10.1159/000429969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Rostaing-Rigattieri S, Guerin J. Douleurs cancéreuses : bonnes pratiques cliniques de prise en charge, gestions des opioïdes forts. Presse Med 2014; 43:252-62. [DOI: 10.1016/j.lpm.2013.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/07/2013] [Accepted: 05/07/2013] [Indexed: 11/26/2022] Open
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25
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Dagain A, Vignes J, Dulou R, Dutertre G, Delmas J, Guerin J, Liguoro D. Junction between the great cerebral vein and the straight sinus: An anatomical, immunohistochemical, and ultrastructural study on 25 human brain cadaveric dissections. Clin Anat 2008; 21:389-97. [DOI: 10.1002/ca.20635] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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26
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Vignes JR, de Seze M, Guerin J, Barat M. Sacral neuromodulation as a functional treatment of bladder overactivity. Acta Neurochir Suppl 2007; 97:315-22. [PMID: 17691392 DOI: 10.1007/978-3-211-33079-1_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Sacral neuromodulation, namely the electrical stimulation of the sacral nerves has become an alternative treatment for cases of idiopathic bladder overactivity. The mechanism of action in this type of spinal cord modulation is only partially understood but it seems to involve stimulation of inhibitory interneurons. Temporary sacral nerve stimulation is the first step. It consists of the temporary application of neurostimulation as a diagnostic test in order to check the integrity of the sacral root and determine the best location for the implant. If the test stimulation is successful, a permanent device is implanted. In experienced hands, this is a safe procedure. When the patients are selected on the basis of sound criteria, more than three-quarters of them show a clinically significant improvement with a reduction in the frequency of incontinence episodes by more than 50%; however, the results vary according to each author's method of evaluation. The application of this technique should be combined with careful follow-up and attentive adjustments of the stimulation parameters in order to optimize the coordination of activity between the neurological systems involved.
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Affiliation(s)
- J R Vignes
- Department of Neurorehabilitation, CHU Pellegrin, Bordeaux, France.
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27
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Fernet F, Koleck M, Gabinski P, Guerin J, Brochard P. Lombalgies chroniques chez le personnel soignant et médico-technique du CHU de Bordeaux. Étude des facteurs de chronicisation. ARCH MAL PROF ENVIRO 2006. [DOI: 10.1016/s1775-8785(06)78215-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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28
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Le Garlantezec C, Vidal VF, Guerin J, Bébéar JP, Liguoro D, Darrouzet V. [Management of cerebellopontine angle meningiomas and the posterior part of the temporal bone. Report on 44 cases]. Rev Laryngol Otol Rhinol (Bord) 2005; 126:81-9. [PMID: 16180346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To review and study the management of CPA meningiomas through the experience of an otoneurosurgical team. MATERIAL AND METHODS Fourty-two patients (44 meningiomas) were considered. Seventy-seven per cent of tumors (34 cases) were operated on; 6 tumors (14.6%) were exclusively irradiated using fractionated radiation therapy (FRT) and four only surveyed (9,8%). RESULTS transpetrosal approaches were exclusively used. These were translabyrinthine (TLA) in 47%, widened retrolabyrinthine (WRLA) in 41% of cases, transcochlear approach (TCA) in three cases and a middle fossa in one. A transtentorial approach was combined in 35% of cases (8 TLA, 4 WRLA). Surgical removal was incomplete in 11,8% of cases; in 3 cases growing tumor was treated by FRT included one case of anaplasic tumor Postoperative complications were: 1 meningitis, 1 wound abscess, 2 hydrocephalus (6%) and 4 CSF fistulas (12%). No complications have been observed during the last 7 years (21 cases). House and Brackmann Grade 1 or 2 facial function was obtained in 59% of cases (but 10 patients had a preoperative facial nerve paresis). A normal or subnormal AAO-HNS Class A-B Hearing could be preserved in 57% of WRLA. Radiation therapy allowed tumor shrinkage in all cases. In 3 cases this regression was of more than 50%. CONCLUSION Surgery is the gold standard in treating CPA meningiomas. Transpetrosal approaches and particularly WRLA pure or combined to a transtentorial approach are for us the best way to remove these tumors in preserving hearing and facial nerve function. When hearing is poor or when tumor extension to the clivus or the premeatal area is consistent a TLA is either planned preoperatively or obtained from a WRLA.
