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Baron M, Sassolas B, Pinard L, Ealet A. Numerical modelling for retrieval of the coating thickness variations from wavefront errors measurements. Opt Express 2023; 31:32968-32986. [PMID: 37859087 DOI: 10.1364/oe.494683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/08/2023] [Indexed: 10/21/2023]
Abstract
Multilayers coating are needed for large optical components performances, but the thickness non-uniformities over the useful aperture can generate spatial and chromatic variations of the reflectance, the transmittance and the wavefront errors. Although these dependences can be measured, they are difficult to anticipate if the underlying thickness variations are unknown. We present a model to retrieve these variations from wavefront error measurements that enables the computation of any optical properties over the useful aperture at any wavelength, angle of incidence or polarization.
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Delaval S, Dequirez PL, Hentzen C, Baron M, Mille E, Tariel F, Peyronnet B, Perrouin-Verbe MA, Pierache A, Chartier-Kastler E, Capon G, Cornu JN, Castel-Lacanal E, Gamé X, Karsenty G, Ruffion A, Denys P, Even A, Joussain C, Amarenco G, Phé V, Biardeau X. Intravesical injections of botulinum neurotoxin A to treat overactive bladder and/or detrusor overactivity related to multiple sclerosis: 5-Year continuation rate and specific risk factors for discontinuation-A study from the neuro-urology committee of the French Association of Urology. Mult Scler 2023:13524585231174580. [PMID: 37264947 DOI: 10.1177/13524585231174580] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND While intravesical injections of botulinum neurotoxin A (BoNT-A) are currently recommended for patients experiencing refractory neurogenic overactive bladder and/or detrusor overactivity (OAB/DO), it is unclear how much this therapy is effective and sustainable in the long-term in patients with multiple sclerosis (MS). OBJECTIVES To assess the mid-term continuation rate of BoNT-A injections to treat neurogenic OAB/DO in MS patients and to investigate MS-specific risk factors for discontinuation. METHODS This retrospective study involved 11 French university hospital centers. All MS patients who received BoNT-A to treat neurogenic OAB/DO between 2008 and 2013 and were subsequently followed up for at least 5 years were eligible. RESULTS Of the 196 MS patients included, 159 (81.1%) were still under BoNT-A 5 years after the first injection. The combination of the Expanded Disability Status Scale (EDSS < 6 or ⩾ 6) and of the MS type (relapsing-remitting vs progressive) predicted the risk of discontinuation. This risk was 5.5% for patients with no risk factor, whereas patients presenting with one or two risk factors were 3.3 and 5.7 times more likely to discontinue, respectively. CONCLUSION BoNT-A is a satisfying mid-term neurogenic OAB/DO therapy for most MS patients. Combining EDSS and MS type could help predict BoNT-A discontinuation.
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Affiliation(s)
- Stéphanie Delaval
- Department of Urology, University of Lille, Claude Huriez Hospital, Lille University Hospital, Lille, France
| | - Pierre-Luc Dequirez
- Department of Urology, University of Lille, Claude Huriez Hospital, Lille University Hospital, Lille, France
| | - Claire Hentzen
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon Academic Hospital, Paris, France
| | - Maximilien Baron
- Department of Urology, Hotel Dieu Hospital, University of Nantes, Nantes, France
| | - Eva Mille
- Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Academic Hospital, Marseille, France
| | - François Tariel
- Department of Urology, University of Rennes, Rennes Academic Hospital, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, University of Rennes, Rennes Academic Hospital, Rennes, France
| | | | | | - Emmanuel Chartier-Kastler
- Department of Urology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière Academic Hospital, Paris, France
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux Academic Hospital, Bordeaux, France
| | - Jean-Nicolas Cornu
- Department of Urology, University of Rouen Normandy, Rouen Academic Hospital, Rouen, France
| | - Evelyne Castel-Lacanal
- Department of Rehabilitation and Physical Medicine, Université of Toulouse, Rangueil Academic Hospital, Toulouse, France
| | - Xavier Gamé
- Department of Urology, University of Toulouse, Rangueil Academic Hospital, Toulouse, France
| | - Gilles Karsenty
- Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Academic Hospital, Marseille, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Pierre Denys
- Department of Rehabilitation and Physical Medicine, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris (AP-HP), Raymond Poincaré Academic Hospital, Garches, France/Inserm UMR 1179, END-ICAP, Laboratoire Handicap Neuromusculaire: Physiopathologie, Biothérapie et Pharmacologie Appliquées, UFR Simone Veil, Université Paris-Saclay, Paris, France
| | - Alexia Even
- Department of Rehabilitation and Physical Medicine, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris (AP-HP), Raymond Poincaré Academic Hospital, Garches, France
| | - Charles Joussain
- Department of Rehabilitation and Physical Medicine, Université Paris-Saclay, Assistance Publique-Hôpitaux de Paris (AP-HP), Raymond Poincaré Academic Hospital, Garches, France
| | - Gérard Amarenco
- GRC 001, GREEN Groupe de Recherche Clinique en Neuro-Urologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon Academic Hospital, Paris, France
| | - Véronique Phé
- Department of Urology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Tenon Academic Hospital, Paris, France
| | - Xavier Biardeau
- Department of Urology, University of Lille, Claude Huriez Hospital, Lille University Hospital, Lille, France/Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, University of Lille, CHU Lille, Lille, France
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Calën L, Mesnard B, Hedhli O, Broudeur L, Reiss B, Loubersac T, Branchereau J, Baron M, Rigaud J, Le Fort M, Perrouin-Verbe B, Le Normand L, Lefevre C, Perrouin-Verbe MA. Robot-assisted laparoscopic cystectomy with non-continent urinary diversion for neurogenic lower urinary tract dysfunction: Midterm outcomes. Neurourol Urodyn 2023; 42:586-596. [PMID: 36695768 DOI: 10.1002/nau.25134] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of this study was to assess midterm functional outcomes and complications of robot-assisted laparoscopic cystectomy with non-continent urinary diversion in patients with neurogenic lower urinary tract dysfunction. MATERIALS AND METHODS We performed a retrospective single center study including all patients who underwent robot-assisted laparoscopic cystectomy with non-continent urinary diversion between January 2008 and December 2018 for neurogenic lower urinary tract dysfunction. Perioperative data, early and late complications, reoperation rate, renal function, and patient satisfaction (PGI-I) were evaluated. RESULTS One hundred and forty patients were included (70 multiple sclerosis, 37 spinal cord injuries, 33 others) with a median follow-up of 29 months (12-49). The main indication for surgery was an inability to perform intermittent self-catheterization (n = 125, 89%). The early complication rate (<30 days) was 41% (n = 58), including 72% (n = 45) minor complications (Clavien I-II) and 29% (n = 17) major complications (Clavien III-V). Three patients died in the early postoperative period. Late complications appear in 41% (n = 57), with 9% (n = 13) being ureteroileal anastomotic stricture. The overall reintervention rate was 19% (n = 27), mainly for lithiasis surgery. Pre- and postoperative renal function were comparable. Most of patients reported an improvement in their quality of life following their surgery (PGI-I 1-2). CONCLUSION Robot-assisted laparoscopic cystectomy with non-continent urinary diversion may be of particular interest in patients with neurogenic lower urinary tract dysfunction who are unable to benefit from conservative treatment, as it provides midterm protection of the upper urinary tract and an improvement in quality of life.