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Affiliation(s)
- C Le Garlantezec
- CHU Pellegrin, Service ORL, Place Amélie Raba-Léon, F-33076 Bordeaux cedex, France
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29
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Riem T, Vignes JR, San-Galli F, Guerin J, Allard M. [Functional neuronavigation. Fusion of functional MRI data in a neuronavigation system]. Neurochirurgie 2004; 50:111-6. [PMID: 15213640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Neuronavigation systems integrating functional magnetic resonance imaging data have been reported recently, but generally without many details about methodology. We propose an easy method to perform functional neuronavigation by integrating functional MRI data analyzed with the Statistical Parametric Mapping 99 reference software, in the Stealth Station which is the most common neuronavigation system. Users of this new and promising technique, which requires further validation, must be aware of its limitations. Functional MRI data seem to be the major source of imprecision. As a result we do not yet recommend the use of functional neuronavigation without the control of direct cortical stimulations.
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Affiliation(s)
- T Riem
- Service de Neurochirurgie A, ERT - CNRS, Laboratoire d'Imagerie Moléculaire et Fonctionnelle, Groupe Hospitalier Pellegrin, Bordeaux.
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30
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Abstract
We report the five- to-ten year results of Anderson Orthopaedic Research Institute type-2 bone defects treated with modular metal augments in revision knee surgery. A total of 102 revision knee arthroplasties in patients with type-2 defects treated with augments and stems were prospectively studied. Seven patients (seven knees) had incomplete follow-up and 15 patients (16 knees) died with the arthroplasty in situ. The mean follow-up of the 79 remaining knees was 7 ± 2 years (5 to 11). The presence of non-progressive radiolucent lines around the augment in 14% of knees was not associated with poorer knee scores, the range of movement, survival of the component or the type of insert which was used (p > 0.05). The survival of the components was 92 ± 0.03% at 11 years (95% CI, 10.3 to 11.2). We recommend the use of modular augmentation devices to treat type-2 defects in revision knee surgery.
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Affiliation(s)
- J V Patel
- Division of Orthopaedics, London Health Sciences Center, University of Western Ontario, London, Canada
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31
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Vignes JR, De Seze M, Sesay M, Barat M, Guerin J. [Anterior sacral root stimulation with dorsal rhizotomy (Brindley technique)]. Neurochirurgie 2003; 49:383-94. [PMID: 12746715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Patients with spinal cord lesions are exposed to vesico-sphincter dysfunctions which can aggravate the vital or functional prognosis. The pathophysiological characteristics of these neurogenic bladders explains the usefulness of surgical treatment. The objective of the Brindley technique is to improve both voiding and effective continence. Any patient with a stable supra-sacral spinal cord lesion (paraplegia, tetraplegia) with a reflex bladder (incontinence, vesico-sphincter dyssynergia resistant to medical treatment with the risk of upper urinary tract involvement) can benefit from the Brindley technique. The electrodes are placed on the anterior sacral roots in order to obtain the desired micturation. Posterior sacral rhizotomies are indispensable to the technique as they suppress detrusor and sphincter hyperreflexia and improve continence thereby protecting the upper urinary tract. About 90% of the patients considered have an improved quality of life after implantation of the Brindley stimulator. The bladder capacity was constantly improved and the majority of the patients become continent. Micturation was excellent with low residual volume and low rate of urinary tract infections. Complications are analyzed in this review of the literature. The Brindley technique is an excellent alternative to medical treatment in these highly distressed patients. It restores satisfactory continence and improves psychological as well as economical constraints related to auto/hetero catheterisations performed several times a day.
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Affiliation(s)
- J-R Vignes
- Service de Neurochirurgie Ouest, Hôpital Pellegrin, CHU de Bordeaux.
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33
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Bouillot S, Vignes JR, Guerin J, Dubus P, Vital A. Leukemic dissemination within a glioblastoma in a patient with chronic lymphoid leukemia. Clin Neuropathol 2003; 22:10-3. [PMID: 12617188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Metastasis from an extracranial tumor to a primary central nervous system tumor is a rare event, and most reported cases concern metastases to meningiomas. The authors describe the first case of leukemic cell dissemination within a glioblastoma. The patient likely presented a genetic predisposition to multiple neoplasms, and the unusual localization of leukemic cells might be partly related to the characteristic microvascular proliferation in glioblastoma.
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Affiliation(s)
- S Bouillot
- Neuropathology Department, Pellegrin Hospital, Bordeaux, France.
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34
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Vignes JR, Liguoro D, Sesay M, Barat M, Guerin J. Dorsal rhizotomy with anterior sacral root stimulation for neurogenic bladder. Stereotact Funct Neurosurg 2002; 76:243-5. [PMID: 12378103 DOI: 10.1159/000066725] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A spinal cord lesion above the sacral micturition center results in a loss of voluntary control and development of bladder sphincter dysynergia with hyperreflexia of the detrusor and spasticity of the sphincter. Sacral rhizotomy and implantation of an anterior sacral root stimulator appears as an effective method for the treatment not only of voiding dysfunction but also of defecation and sexual disturbance. The surgical technique is described as are the clinical and electrophysiological controls. The results of our series of operated patients with intradural implantation and sacral deaffentation show a constant improvement. 90% have satisfactory continence and no longer require an incontinence appliance. Bladder capacity and compliance have increased to 120% and urethral closure pressure has decreased. 80% have complete voiding or a post-void residue of not more than 50 ml. So, urinary infection rate is dramatically decreased.
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Affiliation(s)
- J R Vignes
- Department of Neurosurgery, Medical School Hospital, Bordeaux, France.
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35
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Bourne RB, Rorabeck CH, Patterson JJ, Guerin J. Tapered titanium cementless total hip replacements: a 10- to 13-year followup study. Clin Orthop Relat Res 2001:112-20. [PMID: 11764339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The 10- to-13 year performance of 307 Mallory Head cementless tapered total hip replacements in 283 patients was assessed. Eighty-five percent of patients had a diagnosis of osteoarthritis. Fifty-one percent of patients were women. The mean patient age was 64 +/- 10 years. The Hex Loc cementless acetabular component and titanium alloy femoral heads were used in each patient. At final followup, 37 (13%) patients died, 32 (10%) had revision surgery, and two (1%) were lost to followup. No femoral stem was revised for aseptic loosening, but one was revised because of sepsis and one was revised because of a periprosthetic fracture. Wear, osteolysis, and loosening were problems with the Hex Loc cementless acetabular components and 31 (10%) acetabular components required revision because of these mechanisms. The mean Harris hip score at final followup of the remaining patients was 87 +/- 14 points. Three percent of these patients had thigh pain. Radiographic assessment revealed that no femoral stem or acetabular socket was definitely or probably loose. Three-dimensional wear assessment using the Devane technique was 0.35 mm per year. The Mallory Head cementless, tapered femoral component performed well in the patients in the current study, but unfortunately, the clinical results were compromised by the use of a suboptimal cementless acetabular component, the use of polyethylene that was gamma-irradiated in air, and by the use of titanium alloy femoral heads. Future developments obviously will be in the areas of better acetabular component design, alternate polyethylene sterilization methods, and enhancements of the femoral stem in terms of offset choices, neck design, and perhaps ingrowth surface.
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Affiliation(s)
- R B Bourne
- London Health Sciences Centre, University of Western Ontario, Canada
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36
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Sheng Y, Hanly JG, Reddel SW, Kouts S, Guerin J, Koike T, Ichikawa K, Sturgess A, Krilis SA. Detection of 'antiphospholipid' antibodies: a single chromogenic assay of thrombin generation sensitively detects lupus anticoagulants, anticardiolipin antibodies, plus antibodies binding beta(2)-glycoprotein I and prothrombin. Clin Exp Immunol 2001; 124:502-8. [PMID: 11472415 PMCID: PMC1906077 DOI: 10.1046/j.1365-2249.2001.01555.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The diagnosis of the antiphospholipid syndrome (APS) requires both a typical clinical event plus a persistently positive test in an assay for either anticardiolipin (aCL) antibodies or a lupus anticoagulant (LA). Enzyme linked immunosorbent assays (ELISA) specific for autoantibodies against beta(2)-glycoprotein I (beta(2)GPI) or prothrombin are also used, but none of the tests are adequately sensitive or specific. A chromogenic assay was developed that measures the effect of test antibody or plasma samples on in vitro thrombin formation. It is able to detect both LA and beta(2)GPI-dependent aCL antibodies and may have greater specificity for APS than currently available tests. Using this method various monoclonal antibodies (MoAbs) were examined, from mice immunized with beta(2)GPI, mice with a spontaneous animal model of APS, and from three humans with APS. Plasma and affinity purified antibodies from patients with APS and control groups were also examined. Thrombin inhibition was more sensitive to perturbation by MoAbs than a combination of tests for LA (P < 0.05) and at lower antibody concentrations (12.5 microg/ml versus 100 microg/ml). There was a significant correlation between inhibition of thrombin generation and the level of MoAb reactivity to beta(2)GPI (r = 0.90; P < 0.001) but not to CL (r = 0.06; P = 0.76). Plasma and affinity purified antibodies from patients with APS also inhibited thrombin generation, and significantly more so than patients with aPL from causes other than APS. APS patient samples showed thrombin inhibition in the presence of anti-beta(2)GPI or antiprothrombin antibodies. All MoAbs binding beta(2)GPI showed inhibition of thrombin generation, while MoAbs binding domain I of beta(2)GPI had more LA effect.