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Affiliation(s)
- Laura Calën
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Benoît Mesnard
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Oussama Hedhli
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Lucas Broudeur
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Bénédicte Reiss
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Thomas Loubersac
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | | | - Maximilien Baron
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Jérôme Rigaud
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Marc Le Fort
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Loïc Le Normand
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Chloé Lefevre
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
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Sarrazin C, Windisch OL, Baron M, Boillot B, Thuillier C, Lefevre C, Perrouin-Verbe B, Ruffion A, Perrouin-Verbe MA. Synthetic Mid-urethral Sling for the Treatment of Urinary Incontinence in Women With Neurogenic Lower Urinary Tract Dysfunction: A Multicentric Retrospective Study. J Urol 2023; 209:1176-1183. [PMID: 36812396 DOI: 10.1097/ju.0000000000003388] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE We assess the efficacy, safety, and predictive factors for failure of synthetic mid-urethral slings for the treatment of urinary incontinence in a large cohort of women with neurogenic lower urinary tract dysfunction. MATERIALS AND METHODS Women aged 18 years or older who received a synthetic mid-urethral sling for stress urinary incontinence or mixed urinary incontinence in 3 centers between 2004 and 2019 and who had a neurological disorder were included. Exclusion criteria were less than 1 year of follow-up, concomitant pelvic organ prolapse repair, previous synthetic sling implantation, and no baseline urodynamics. The primary outcome was surgical failure, defined as recurrence of stress urinary incontinence during follow-up. Kaplan-Meier analysis was used to estimate the 5-year failure rate. Adjusted Cox proportional hazard model was used to identify factors associated with surgical failure. Complications and reoperations during the follow-up have also been reported. RESULTS A total of 115 women with a median age of 53 years were included. The median follow-up duration was 75 months. The 5-year failure rate was 48% (95 CI 46%-57%). Age above 50 years, negative tension-free vaginal tape test and transobturator route were associated with surgical failure. Thirty-six patients (31.3%) underwent at least 1 reoperation for complications or failure, and 2 required definitive intermittent catheterization. CONCLUSIONS Synthetic mid-urethral slings may be an acceptable alternative to autologous slings or artificial urinary sphincters for the treatment of stress urinary incontinence in a selected group of patients with neurogenic lower urinary tract dysfunction.
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Affiliation(s)
- Clement Sarrazin
- Department of Urology, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Maximilien Baron
- Department of Urology, Nantes University Hospital, Nantes, France
| | - Bernard Boillot
- Department of Urology, Grenoble Alpes University Hospital, Grenoble, France
| | - Caroline Thuillier
- Department of Urology, Grenoble Alpes University Hospital, Grenoble, France
| | - Chloé Lefevre
- Department of Physical Medicine and Rehabilitation, Nantes University Hospital, Nantes, France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation, Nantes University Hospital, Nantes, France
| | - Alain Ruffion
- Department of Urology, Lyon Sud Hospital-Pierre-Bénite, University of Lyon, Lyon, France
| | - Marie-Aimee Perrouin-Verbe
- Department of Urology, Nantes University Hospital, Nantes, France
- University of Nantes, U 1235 TENS, Nantes, France
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Chapelle C, Broudeur L, Bessard A, Durand T, Le Berre - Scoul C, Rigaud J, Baron M, Neunlist M, Perrouin-Verbe MA. Urothelial remodeling after spinal cord injury. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00884-9] [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: 02/12/2023]
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Paret F, Leclair MD, Karam G, Rigaud J, Baron M, Perrouin-Verbe MA. Long-term results of artificial urinary sphincter implantation for urinary incontinence due to intrinsic sphincter deficiency in children. Neurourol Urodyn 2023; 42:355-365. [PMID: 36434815 DOI: 10.1002/nau.25106] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To report long-term results of artificial urinary sphincter implantation for urinary incontinence due to intrinsic sphincter deficiency in children. MATERIALS AND METHODS This retrospective monocentric study included all patients who underwent artificial urinary sphincter (AMS 800) implantation before 18 years of age between 1986 and October 2018 for intrinsic sphincter deficiency. The primary outcome was the continence rate at the last follow-up, defined by the daily use of 0 pads. The secondary outcome was the overall survival of the device, defined as the absence of any repeated surgery (revision or explantation) during follow-up. Reoperation-free, revision-free, and explantation-free device survival rates were estimated using the Kaplan-Meier method. RESULTS Thirty-six patients with a median age of 12 years (interquartile range [IQR]: 10-14) were included (15 females, 21 males). The median follow-up was 18.7 years (IQR: 9-26). The main underlying condition was spinal dysraphism (n = 24; 67%). The median time to the first reoperation was 9 years (IQR: 3.75-14.7). At the last follow-up, survival rates without revision were 84%, 71%, 55%, and 33% at 5, 10, 15, and 20 years, respectively. Survival rates without explantation were 91%, 84%, 80%, and 72% at 5, 10, 15, and 20 years, respectively. At the last follow-up, 29 patients had a functional device. The overall continence rate was 88%. All patients who had their device still in place were continent at the last follow-up. CONCLUSION The artificial urinary sphincter is an effective long-term treatment for urinary incontinence related to intrinsic sphincter deficiency in children, providing a high rate of continence, even if associated with a high rate of reoperation.
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Affiliation(s)
- Fanny Paret
- Urology Department, Nantes University Hospital, Nantes, France
| | - Marc-David Leclair
- Pediatric Surgery Department, Nantes University Hospital, Nantes, France
| | - Georges Karam
- Urology Department, Nantes University Hospital, Nantes, France
| | - Jérôme Rigaud
- Urology Department, Nantes University Hospital, Nantes, France
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Atmani K, Wuestenberghs F, Baron M, Bouleté I, Guérin C, Bahlouli W, Vaudry D, do Rego JC, Cornu JN, Leroi AM, Coëffier M, Meleine M, Gourcerol G. Bladder-colon chronic cross-sensitization involves neuro-glial pathways in male mice. World J Gastroenterol 2022; 28:6935-6949. [PMID: 36632316 PMCID: PMC9827584 DOI: 10.3748/wjg.v28.i48.6935] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/02/2022] [Accepted: 10/26/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Irritable bowel syndrome and bladder pain syndrome often overlap and are both characterized by visceral hypersensitivity. Since pelvic organs share common sensory pathways, it is likely that those syndromes involve a cross-sensitization of the bladder and the colon. The precise pathophysiology remains poorly understood.
AIM To develop a model of chronic bladder-colon cross-sensitization and to investigate the mech-anisms involved.
METHODS Chronic cross-organ visceral sensitization was obtained in C57BL/6 mice using ultrasound-guided intravesical injections of acetic acid under brief isoflurane anesthesia. Colorectal sensitivity was assessed in conscious mice by measuring intracolonic pressure during isobaric colorectal distensions. Myeloperoxidase, used as a marker of colorectal inflammation, was measured in the colon, and colorectal permeability was measured using chambers. c-Fos protein expression, used as a marker of neuronal activation, was assessed in the spinal cord (L6-S1 level) using immunohistochemistry. Green fluorescent protein on the fractalkine receptor-positive mice were used to identify and count microglia cells in the L6-S1 dorsal horn of the spinal cord. The expression of NK1 receptors and MAPK-p38 were quantified in the spinal cord using western blot.
RESULTS Visceral hypersensitivity to colorectal distension was observed after the intravesical injection of acetic acid vs saline (P < 0.0001). This effect started 1 h post-injection and lasted up to 7 d post-injection. No increased permeability or inflammation was shown in the bladder or colon 7 d post-injection. Visceral hypersensitivity was associated with the increased expression of c-Fos protein in the spinal cord (P < 0.0001). In green fluorescent protein on the fractalkine receptor-positive mice, intravesical acetic acid injection resulted in an increased number of microglia cells in the L6-S1 dorsal horn of the spinal cord (P < 0.0001). NK1 receptor and MAPK-p38 levels were increased in the spinal cord up to 7 d after injection (P = 0.007 and 0.023 respectively). Colorectal sensitization was prevented by intrathecal or intracerebroventricular injections of minocycline, a microglia inhibitor, by intracerebroventricular injection of CP-99994 dihydrochloride, a NK1 antagonist, and by intracerebroventricular injection of SB203580, a MAPK-p38 inhibitor.
CONCLUSION We describe a new model of cross-organ visceral sensitization between the bladder and the colon in mice. Intravesical injections of acetic acid induced a long-lasting colorectal hypersensitivity to distension, mediated by neuroglial interactions, MAPK-p38 phosphorylation and the NK1 receptor.