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Affiliation(s)
- Y Sheng
- Department of Medicine, St George Hospital, Kogarah and the University of New South Wales, Sydney, New South Wales, Australia
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37
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Abstract
Using simple successive tasks we assessed the influence of Alzheimer's disease on the processing of different odours. Fifteen patients with Alzheimer's disease, 15 old control subjects and 15 young control subjects were tested. The experiment included two sessions. Initially 12 odorants were presented, one odorant every minute. For each odour the subjects were asked to rate intensity, pleasantness, familiarity and edibility using linear rating scales. The odorants were then presented a second time and the subjects were asked to identify them. The results show that the intensity scores were lower in old control subjects and Alzheimer patients than in the young control subjects and that familiarity and identification scores were lower in Alzheimer patients than in old control and young control subjects. When we compared the five olfactory tasks the impairment of performance in Alzheimer patients was relatively higher for identification than familiarity, itself higher than the intensity judgement. No difference was observed between the three groups of subjects for pleasantness and edibility judgements.
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Affiliation(s)
- J P Royet
- Laboratoire de Neuroscience et Systèmes Sensoriels (UMR CNRS 5020), Université Claude-Bernard Lyon 1, F-69622 Villeurbanne, France.
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38
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Bouvard M, Robbe-Grillet P, Milliery M, Pham S, Amireche S, Fanget F, Guerin J, Cottraux J. [Validation of a scale for responsibility (Salkovskis Responsibility Scale)]. Encephale 2001; 27:229-37. [PMID: 11488253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Appraisal of inflated responsibility for harm is the cornerstone of Salkovskis's cognitive theory for obsessive compulsive disorder. The aim of our study is to present the validation study of the French translation of the R scale. The present study compared 50 subjects with obsessive compulsive disorder, 37 patients suffering from social phobia and 183 control subjects on a responsibility questionnaire (R scale). The cognitive hypothesis of Obsessive Compulsive Disorder (OCD) specifies two levels of responsibility-related cognitions: responsibility assumptions (attitudes) and responsibility appraisals (interpretations). The R scale evaluates the responsibility assumptions. Such attitudes should reflect the more generalized tendency to assume responsibility in a given situation, particularly situations involving intrusions and doubts. It is possible that such assumptions may be less specific to OCD. The inclusion of social phobia subjects in the present study allows evaluation of the specificity of any findings to OCD. Patients were diagnosed and classified according DSM IV criteria. The control subjects were taken in the general population. No formal interview was conducted. The three groups were compared for sex, age and educational level. Before treatment, all the participants filled in the Responsibility Scale of Salkovskis (27 items), the Beck Depression Inventory (21 items), the Beck Anxiety Inventory and the Bouvard's Obsessive Compulsive Thoughts Checklist. The results indicate that the two anxious groups scored significantly higher than the control group on Beck Depression and Anxiety Inventories but no significant difference was observed between the two anxious groups. OCD patients scored significantly higher than both social phobic patients and control subjects on the Obsessive Compulsive Thoughts Checklist (OCTC). The social phobic group scored this checklist significantly higher than the control group. In sum, the three groups were different on obsessive compulsive thoughts. On the washing subscale of the Obsessive Compulsive Thoughts Checklist, the OCD patients differed significantly from the control group and the social phobia patients. No difference was observed between the social phobia subjects and the control group. On the two other subscales of the OCTC, the checking and the responsibility scales, the three groups were different: OCD patients scored significantly higher than both social phobic patients and control subjects; the social phobic patients scored higher than the control group. Results support the reliability (test retest) and the internal consistency of the questionnaire. Patients with obsessive compulsive disorder (OCD) and social phobia subjects had significantly elevated score on the total scale compared to control subjects. However social phobia patients did not differ from patients with OCD. So, the responsibility for harm, evaluated by the R-scale seems not to be specific of OCD. This finding does not support the results of two studies (28, 30). But these two studies compared OCD patients with an anxious group including panic disorder with agoraphobia, generalized anxiety disorder and social phobia. The correlations with a measure of OCD symptoms were higher than the correlations with anxiety and depression. Finally, the factor structure was only studied on the control group. The exploratory factor analysis indicates that the R scale is a two-dimensional scale, reflecting a need to prevent risks and the belief that one has power to harm. The first dimension is less specific to the pathology than the second. Only patients with OCD had significantly elevated score on the "need to prevent risks" compared to the non-clinical group. The two anxious groups differed on "the belief that one has power to harm" from the non-clinical group but social phobia patients did not differ from patients with OCD. In sum, the two subscales of the R scale did not discriminate OCD patients and social phobic subjects. Further research is needed to replicate the present findings and to confirm the two dimensions of the R scale. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems. However, responsibility assumptions such as the belief that one has the power to harm are shared with social phobia.