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Affiliation(s)
- Karim Atmani
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
| | - Fabien Wuestenberghs
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Department of Gastroenterology and Hepatology, Université Catholique de Louvain, CHU UCL Namur, Yvoir 5530, Belgium
- Department of Physiology, CHU Rouen, Université de Rouen Normandie, Rouen 76031, France
| | - Maximilien Baron
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Department of Urology, CHU Rouen, Université de Rouen Normandie, Rouen 76000, France
| | - Illona Bouleté
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
| | - Charlène Guérin
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
| | - Wafa Bahlouli
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
| | - David Vaudry
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Inserm, UMR 1245, Team Epigenetics and Pathophysiology of Neuro-developmental Disorders, Université de Rouen Normandie, Rouen 76000, France
| | - Jean Claude do Rego
- Behavioural Analysis Platform (SCAC), HeRacLeS Inserm US51-CNRS UAR2026, Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
| | - Jean-Nicolas Cornu
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Department of Urology, CHU Rouen, Université de Rouen Normandie, Rouen 76000, France
| | - Anne-Marie Leroi
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Department of Physiology, CHU Rouen, Université de Rouen Normandie, Rouen 76031, France
| | - Moïse Coëffier
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Department of Nutrition, CHU Rouen, Université de Rouen Normandie, Rouen 76000, France
| | - Mathieu Meleine
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Inserm U1107, NeuroDol, Clermont Auvergne University, Clermont-Ferrand 63000, France
| | - Guillaume Gourcerol
- Nutrition, Gut and Brain Unit (Inserm U1073), Institute for Research and Innovation in Biomedicine, Université de Rouen Normandie, Rouen 76000, France
- Department of Physiology, CHU Rouen, Université de Rouen Normandie, Rouen 76031, France
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Wuestenberghs F, Baron M, Melchior C, Desprez C, Cornu JN, Leroi AM, Gourcerol G. Overlaps with bladder pain syndrome and irritable bowel syndrome are associated with higher symptom burden and reduced quality of life in functional dyspepsia. Neurogastroenterol Motil 2022; 34:e14414. [PMID: 35608061 DOI: 10.1111/nmo.14414] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Functional dyspepsia and bladder pain syndrome are well-known to overlap with irritable bowel syndrome. Whether functional dyspepsia overlaps with bladder pain syndrome remains unknown. Our aim was to evaluate the presence of bladder pain syndrome in functional dyspepsia patients and its impact. METHODS All consecutive patients with investigated dyspeptic symptoms in our tertiary care center between March 2015 and November 2018 were studied. Functional dyspepsia and irritable bowel syndrome were diagnosed according to Rome III and IV criteria while bladder pain syndrome was diagnosed using ESSIC criteria. Validated questionnaires were filled to assess quality of life (GIQLI), anxiety and depression (HADS), sleep (PSQI), and insomnia (ISI). Dyspeptic symptoms severity was assessed individually for eight dyspeptic complaints. KEY RESULTS Among 1453 patients with dyspeptic symptoms, 61.4% fulfilled Rome criteria for functional dyspepsia. Bladder pain syndrome was present in 16.0% of the patients not fulfilling diagnostic criteria for functional dyspepsia, 22.2% of patients with functional dyspepsia alone, and 36.4% of patients with overlapping functional dyspepsia and irritable bowel syndrome (p-values <0.0001). In patients with bladder pain syndrome overlapping with functional dyspepsia, dyspeptic symptoms severity, anxiety, depression, and insomnia levels were higher while quality of life and sleep quality were reduced (p-values <0.0001). These results were even more pronounced in case of overlap with irritable bowel syndrome (p-values <0.0001). CONCLUSIONS AND INFERENCES Bladder pain syndrome is present in 26.9% of functional dyspepsia patients and is associated with higher gastrointestinal, psychological distresses, and sleep symptom burdens, and with reduced quality of life.
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Affiliation(s)
- Fabien Wuestenberghs
- Department of Physiology, INSERM Unit 1073, Rouen University Hospital, UNIROUEN, Normandie University, Rouen, France.,Department of Gastroenterology and Hepatology, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Maximilien Baron
- Department of Urology, Rouen University Hospital, UNIROUEN, Normandie University, Rouen, France
| | - Chloé Melchior
- Department of Gastroenterology, INSERM Unit 1073, INSERM CIC-CRB 1404, Rouen University Hospital, UNIROUEN, Normandie University, Rouen, France.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte Desprez
- Department of Physiology, INSERM Unit 1073, Rouen University Hospital, UNIROUEN, Normandie University, Rouen, France
| | - Jean-Nicolas Cornu
- Department of Urology, Rouen University Hospital, UNIROUEN, Normandie University, Rouen, France
| | - Anne-Marie Leroi
- Department of Physiology, INSERM CIC-CRB 1404, Rouen University Hospital, UNIROUEN, Normandie University, Rouen, France
| | - Guillaume Gourcerol
- Department of Physiology, INSERM Unit 1073, Rouen University Hospital, UNIROUEN, Normandie University, Rouen, France
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Lafont C, Paillaud E, Bertolus C, Baron M, Caillet P, Bouvard E, Laurent M, Salvan D, Chaumette L, De Decker Lemarcis L, Piot B, Barry B, Raynaud-Simon A, Sauvaget E, Minard A, Anota A, Panjo H, Brugel L, Canouï-Poitrine F. 657MO Effectiveness of geriatric assessment-driven interventions on quality of life for 2 years in older patients with head and neck cancer: Results from the EGeSOR trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.781] [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: 11/01/2022] Open
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Cornu JN, Auble A, Degremont S, Baron M, Roman H, Pfister C, Grise P. Sacral neuromodulation for management of severe bladder dysfunction due to endometriosis: experience from a tertiary reference center. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)00779-0] [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: 10/16/2022] Open
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Chkir S, Michel F, Akakpo W, Chinier E, Capon G, Peyronnet B, Saussine C, Baron M, Biardeau X, Ruffion A, Gamé X, Denys P, Chartier-Kastler E, Phé V, Karsenty G. Non-continent urinary diversion (ileal conduit) as salvage therapy in patients with refractory lower urinary tract dysfunctions due to multiple sclerosis: results of a national cohort from the French Association of Urology (AFU) Neurourology Committee and the French-speaking Neurourology Study Group (GENULF). Urology 2022; 168:216-221. [PMID: 35768028 DOI: 10.1016/j.urology.2022.06.014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe the outcomes of ileal conduit as a salvage therapy for refractory lower urinary tract dysfunctions (LUTDs) due to multiple sclerosis (MS) in a national neurourology referral center network. METHODS A retrospective multicenter French study was carried out to identify MS patients who underwent non-continent urinary diversion for refractory LUTDs from January 2010 to December 2015. Multiple sclerosis status, urological history, surgical indication and technique, postoperative complications, renal anatomy and function at last follow-up as well as number of rehospitalizations for urinary tract infections (UTI) were collected. Preoperative and postoperative urinary-related quality of life (urQoL) through the QualiveenTM short-form questionnaire (QSFTM) and patient global impression of improvement (PGI-I) were collected and analyzed. RESULTS Overall, 10 centers identified 211 patients with a mean age of 54±11 and mean preoperative EDSS (expanded disability status scale) score of 7.3±0.9. The main indication for diversion was MS progression leading to impossible intermittent self-catheterization (55%). Cystectomy was performed either by open (34.6%), laparoscopic (39.3%) or robotic (21.8%) approach (unknown: 4.2%) with cystectomy in all cases. Early complications were reported in 42% of the patients, mainly Clavien I or II grades. There was no difference in GFR (glomerular filtration rate) after surgery. After diversion, patients had fewer hospitalizations for UTI and better urQoL on QSF™ confirmed by evaluation of PGI-I. CONCLUSION This study, reporting the largest series of ileal conduit in selected MS patients with end-stage LUTDs, showed significant improvement in symptomatic UTI and quality of life with a low high-grade complication rate.
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Affiliation(s)
- Sadok Chkir
- Urology and Kidney Transplantation, Aix-Marseille University, La Conception Univeristy Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | - Floriane Michel
- Urology and Kidney Transplantation, Aix-Marseille University, La Conception Univeristy Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | - William Akakpo
- Urology, Sorbonne University, Hôpital La pitié Salpétrière, Assistance-Publique Hôpitaux de Paris, Paris, France.
| | - Eva Chinier
- Neuro-Rehabilitation, University of Nantes, Hôpital Saint Jacques, Nantes, France.
| | - Gregoire Capon
- Urology, University of Bordeaux, Hôpital Pellegrin, Bordeaux France.
| | - Benoit Peyronnet
- Urology, University of Rennes, Hôpital Pontchaillou, Renne, France.
| | - Christian Saussine
- Urology, University of Strasbourg, Hôpital Hautepierre, Strasbourg, France.
| | | | | | - Alain Ruffion
- Urology, University Claude Bernard Lyon 1, Hôpital Lyon Sud, HCL, Pierre Bénite, France.
| | - Xavier Gamé
- Urology, University of Toulouse Purpan, Hôpital Rangueil, Toulouse, France.
| | - Pierre Denys
- Urology, Paris Saclay University, neuro-urology unit, Hôpital Raymond Poincaré, AP-HP, Garches, France.
| | - Emmanuel Chartier-Kastler
- Urology, Sorbonne University, Hôpital La pitié Salpétrière, Assistance-Publique Hôpitaux de Paris, Paris, France; Urology, Paris Saclay University, neuro-urology unit, Hôpital Raymond Poincaré, AP-HP, Garches, France.
| | - Véronique Phé
- Urology, Sorbonne University, Tenon Academic Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
| | - Gilles Karsenty
- Urology and Kidney Transplantation, Aix-Marseille University, La Conception Univeristy Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
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Nevskaya T, Martin Calderon L, Baron M, Pope J. POS0913 INCREASED HEALTH CARE UTILIZATION IN SYSTEMIC SCLEROSIS PATIENTS WHO HAVE DIGITAL ULCERS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundSystemic sclerosis is a multi-system autoimmune disease characterized by fibrosis of the skin and internal organs, and vasculopathy which manifests as pulmonary arterial hypertension and digital ulcers. Digital ulcers are debilitating and painful lesions most commonly present in the digit tips or extensor surfaces of the hands leading to significant morbidity and decreased quality of life. SSc patients with digital ulcers may require increased support and therefore may have greater healthcare resource utilization compared to those patients without digital ulcers.ObjectivesWe assessed the impact of DUs on resource utilization including hospitalizations, outpatient visits and procedures within a large SSc Canadian registry.MethodsA cohort of patients with SSc and digitals ulcers was derived from the Canadian Scleroderma Research Group registry and matched to controls individually based on sex, age (±3 years), SSc subtype, and disease duration (±2 years). Eligible patients met the 2013 ACR/EULAR criteria (confirmed by an experienced rheumatologist), were 18 years of age, had completed the Resource Utilization Questionnaire (RUQ), and had active digital ulcers at two consecutive annual visits (baseline study visit and at 1st year). The Medgser Disease Severity Scale was used to assess ulcer disease severity. Unadjusted and adjusted regression analyses compared the association between DUs and resource utilization.ResultsRUQs in 104 SSc patients with active DUs at two consecutive annual visits were compared with 104 patients without DUs matched 1:1 for age, sex, disease subtype and duration. Over one year, DUs were associated with a higher number of tests (p˂0.05) and visits to health professionals, especially to a rheumatologist (p˂0.0001) and internist (p=0.003), a greater need for an accompanying person (p˂0.05) and aids purchased/received (p˂0.05). Having DUs was associated with more severe disease, even after excluding the peripheral vascular domain from a total DSS (9.7±4.5 vs 5.6±2.7, p˂0.0001). After adjustment for disease severity in other organs, the presence of DUs remained a significant predictor of more frequent physician visits and more tests (all˂0.05) by linear regression analysis.ConclusionSSc patients with DUs utilized significantly more healthcare resources per annum even after adjustment for disease severity in other organ systems.References[1]Khimdas S, Harding S, Bonner A, Zummer B, Baron M, Pope J, Canadian Scleroderma Research Group. Associations with digital ulcers in a large cohort of systemic sclerosis: results from the Canadian Scleroderma Research Group registry. Arthritis care & research. 2011 Jan;63(1):142-9.[2]Nihtyanova SI, Brough GM, Black CM, Denton CP. Clinical burden of digital vasculopathy in limited and diffuse cutaneous systemic sclerosis. Annals of the rheumatic diseases. 2008 Jan 1;67(1):120-3.Disclosure of InterestsNone declared
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Campochiaro C, Suliman YA, Hughes M, Schoones J, Giuggioli D, Moinzadeh P, Maltez N, Ross L, Baron M, Chung L, Allanore Y, Denton CP, Distler O, Frech T, Furst D, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. POS0888 NON-SURGICAL LOCAL TREATMENTS FOR DIGITAL ULCERS IN SYSTEMIC SCLEROSIS: A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundDigital ulcers(DUs) in systemic sclerosis(SSc) represent a major clinical challenge. There are no recommendations for the local management of SSc-DUs. Systemic therapy is considered the standard of care. However, there is a strong rationale for local approaches to DU by avoiding side effects from systemic therapies. The World Scleroderma Foundation DU Working Group intends to develop evidence-based recommendations for DU management including local, non-surgical treatment(ln-sT).ObjectivesTo summarise the literature on the safety and efficacy of ln-sT for SSc-DUs.MethodsA systematic literature review(SLR) of papers describing the use of ln-sT for DU in SSc was performed up to May 2021 according to the PICO framework. References were independently screened by two reviewers who independently assessed the full text of eligible articles and extracted data.ResultsAmong 790 retrieved references, 12 were included. Median(range) number of patients per study was 9(7–84), mean age ranging from 37 to 62.5 years. In 5(41%) studies a control group was included. Background systemic therapies are summarized in Table 1. The most studied treatment was botulin toxin A(BTA). It was used as hand injection in 3 studies (median dose ranging from 90 to 150 U) and as 50 U single finger injection in 1 study. Healing rate after a median time of 8-49 weeks ranged from 71% to 100%. In 2 studies a reduction in VAS pain was observed from 20% to 100%. Transient muscle weakness was the most common side effect in 10% of patients. Amniotic(Am) and hydrocolloid membranes(HyM) were used in 1 study each. They were associated with a good healing rate, statistically significant for the HyM. Tadalafil 2% cream was studied in 1 study and was associated with a reduction in the median DU number from 1.6 to 1 per patient after a median time of 4 weeks and a reduction by 1.4 point in the 10-mm VAS scale. Vitamin E gel was shown to be associated with a statistically significant reduction in the healing time compared to SoC alone in 1 RCT(13.2 ± 2.7 versus 20.9 ± 3.6 weeks, P=<0.001). Low-level light therapy, hydrodissection and corticosteroid injection and extracorporeal shock wave(ESW) were evaluated in 1 study each. They were all associated with positive outcomes which was statistically significant only for the ESW. The only negative trial examined dimethyl sulfoxide and was associated with local toxicity.Table 1.Characteristics of the studies.TreatmentType of studyPatientsBaseline DUBackground therapy (%) ETA CCB APA PG ARB ACE-I PDE-5i ISFollow-up (weeks)Healing rate(%)*Pain Reduction (VAS/10)ComparatorHydrodissection and corticosteroid injectionP1202334.4Rheumatoid ArthritisTadalafil 2% Vitamin E gelRRCT15131.6(1)3.5±2.30462700130704 241(1)Reduced time to heal**1.4SoCAmHyMRP67310001002800002817033143810090**SoCBTAMedian 90 U per handHigh-concentration hand100 U non-dominant handSingle finger 50 URRPP772010314571140718558551008514201001414718 4981277717510020%100%Untreated