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Affiliation(s)
- M Bouvard
- UTA, Hôpital Neurologique, 59, boulevard Pinel, 69394 Lyon
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39
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Guerin J, Sim R, Yu BB, Ferluga J, Feighery C, Jackson J. Heterogeneous recognition of beta 2-glycoprotein I by antibodies from antiphospholipid syndrome patients. Thromb Haemost 2000; 84:374-80. [PMID: 11019958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Beta 2-glycoprotein I plays a pivotal role in the binding of antiphospholipid antibodies to phospholipid in patients with antiphospholipid syndrome. In this study the nature of the epitopes on beta 2-glycoprotein I (beta2-GPI) recognised by sera from antiphospholipid syndrome (APS) patients (n = 15) was investigated and compared to rabbit polyclonal and mouse monoclonal anti-beta2-GPI antibodies. beta2-GPI was only recognised when bound to a high affinity binding support. The antigenic epitope on beta2-GPI recognised by all APS patients was also dependent on disulphide bond integrity. Digestion of beta2-GPI with elastase rapidly destroyed the epitope(s) on beta2-GPI recognised by antibodies in 91% of APS patients. The main cleavage occurred at tryptophan316-lysine317 in the fifth domain. Digestion with staphylococcal V8 protease resulted in a 50% reduction in antibody binding in 81% of patients and the cleavage sites mainly involved the first domain of the molecule. There was considerable variability in the recognition of six different species of beta2-GPI by serum from APS patients. The epitopes on beta2-GPI bound by APS sera appear conformationally determined in all patients but are quite heterogeneous in the regions of beta2-GPI that are recognised.
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Affiliation(s)
- J Guerin
- Department of Immunology, St. James's Hospital, Dublin, Ireland
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40
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Guerin J, Rossel JB, Robert S, Tsuchiya T, Koltunow A. A DEFICIENS homologue is down-regulated during apomictic initiation in ovules of Hieracium. Planta 2000; 210:914-20. [PMID: 10872222 DOI: 10.1007/s004250050697] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Hieracium is a member of the Asteraceae family, and contains sexual species in addition to apomictic species that reproduce by apospory and produce seed without fertilization. A homologue of the floral organ-identity gene DEFICIENS (DEF) was isolated from an apomictic line of Hieracium piloselloides (Vill.) following differential display between mature ovules and those initiating autonomous embryogenesis. The gene termed HPDEF has 93% amino acid identity with GDEF2, a DEF homologue isolated from Gerbera hybrida (D. Yu et al., 1999, Plant J. 17: 51-62), another member of the Asteraceae. In-situ analysis showed that early in floral development HPDEF is expressed in stamen and petal primordia, indicating expected B-function activity, according to the ABC model of floral organ identity (J. L. Bowman et al., 1991, Development 112: 1-20; E. S. Coen and E. M. Meyerowitz, 1991, Nature 353: 31-37). However, HPDEF expression was also observed in ovule primordia and expression continued in developing ovules until anthesis, indicating that this gene may have a role in ovule development. Expression of HPDEF was not detected in megaspore mother cells, or in sexual or aposporous embryo sacs. In sexual Hieracium, HPDEF was uniformly expressed throughout the ovule integument until anthesis. In most ovules of the apomict, however, HPDEF expression was transiently down-regulated in a specific zone in the chalazal region where cells initiating aposporous embryo sac formation differentiate. Uniform low-level HPDEF expression was subsequently observed prior to anthesis in ovules from sexual and apomictic plants. HPDEF may be down-regulated as a consequence of apomictic initiation and/or its down-regulation may facilitate progression of apomictic events.