CHLow-level light therapyP8102537025378100ESWP9493355661144441**1.31Dimethyl sulfoxideDBRCT84No change, skin toxicity with 70% formulation*Unless otherwise stated. **Statistically significant. ARB= angiotensin receptor antagonist. ACEi= ACE inhibitors. APA= anti-platelet agents. CCB= calcium channel blockers. CH= contralateral hand. DBRCT= double blind randomized-controlled trial. ETA = endothelin antagonist. IS= immunosuppression. PG= prostaglandins. PDE-5i= Phosphodiesterase type-5 inhibitors. P = prospective. R = retrospective. SoC= standard of care (as per local protocol).ConclusionOur SLR supports interest to develop ln-sTs for SSc-DUs. The number of studies is limited and mainly case reports and small single studies are present. Treatments were well tolerated and there was evidence of efficacy for BTA, vitamin E, ESW and HyM in refractory DUs. The evidence is not robust and confounding factors (vasodilators background therapies) could impact on the findings. Future research is indicated to conduct larger, well-designed studies.Disclosure of InterestsCorrado Campochiaro: None declared, Yossra A. Suliman: None declared, Michael Hughes Speakers bureau: Actelion pharmaceuticals, Eli Lilly, and Pfizer, outside of the submitted work., Jan Schoones: None declared, Dilia Giuggioli: None declared, Pia Moinzadeh Speakers bureau: speaking fees from Actelion pharmaceuticals and Boehringer Ingelheim, Nancy Maltez: None declared, Laura Ross: None declared, Murray Baron: None declared, Lorinda Chung: None declared, Yannick Allanore: None declared, Christopher P Denton: None declared, Oliver Distler Speakers bureau: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur, Tracy Frech: None declared, Daniel Furst: None declared, Dinesh Khanna Speakers bureau: Janssen and Eicos Sciences, Inc., Thomas Krieg: None declared, Masataka Kuwana Speakers bureau: Speakers fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and Consultant fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida, outside of the submitted work., Marco Matucci-Cerinic: None declared, Janet Pope: None declared, Alessia Alunno: None declared
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Suliman YA, Campochiaro C, Hughes M, Schoones J, Giuggioli D, Maltez N, Moinzadeh P, Ross L, Chung L, Allanore Y, Baron M, Denton CP, Distler O, Frech T, Furst D, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. POS0898 SURGICAL MANAGEMENT OF DIGITAL ULCERS IN SYSTEMIC SCLEROSIS: A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundManagement of digital ulcers (DUs) in systemic sclerosis (SSc) is a major clinical challenge. To date, systemic therapy is generally considered as the ‘standard of care’ for significant SSc-DUs. However, there is a strong rationale to develop local approaches to DUs, to avoid side effects from systemic therapies. World Scleroderma Foundation DU Working Group intends to develop practical, evidence-based recommendations for DU management including local, Surgical Treatment (L-ST).ObjectivesTo summarize the literature on the safety and efficacy of L-ST for SSc-DUs.MethodsA systematic literature review (SLR) was conducted up to May 2021. According to the PICO framework, eligibility criteria were defined and original research articles about surgical treatment of SSc DUs in adult patients were included. References were independently screened by 2 reviewers who assessed the full text of eligible articles and extracted data.ResultsThirteen eligible articles out of 790 total publications were identified (Table 1). Due to the paucity of randomized controlled trials of surgical treatments for SSc-DU, we included retrospective studies and case series with at least 4 patients. Autologous fat (adipose tissue AT) grafting was the surgical modality mostly identified (7 studies of which 1 RCT and 6 prospective open label single arm). The healing rate (HR) with autologous fat grafting (4 studies) ranged from 66-100 %. In the RCT, two age and sex matched groups were included, adipose tissue (AT)group (n=25 pts) and sham procedure (SP) group (n=13), DU healing was reported in 23/25 in AT group versus 1/13 in the SP group in 8 wks, (p<0.0001), 12 pts in the SP group, received rescue AT injection, all of them healed after 8 wks. Three studies reported autologous adipose-derived stromal vascular fraction(SVF) grafting and the HR ranged from 32-60%, followed up to 12 months. Transient edema and paresthesia were reported in 2 studies, and amputation in 2 ulcers in 1 study, and no complications were reported in other studies. Surgical sympathectomy was reported in 3 studies, with a median healing rate of 81%. Bone marrow derived cell transplantation in a single study showed 87% healing rate over (4-24 wks). Two surgical studies (of direct microsurgical revascularization N=4, and microsurgical arteriolysis, N=6), showed 100% healing of ulcers, no complications reported.Table 1.Characteristics of the extracted studies.StudydesignPatients (n)Baseline DU (n)Background therapy (%)Follow-upOutcomeHealed ulcers(%) Adipose tissue graftAutologous fat graftp9.15PG, CCB—100ETA 26PDE-5i 138-12 wks66Adipose tissue graftingRCT25 case13- Ctr25-case13- CtrPG- 100CCB 1008 wks92-case7-CtrAdipose tissue implantp1515no therapy7 wks100Adipose tissue graftp129PG,CCB-100ETA6 month88adipose derived SVFp1215PDE-5i, ccb, PG allowed22m6Adipose derived SVFp1215CCB 50ETA166 m63 Adipose derived SVFp1819CCB 50PG 27ETA 5IS 7124 wks32SympathectomySympathectomyR611CCB-10020 m81SympathectomyR1335PGCCBAPA35Sympathectomy, vascular bypass (+vein graftR1726Ccb 35APA 47PDE-i5 589 m100Bone marrow derived cells transplantation)p88PG-6236 m87Direct microsurgical revascularizationR44m100Limited microsurgical arteriolysisR61712 m100SVF =stromal vascular fraction P = prospective. R = retrospective. RCT= double blind randomized-controlled trial. ETA = endothelin antagonist. CCB= calcium channel blockers. APA= anti-platelet agents. PG= prostaglandins. ARB= angiotensin receptor antagonist. ACEi= ACE inhibitors. PDE-5i= PDE-5 inhibitors. IS= immunosuppression. M=median. SoC= standard of care. HR= healing rateConclusionOur SLR has identified several surgical modalities for SSc-DUs. L-STseemed generally effective and safe for DU healing, thus Significant methodological issues emerged including small numbers of pts, lack of comparator, failure to report confounders such as background therapies and variable follow up. Future research is warranted to rigorously investigate surgical interventions for Dus.Disclosure of InterestsYossra A. Suliman: None declared, Corrado Campochiaro: None declared, Michael Hughes Speakers bureau: speaking fees from Actelion pharmaceuticals, Eli Lilly, and Pfizer, outside of the submitted work, Jan Schoones: None declared, Dilia Giuggioli: None declared, Nancy Maltez: None declared, Pia Moinzadeh Speakers bureau:: speaking fees from Actelion pharmaceuticals and Boehringer Ingelheim, Laura Ross: None declared, Lorinda Chung: None declared, Yannick Allanore: None declared, Murray Baron: None declared, Christopher P Denton: None declared, Oliver Distler Shareholder of: Consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Speakers bureau: Consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Consultant of: Consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Grant/research support from: Consultancy relationship with and/or has received research funding from and/or has served as a speaker for the following companies in the area of potential treatments for systemic sclerosis and its complications in the last three calendar years: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur. Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143)., Tracy Frech: None declared, Daniel Furst: None declared, Dinesh Khanna Speakers bureau: Janssen and Eicos Sciences, Inc., Paid instructor for: Janssen and Eicos Sciences, Inc., Consultant of: Janssen and Eicos Sciences, Inc., Thomas Krieg: None declared, Masataka KUWANA Speakers bureau: Speakers fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and Consultant fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida, outside of the submitted work., Paid instructor for: Speakers fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and Consultant fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida, outside of the submitted work., Consultant of: Speakers fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and Consultant fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida, outside of the submitted work., Marco Matucci-Cerinic: None declared, Janet Pope: None declared, Alessia Alunno: None declared