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Affiliation(s)
- J Guerin
- CSIRO Plant Industry, Horticulture Unit, Adelaide, South Australia
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41
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Dentresangle C, Veyre L, Le Bars D, Pierre C, Lavenne F, Pollak P, Guerin J, Froment JC, Brousolle E. Striatal D2 dopamine receptor status in Parkinson's disease: an [18F]dopa and [11C]raclopride PET study. Mov Disord 1999; 14:1025-30. [PMID: 10584682 DOI: 10.1002/1531-8257(199911)14:6<1025::aid-mds1020>3.0.co;2-p] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- C Dentresangle
- CERMEP Cyclotron Unit, Hôpital Neurologique Pierre Wertheimer, Lyon, France
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42
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Abstract
Beta 2-glycoprotein I (beta2-GPI) is an antigenic target recognised by antiphospholipid antibodies found in association with the antiphospholipid syndrome (APS). In this study, the prevalence of Immunoglobulin M (IgM) and IgA anti-beta2-GPI antibodies was examined in APS patients and compared with IgG antibodies. In addition the value of measuring antibody isotypes and IgG subclass was investigated in the laboratory diagnosis of APS. A solid phase enzyme linked immunosorbent assay was established to measure IgG, IgM and IgA and IgG subclass antibodies to beta2-GPI in patients with APS and a variety of other thrombotic and non-thrombotic disorders. Raised levels of IgM anti-beta2-GPI antibodies were observed in 65% of patients with APS, 21% with systemic lupus erythematosus (SLE), 23% with rheumatoid factor, 4% with stroke, 5% carotid artery stenosis (CAS), 17% with a biological false positive serology for syphilis, 43% with infectious mononucleosis (IM) and 27% with human immunodeficiency virus (HIV). The median value for IgM antibodies to beta2-GPI for all these groups ranged from 2 to 7 arbitrary units (AU). Elevated levels of IgA antibodies to beta2-GPI were found in patients with APS (47%), SLE (13%), rheumatoid factor (26%), CAS (48%), stroke (25%), VDRL false positive serology for syphilis (33%), IM (47%) and HIV (7%). The median value of IgA antibodies to beta2-GPI in all of these groups ranged from 2 to 4 AU. Conversely the median value for IgG anti-beta2-GPI in APS patients was 112 AU compared to 1-4 AU in the other conditions examined. The presence of IgM and IgA antibodies to beta2-GPI was much less specific and sensitive for APS than IgG, with raised levels of these isotypes seen in a variety of thrombotic and non-thrombotic disorders. Elevated levels of IgG1, IgG2, IgG3 and IgG4 antibodies to beta2-GPI were detected in APS patients. While all four IgG anti-beta2-GPI antibody subclasses were represented in APS patients there appeared to be a significant overall skewing towards to the IgG2 subclass.
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Affiliation(s)
- J Guerin
- Department of Immunology, St. James's Hospital, Dublin, Ireland
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43
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Abstract
Few cases of pituitary adenoma with metastases have been reported. We report a case with histologically benign intracranial and cauda equina metastases. We compare it to the others in the literature.
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Affiliation(s)
- L De Boucaud
- Service de Neuroradiologie, CHU Pellegrin, Place Amélie Raba Leon, F-33000 Bordeaux, France
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44
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Abstract
The vascular and nervous structures and their relations with the spinal nerve roots were examined in the 2nd, 3rd and 4th posterior sacral foramina in relation to percutaneous needle insertion for neuromodulation. A foraminal branch provided by the lateral sacral artery to each foramen entered the inferior lateral quadrant of each foramen, adjacent to the nerve root medially. Facing the posterior sacral aperture and around the sacral nerves, there was no venous plexus. A venous plexus was sometimes present near the median line, and always around the proximal part of the spinal ganglion. The sacral nerve roots, especially the 3rd, had a long extradural course in the foramen, presenting a potential risk of nerve lesions during procedures involving needle insertion.