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Maltez N, Ross L, Hughes M, Schoones J, Baron M, Chung L, Campochiaro C, Suliman YA, Giuggioli D, Moinzadeh P, Allanore Y, Denton CP, Distler O, Frech T, Furst D, Khanna D, Krieg T, Kuwana M, Matucci-Cerinic M, Pope J, Alunno A. POS0900 SYSTEMIC PHARMACOLOGICAL TREATMENT OF DIGITAL ULCERS IN SYSTEMIC SCLEROSIS: A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundDigital ulcers (DU) are common in systemic sclerosis (SSc) and associated with reduced survival, high morbidity and poor quality of life. Recommendations have previously been proposed for DU management yet there remains significant unmet patient need. Therefore the World Scleroderma Foundation DU Working Group intends to develop practical evidence based recommendations for DU management.ObjectivesTo summarise data on efficacy and safety of systemic treatments for SSc DU.MethodsA systematic literature review to May 2021 was performed. PubMed, MEDLINE, Embase, Web of Science, Cochrane Library, Emcare (OVID) and Academic Search Premier databases were searched for original studies on adult patients with SSc DU treated with systemic pharmacological treatment. Based on the PICO framework, eligibility criteria were defined and references were independently screened by two reviewers. Reviewers independently assessed the full text of eligible articles. Owing to interstudy heterogeneity narrative summaries were used to present data.ResultsThe search strategy identified 1271 references of which 45 eligible articles were included. Seventeen studies were randomised placebo controlled trials (RCT) pertaining to PDE5 antagonists (PDE5i) (n=3), endothelin receptor antagonists (ERA) (n=3), prostanoids (n=7), antiplatelet agents (n=1) and other (n=3) (Table 1). No head to head RCT was retrieved. All other studies were observational studies (OBS). Studies were highly heterogeneous with application of differing definition of DU, variable study eligibility criteria, clinical endpoints and follow up periods. This limited the calculation of effect size and comparison across studies.Table 1.Characteristics of placebo controlled randomised controlled trialsAuthor YearInterventionnFollow upOutcomeFavours interventionHachulla 2016Sildenafil8312 weeksTime to DU healing-Andrigueti 2017Sildenafil4112 weeksDU healing+Shenoy 2010Tadalafil246 weeksNew DU+Khanna 2016Macitentan55416 weeksNew DU-Matucci-Cerinic 2011Bosentan18832 weeksNew DU Time to healing of DU+-Korn 2004Bosentan12212 weeksNew DU+Kawald 2008IV iloprost5012 monthsDU healing-Wigley 1992IV iloprost3510 weeksDU healing+Wigley 1994IV iloprost739 weeks50% reduction in DU score-Seibold 2017Treprostinil14820 weeksNet DU burden-Vayssairat 1999Beraprost10725 weeks% patients with new DU-Denton 2017Selexipag7412 weeksNumber of new DU DU healing-Lau 1993Cicaprost334 weeksNumber of DU-Abou-Raya 2008Atorvastatin844 monthsNumber of DU+Au 2010Cyclophosphamide15812 monthsNumber of patients with DU-Beckett 1984Dipyridamole / aspirin412 yearsChange in general SSc-Nagaraja 2019Riociguat1732 weeksNet DU burden-+ significantly superior to comparator- non significantly different from comparatorDU: digital ulcers IV: intravenous SSc: systemic sclerosisSeveral RCT found improved DU healing with treatment: two with PDE5i, one with iloprost and one showed improved DU healing and prevention with atorvastatin. Two RCT demonstrated effective prevention of new DU with bosentan. OBS studies with a total of 621 patients showed variable improvements in the healing of DU with CCB, PDE5i, ERA, statins, N-acetylcysteine, prostanoids and ketanserin and prevention of new DU with ERA.Regarding safety, all treatments were generally tolerated with few serious adverse events. Treatment was ceased in 6.25-17.5% of patients in RCT due to treatment related side effects.ConclusionDespite several studies assessing the efficacy and safety of systemic pharmacological treatment of SSc DU, it is not possible to draw solid conclusions due to study heterogeneity. Small RCT have shown treatment benefit with PDE5i, iloprost and atorvastatin. Large studies demonstrated effective prevention of new DU with bosentan. Our results highlight the urgent need for improved clinical trial design to generate more robust evidence and novel therapies to guide the management SSc DU.AcknowledgementsThis work was supported by the World Scleroderma Foundation.Disclosure of InterestsNancy Maltez: None declared, Laura Ross: None declared, Michael Hughes Speakers bureau: Actelion Pharmaceuticals, Eli Lilly and Pfizer outside of the submitted work., Jan Schoones: None declared, Murray Baron: None declared, Lorinda Chung Consultant of: Eicos, Corrado Campochiaro: None declared, Yossra A. Suliman: None declared, Dilia Giuggioli: None declared, Pia Moinzadeh Speakers bureau: Actelion Pharmaceuticals, Boehringer Ingelheim, Yannick Allanore: None declared, Christopher P Denton: None declared, Oliver Distler Speakers bureau: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur., Consultant of: Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur., Grant/research support from: Patent issued “mir-29 for the treatment of systemic sclerosis” (US8247389, EP2331143), Abbvie, Acceleron, Alcimed, Amgen, AnaMar, Arxx, AstraZeneca, Baecon, Blade, Bayer, Boehringer Ingelheim, Corbus, CSL Behring, Galapagos, Glenmark, Horizon, Inventiva, Kymera, Lupin, Medscape, Miltenyi Biotec, Mitsubishi Tanabe, MSD, Novartis, Prometheus, Roivant, Sanofi and Topadur., Tracy Frech: None declared, Daniel Furst: None declared, Dinesh Khanna Consultant of: Eicos Sciences Inc, Janssen, Thomas Krieg: None declared, Masataka Kuwana Speakers bureau: Speaker fees from AbbVie, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai, Eisai, GlaxoSmithKline, Janssen, Nippon Shinyaku, Ono Pharmaceuticals, Tanabe-Mitsubishi, and consultancy fees from AstraZeneca, Boehringer Ingelheim, Corbus, Kissei, Mochida outside of the submitted work., Marco Matucci-Cerinic: None declared, Janet Pope: None declared, Alessia Alunno: None declared
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Guillot-Tantay C, Robert G, Ruffion A, Gamé X, Balanca A, Cousin T, Campello PV, Simon J, Baron M, Fleury R, Dequirez PL, Davidson S, Joussain C, Vangheluwe L, Anastay V, Léon P, Perrouin-Verbe MA, Peyronnet B, Biardeau X, Cornu JN, Karsenty G, Phé V. Impact of COVID-19 pandemic on functional urology procedures in France: a prospective study. World J Urol 2021; 40:277-282. [PMID: 34476595 PMCID: PMC8412852 DOI: 10.1007/s00345-021-03821-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To evaluate the impact of COVID-19 pandemic on functional urology procedures in France. Methods A prospective study was conducted within 11 secondary and tertiary referral centers in France. Patients aged > 18 years who were diagnosed with a functional urology disease before the national lockdown (March 17th, 2020) and who required a surgery were included. Study period went from March 17th to September 30th 2020. The included interventions were listed according to the guidelines for functional urology enacted by the French Association of Urology and delay of reoperation was compared to the guidelines’ delay. The primary outcome was the number of procedures left unscheduled at the end of the study period. Descriptive statistics were performed. Results From March 17th 2020 to September 3 rd 2020, 1246 patients with a previous diagnosis of a functional urological disease requiring a surgery were included. The mean follow-up was 140.4 days (± 53.4). Overall, 316 interventions (25.4%) were maintained whereas 74 (5.9%) were canceled, 848 (68.1%) postponed and 8 patients (0.6%) died. At the end of the follow-up, 184 patients (21.7%) were still not rescheduled. If the intervention was postponed, the mean delay between the initial and final date was 85.7 days (± 64.4). Conclusion Overall, more than two thirds of interventions had to be postponed and the mean delay between the initial and final date was about three months.