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Affiliation(s)
- D Liguoro
- Anatomy Department, University of Medical Sciences, Bordeaux, France
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45
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Abstract
OBJECTIVES To measure the effect of an impaction fracture of the femoral head on load transmission in the hip joint. DESIGN We measured the contact areas and pressure between the acetabulum and femoral head of cadaveric pelves in four different conditions: intact, with an operatively created one-square-centimeter defect in the superior femoral head, with a two-square-centimeter defect, and with a four-square-centimeter defect. All defects were uniformly three millimeters deep. SETTING Hips were loaded in a simulated single-limb stance. Pressure and area measurements were made with Fuji pressure-sensitive film. SPECIMENS Seven hip joints in seven whole pelves were tested. MAIN OUTCOME MEASUREMENTS Contact area, load, and mean and maximum pressures were measured. RESULTS Peripheral loading was seen in the intact acetabulum. This was not disrupted after impaction fractures of any size. A significant increase in mean maximum pressures in the superior acetabulum was seen with two-square-centimeter and four-square-centimeter defects. CONCLUSIONS In contrast to prior biomechanical studies of acetabular fractures, our investigation revealed that disruption of the peripheral distribution of load does not occur with impaction fractures of the femoral head. Clinical series indicate that impaction injuries to the femoral head are associated with a poor prognosis. Previous biomechanical data on acetabular fracture patterns associated with a poor prognosis have shown increases in mean and peak pressures in the superior acetabulum. This was seen with two-square-centimeter and four-square-centimeter impaction injuries. Other factors, such as wear of the articular cartilage during joint motion or associated microscopic damage to the remainder of the joint surface at the time of injury, may also contribute to the rapid joint deterioration seen in these injuries. Further study is indicated.
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46
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Liguoro D, Viejo-Fuertes D, Vital A, San Galli F, Dautheribes M, Guerin J. [Intramuscular myxoma. A case of myxoma of the spinal erector muscle]. Neurochirurgie 1999; 45:54-7. [PMID: 10374236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
A case of intramuscular myxoma, extended in the lumbar erector spinae muscles, is reported. This soft tissue tumor is rare, about one hundred observations are indexed in the literature. The clinical findings are nonspecific, magnetic resonance imaging reveals few characteristics, and finally a histological examination is required, after surgical removal, to pinpoint the diagnosis. Recurrence is uncommon, but a systematic follow-up is necessary.
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Affiliation(s)
- D Liguoro
- Service de Neurochirurgie, Hôpital Pellegrin, Bordeaux
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47
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Carulli JP, Artinger M, Swain PM, Root CD, Chee L, Tulig C, Guerin J, Osborne M, Stein G, Lian J, Lomedico PT. High throughput analysis of differential gene expression. J Cell Biochem Suppl 1999; 30-31:286-96. [PMID: 9893282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Elucidation of the changes in gene expression associated with biological processes is a central problem in biology. Advances in molecular and computational biology have led to the development of powerful, high-throughput methods for the analysis of differential gene expression. These tools have opened up new opportunities in disciplines ranging from cell and developmental biology to drug development and pharmacogenomics. In this review, the attributes of five commonly used differential gene expression methods are discussed: expressed sequence tag (EST) sequencing, cDNA microarray hybridization, subtractive cloning, differential display, and serial analysis of gene expression (SAGE). The application of EST sequencing and microarray hybridization is illustrated by the discovery of novel genes associated with osteoblast differentiation. The application of subtractive cloning is presented as a tool to identify genes regulated in vivo by the transcription factor pax-6. These and other examples illustrate the power of genomics for discovering novel genes that are important in biology and which also represent new targets for drug development. The central theme of the review is that each of the approaches to identifying differentially expressed genes is useful, and that the experimental context and subsequent evaluation of differentially expressed genes are the critical features that determine success.