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Affiliation(s)
- Cyrille Guillot-Tantay
- Department of Urology, Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Academic Hospital, 47-83 boulevard de l'hôpital, 75013, Paris, France
| | - Grégoire Robert
- Department of Urology, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | - Xavier Gamé
- Department of Urology, Centre Hospitalier Universitaire de Rangueil, Toulouse, France
| | - Astrid Balanca
- Department of Neuro-Urology, Assistance-Publique-Hôpitaux de Paris (AP-HP), Raymond Poincaré Academic Hospital, Garches, France
| | - Tiffany Cousin
- Department of Urology, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | | | - Jeanne Simon
- Department of Urology, Centre Hospitalier Universitaire de Rangueil, Toulouse, France
| | - Maximilien Baron
- Department of Urology, Nantes Academic Hospital, Hôtel Dieu, Nantes, France
| | - Raphael Fleury
- Centre Hospitalier Universitaire de Rennes, Service d'urologie, Rennes, France
| | - Pierre-Luc Dequirez
- Department of Urology, Lille Academic Hospital, Claude Huriez Hospital, Lille, France
| | - Sypre Davidson
- Department of Urology, Lille Academic Hospital, Claude Huriez Hospital, Lille, France
| | - Charles Joussain
- Department of Neuro-Urology, Assistance-Publique-Hôpitaux de Paris (AP-HP), Raymond Poincaré Academic Hospital, Garches, France
| | - Lucie Vangheluwe
- Department of Urology, Centre Hospitalier Universitaire Rouen, Rouen, France
| | - Vassily Anastay
- Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Hospital, Marseille, France
| | | | | | - Benoit Peyronnet
- Centre Hospitalier Universitaire de Rennes, Service d'urologie, Rennes, France
| | - Xavier Biardeau
- Department of Urology, Lille Academic Hospital, Claude Huriez Hospital, Lille, France
| | - Jean-Nicolas Cornu
- Department of Urology, Centre Hospitalier Universitaire Rouen, Rouen, France
| | - Gilles Karsenty
- Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Hospital, Marseille, France
| | - Véronique Phé
- Department of urology, Sorbonne Université, Assistance Publique - Hôpitaux de Paris, Tenon Academic Hospital, Paris, France.
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Wortman B, Post C, Powell M, Khaw P, Fyles A, D’Amico R, Haie-Meder C, Jurgenliemk-Schulz I, McCormack M, Do V, Katsaros D, Bessette P, Baron M, Nout R, Whitmarsh K, Mileshkin L, Lutgens L, Kitchener H, Brooks S, Nijman H, Astreinidou E, Putter H, Creutzberg C, de Boer S. OC-0298 Toxicity and patient-reported symptoms after 3D-conformal or intensity-modulated pelvic radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06845-6] [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: 10/20/2022]
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Martin Calderon L, Baron M, Pope J. AB0419 ACCESS TO TREATMENT FOR RAYNAUD’S PHENOMENON AND DIGITAL ULCERS FOR PATIENTS WITH SYSTEMIC SCLEROSIS DOESN’T FOLLOW EULAR/EUSTAR GUIDELINES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Patients with Raynaud’s Phenomenon (RP) from systemic sclerosis (SSc) may experience severe complications. Digital ulcers (DUs), occur in approximately half the patients with SSc, and cause hand dysfunction, severe pain, and decreased quality of life. DUs lead to increased healthcare utilization and systemic economic burden through hospitalizations, ED visits, and ambulatory services (1). However, access to medications such as PDE5 inhibitors and prostacyclins that are within the EULAR/EUSTAR SSc guidelines (2) in a country with global health care but patchy pharmacare such as Canada has not been studied.Objectives:The purpose of this study was to elucidate the access to treatment of medications for RP and DU in patients with SSc in Canadian provinces through identifying the provincial and private insurance coverage of PDE5 inhibitors (PDE5i) and prostanoids, the timelines and procedures of requesting these medications, and the process of administering IV prostanoids if required for patient care.Methods:We designed an online survey and collected data through the Survey Monkey platform. The survey was administered to rheumatologists affiliated with the Canadian Scleroderma Research Group (CSRG) from December 2020 to January 2021. Responders were asked to report if the province or private insurance automatically provided PDE5i for patients with RP and DU or if a dedicated process was required to attain these medications. Additionally, responders were asked to describe the process of administering Iloprost, Epoprostenol and Alprostadil and the barriers inherent to their administration. Of note, there is no DIN number for Iloprost in Canada so every time it is used there must be an application to Health Canada.Results:The survey was completed by 100% of CSRG researchers (17/17), representing 8 provinces in Canada. None of the provincial governments provided coverage for PDE5i without special requests that were adjudicated on a case by case basis with approximately half the provinces paying for PDE5i upon special request if a patient was eligible for provincial drug insurance (ex elderly, youths, low income families). Two provinces, Quebec and Saskatchewan, provided PDE5i “all the time”. Whereas NS, MB, ON, BC, and AB provided them “sometimes”; NFLD provided them “never”. Provincial governments and private insurance fulfilled requests “within 1 month” 62% of the time and the other requests took longer to be answered. Private insurance approved coverage with special request in AB, MB, QC, ON, and NS. Respondents described administration of IV prostanoids as “inconsistent”, requiring “a lot of work”, and that patients in most jurisdictions be admitted as in-patients for provinces to cover these medications.Conclusion:Most jurisdiction within Canada do not provide coverage for PDE5i and the process to obtain access for patients is delayed, non-uniform, and often not approved. Intravenous prostanoid infusions are difficult to obtain and have system barriers. Advocacy and cost effectiveness data should be used to advocate for access to medications that are recommended within SSc recommendations.References:[1]Morrisroe K, et al. Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden. Arthritis research & therapy. 2019 Dec;21(1):1-2.[2]Kowal-Bielecka O, et al. Update of EULAR recommendations for the treatment of systemic sclerosis. Annals of the rheumatic diseases. 2017 Aug 1;76(8):1327-39.Disclosure of Interests:None declared
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Bérubé A, Clément MÈ, Lafantaisie V, LeBlanc A, Baron M, Picher G, Turgeon J, Ruiz-Casares M, Lacharité C. How societal responses to COVID-19 could contribute to child neglect. Child Abuse Negl 2021; 116:104761. [PMID: 33077248 PMCID: PMC7561330 DOI: 10.1016/j.chiabu.2020.104761] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND The ecosystemic approach to children's needs demands a cohesive response from societies, communities, and families. During the COVID-19 pandemic, the choices societies made to protect their community members from the virus could have created contexts of child neglect. With the closure of services and institutions, societies were no longer available to help meet the needs of children. OBJECTIVE The purpose of this study is to examine parents' reports on the response their children received to their needs during the COVID-19 crisis. METHODS During the period of the spring 2020 lockdown, 414 parents in the province of Quebec, Canada, completed an online questionnaire about the impact of the crisis on the response their children received to their needs. RESULTS Compared to parents of younger children, parents of older children reported less fulfillment of their child's needs in three measured domains, namely cognitive and affective, security, and basic care needs. CONCLUSION These results are discussed in light of the policies and the resources societies have put in place during the crisis to help families meet the needs of their children. Societies must learn from this crisis to put children at the top of their priorities in the face of a societal crisis. Thoughtful discussions and energy must be given to ensure that, while facing a crisis, the developmental trajectories of children are not sacrificed.
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Affiliation(s)
- A Bérubé
- Université du Québec en Outaouais, 283 Boul Alexandre-Taché, Gatineau, J8X 3X7, Canada.