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Affiliation(s)
- J P Carulli
- Department of Human Genetics, Genome Therapeutics Corporation, Waltham, Massachusetts 02154, USA
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48
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Darrouzet V, Guerin J, Bébéar JP. New technique of side-to-end hypoglossal-facial nerve attachment with translocation of the infratemporal facial nerve. J Neurosurg 1999; 90:27-34. [PMID: 10413152 DOI: 10.3171/jns.1999.90.1.0027] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The goal of this study was to assess the clinical results of hypoglossal-facial nerve attachment (HFA), which was primarily performed in patients following excision of tumors of the cerebellopontine angle. In six of the patients a new side-to-end procedure was used. METHODS The authors have performed a retrospective study of 33 patients who underwent HFA, including 24 classic end-to-end, three May, and six side-to-end procedures. For the latter procedure, a hemihypoglossal-facial nerve attachment was performed by rerouting the intratemporal facial nerve; this avoided the jump-cable graft used in May's technique. The goal of the new procedure is to reduce the incidence of morbidity due to hemilingual paralysis (difficulty in chewing, speaking, and swallowing). The incidence of hemilingual paralysis was evaluated based on the findings of a questionnaire that was completed by the patients. The patient's facial mobility was assessed using the House and Brackmann grading system and the author's analytic scoring system. CONCLUSIONS The HFA offers good functional results. Of the 28 cases evaluated, nine had House and Brackmann Grade III, 17 Grade IV, and only two Grade V at 18 months. When the new technique of side-to-end hemihypoglossal-facial nerve attachment was used, there was considerable reduction, if not complete disappearance, of lingual morbidity and the facial functional results were constant and satisfactory: there were five patients with House and Brackmann Grade III and one with Grade IV, and their mean percentage of facial mobility was 43.3%.
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Affiliation(s)
- V Darrouzet
- Department of Otorhinolaryngology, University Hospital of Bordeaux, France.
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49
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Egon G, Barat M, Colombel P, Visentin C, Isambert JL, Guerin J. Implantation of anterior sacral root stimulators combined with posterior sacral rhizotomy in spinal injury patients. World J Urol 1998; 16:342-9. [PMID: 9833314 DOI: 10.1007/s003450050078] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Brindley-Finetech sacral anterior root stimulators combined with posterior sacral rhizotomy were implanted in 68 males and 28 females with spinal cord lesions. In 9 patients the electrodes were implanted extradurally in the sacrum, and in 90 patients they were implanted intradurally (3 patients had a second extradural implant after a first intradural implant). Three patients died from causes unrelated to the implant. Of the 93 surviving patients, 83 used their implants for micturition and 82 were fully continent. The mean bladder capacity increased from 206 ml preoperatively to 564 ml after the operation. Three patients had a preoperative vesicorenal reflux that disappeared after surgery. In all, 51 patients used the stimulator for defecation. Erection was possible with electrical stimulation in 46 males and was used for coitus by 17 couples. Secondary deafferentation at the level of the conus was performed four times. Three patients who had a cerebrospinal fluid leak were operated on again. Two implants had to be removed because of infection. Sacral anterior root stimulation combined with sacral deafferentation is a welcome addition to the treatment of neurogenic bladder in spinal cord injury patients.
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Affiliation(s)
- G Egon
- Centre Hospitalier Spécialisé de l'Arche, Saint-Saturnin-Le Mans, France
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50
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Abstract
Antiphospholipid antibodies associated with the antiphospholipid syndrome (APS) have been shown to bind plasma proteins, particularly beta 2-glycoprotein I (beta2-GPI). In this study the incidence of antibodies to solid-phase prothrombin was examined in patients with antiphospholipid syndrome and a variety of other inflammatory disorders. Significantly elevated levels of IgG anti-prothrombin (anti-PT) antibodies were detected in 63% of patients with APS (n = 27, median 22 arbitrary units: AU), 33% with SLE (n = 92, median 14 AU). 45% with rheumatoid factor (n = 22, median 16 AU), 21% with carotid artery stenosis (n = 21, median 15 AU), 32% with stroke (n = 38, median 13 AU). 67% of patients with a false positive serology for syphilis (n = 21, median 24 AU), 37% with HIV (n = 30, median 14 AU), 29% with syphilis (n = 14, median 19 AU) and 3% with infectious mononucleosis (n= 30, median 9 AU). In addition, a group of lupus anticoagulant (LA) positive patients (n = 48) was examined for antibodies to prothrombin, beta2-GPI and cardiolipin. 10 (21%) patients had raised levels of IgG anti-PT antibodies, 30 (62%) had significantly elevated levels of anti-beta2-GPI antibodies and 15 (31%) had elevated levels of anticardiolipin antibodies (ACA). Of the LA-positive patients, 15 (43%) were identified with definite APS, eight (23%) with probable APS, two (6%) with possible APS and 10 (28%) patients had no clinical evidence of APS. In conclusion, antibodies to prothrombin were found in a variety of inflammatory disorders and were therefore not specific for the APS. However, identification of the plasma proteins recognized by antibodies from patients with APS may provide insight into the pathogenic mechanisms involved in the heterogenous clinical manifestations of the APS.
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Affiliation(s)
- J Guerin
- Department of Immunology, St James's Hospital, Dublin, Ireland
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