| | - M-È Clément
- Université du Québec en Outaouais, 283 Boul Alexandre-Taché, Gatineau, J8X 3X7, Canada
| | - V Lafantaisie
- Université du Québec en Outaouais, 283 Boul Alexandre-Taché, Gatineau, J8X 3X7, Canada
| | - A LeBlanc
- Université Laval, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada; VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center (CIUSSS de la Capitale Nationale), Canada
| | - M Baron
- VITAM Research Center on Sustainable Health, Quebec Integrated University Health and Social Services Center (CIUSSS de la Capitale Nationale), Canada
| | - G Picher
- Université Laval, 2325 Rue de l'Université, Québec, QC G1V 0A6, Canada; CERVO Research Center, Quebec Integrated University Health and Social Services Center (CIUSSS de la Capitale Nationale), Canada
| | - J Turgeon
- Université du Québec en Outaouais, 283 Boul Alexandre-Taché, Gatineau, J8X 3X7, Canada
| | - M Ruiz-Casares
- McGill University, 845 Sherbrooke Ouest, Montreal, H3A 0G4, Canada
| | - C Lacharité
- Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, Trois-Rivières, G8Z 4M3, Canada
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Muntyanu A, Ouchene L, Hudson M, Baron M, Netchiporouk E. 317 Geographical distribution of systemic sclerosis in Canada: A large Canadian database study. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.339] [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: 10/21/2022]
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Fosse A, Karam G, Kerleau C, Perrouin-Verbe, Rigaud J, Baron M, Mesnard B, Hedhli O, Ville S, De Vergie S, Chelghaf I, Loubersac T, Boutin JM, Faivre d'Arcier B, Bruyère F, Cantarovich D, Branchereau J. [Acute renal failure of the donor in encephalic death: A real contraindication to kidney transplantation?]. Prog Urol 2021; 31:519-530. [PMID: 33478867 DOI: 10.1016/j.purol.2020.11.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The shortage of kidney transplants encourages the expansion of the limits of eligibility criteria for donation. Many donors who are brain dead display acute renal failure at the time of death; is this a real contraindication to harvesting? The aim of this study was to assess kidney graft survival from donors after brain death with confirmed acute renal failure, with or without anuria previous donation. MATERIALS AND METHODS All of the transplants performed in two university hospitals between 2010 and 2017 were analyzed retrospectively. All patients who underwent single kidney transplant from a brain-dead donor with acute renal failure (ARF) were included in this study. ARI was defined here by a decrease over 50 % of glomerular filtration rate (GFR) to a threshold below 45mL/min/1.73 m2 at the time of kidney procurement. Kidney graft survival, incidence of delayed graft function (DGF) and the GFR at 12 months were analyzed. Analysis of kidney transplant survival based on pre-implantation biopsies was additionally done. RESULTS One hundred and sixty four patients were transplanted with a kidney from donor with ARF during the selected period. At the admission in ICU the average GFR was 67,7±19mL/min/1,73m2. At the time of donation, the average age of donors was 56.4±17.7 years, the GFR was 33.7±8.0mL/min/1.73 m2 16 % of donors were anuric. Cold ischemia time (CIT) was 16.8±5.0hours. The average age of recipients was 55.6±14.1 years. 81 % of the cases were primary transplants. Graft function took place within 7.8±9.4 days after transplantation. There were two non-primary functions (PNF). One hundred and fifty two patients (93 %) had a functional graft at 12 months. The mean GFR at 12 months was 46.8±20.1mL/min/1.73 m2 and 122 patients (73 %) had a GFR greater than 30mL/min/1.73 m2. Seventy-one percent of preimplantation biopsies revealed acute tubular necrosis (ATU); no cortical necrosis was observed. Survival of theses grafts was 85 %, comparable to the total population of study (P=0,21) CONCLUSION: The acute renal failure of the brain-dead donor should not alone be systematically a contraindication to harvesting and kidney transplantation.
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Affiliation(s)
- A Fosse
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
| | - G Karam
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France
| | - C Kerleau
- Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France; Centre de recherche en transplantation et immunologie, UMR 1064, Inserm, 30, boulevard Jean-Monnet, 44093 Nantes, France
| | - Perrouin-Verbe
- Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France
| | - J Rigaud
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France
| | - M Baron
- Service d'urologie, CHU de Rouen, 76031 Rouen cedex 1, France
| | - B Mesnard
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - O Hedhli
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - S Ville
- Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France; Centre de recherche en transplantation et immunologie, UMR 1064, Inserm, 30, boulevard Jean-Monnet, 44093 Nantes, France
| | - S De Vergie
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - I Chelghaf
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - T Loubersac
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - J M Boutin
- Service d'urologie, CHRU de Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - B Faivre d'Arcier
- Service d'urologie, CHRU de Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - F Bruyère
- Service d'urologie, CHRU de Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - D Cantarovich
- Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France; Centre de recherche en transplantation et immunologie, UMR 1064, Inserm, 30, boulevard Jean-Monnet, 44093 Nantes, France
| | - J Branchereau
- Service d'urologie et de transplantations rénales, CHRU de Nantes-Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Institut de transplantation urologie-néphrologie, 30, boulevard Jean-Monnet, 44093 Nantes, France; Centre de recherche en transplantation et immunologie, UMR 1064, Inserm, 30, boulevard Jean-Monnet, 44093 Nantes, France; Nuffield department of surgical sciences, Oxford university, Oxford, UK
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Post C, De Boer S, Powell M, Mileshkin L, Katsaros D, Bessette P, Haie-Meder C, Ottevanger P, Ledermann J, Khaw P, D'Amico R, Fyles A, Baron M, Kitchener H, Nijman H, Lutgens L, Brooks S, Jürgenliemk-Schulz I, Feeney A, Nout R, Verhoeven-Adema K, Smit V, Putter H, Creutzberg C. OC-0369: Long-Term Quality of Life after (chemo)radiotherapy for high-risk Endometrial Cancer in PORTEC-3. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00393-5] [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: 11/16/2022]
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Baron M, Aublé A, Paret F, Pfister C, Cornu JN. Long-term follow-up reveals a low persistence rate of abobotulinumtoxinA injections for idiopathic overactive bladder. Prog Urol 2020; 30:684-691. [PMID: 32891504 DOI: 10.1016/j.purol.2020.07.242] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/28/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Little is known about long-term efficacy and tolerance of intra-detrusor injections of abobotulinumtoxinA for management of idiopathic overactive bladder (OAB). We report long-term efficacy and compliance of abobotulinumtoxinA in patients treated for OAB. METHODS All patients treated with abotulinumtoxinA for OAB in a tertiary reference centre between 2005 and 2012 were included in a retrospective analysis. Patients received 150, 250 or 500 U of abotulinumtoxinA as first injection. The primary endpoint was the discontinuation rate at 5 years. Other outcomes of interest were: rate of failure, reasons for discontinuation and subsequent treatment elected in those who did not persist with abobotulinumtoxinA. RESULTS Fifty-nine patients (50 women and 9 men) were included. Forty-one patients (69.4%) received 250 U of abobotulinumtoxinA as first injection. Thirteen patients (22%) received 500 U and 5 (8.4%) received 150 U of BoNT-A. Median follow-up was 83.6 months [0.3-183.6]. Median number of injections per patient was 2 [1-15] and median reinjection interval was 10.7 [3-86.4] months. The estimated 5-year discontinuation-free survival rate was 23.4%. Fourteen patients (23.7%) experienced persistent improvement of symptoms and 12 patients (20.3%) stopped the injections because of tolerability issues. Main cause of discontinuation was primary failure, which occurred in 21 patients (35.5%). CONCLUSION Overall, 59.3% of patients were successfully treated with first abobotulinumtoxinA injection. Although the estimated 5-year discontinuation-free survival rate is low, abobotulinumtoxinA could be considered as an alternative off-labelled in patients not responders to onabotulinumtoxinA after failure of other conservative measures. LEVEL OF PROOF 3.
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Affiliation(s)
- M Baron
- Urology Department, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex 1, France.
| | - A Aublé
- Urology Department, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - F Paret
- Urology Department, Nantes University Hospital, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - C Pfister
- Urology Department, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex 1, France
| | - J-N Cornu
- Urology Department, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex 1, France
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Auble A, Desprez C, Baron M, Leroi A, Pfister C, Cornu J. Sacral neuromodulation and material infections: Retrospective data from an expert center. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33988-4] [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: 11/24/2022] Open
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Auble A, Baron M, Chebbi A, Surlemont L, Leroi A, Cornu J. Sacral neuromodulation and non-obstructive retention: Monocentric retrospective study. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33570-9] [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: 11/26/2022] Open
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Nevskaya T, Jiang Y, Wang M, Baron M, Pope J, Pope JE, Baron M, Hudson M, Gyger G, Larché MJ, Khalidi NA, Masetto A, Sutton E, Robinson D, Rodriguez-Reyna TS, Smith D, Thorne C, Fortin PR, Fritzler MJ. FRI0258 CUMULATIVE INCIDENCE, SURVIVAL AND PREDICTORS OF PULMONARY HYPERTENSION IN SYSTEMIC SCLEROSIS SUBSETS: PAH IS NOT INCREASED IN LIMITED VS DIFFUSE PATIENTS BY ADJUSTED COMPETING RISK ANALYSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3847] [Citation(s) in RCA: 5] [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: 11/03/2022]
Abstract
Background:Pulmonary hypertension (PH) is a life-threatening complication of systemic sclerosis (SSc), thought to be more commonly found in limited cutaneous (lcSSc) compared to diffuse (dcSSc) subset. Since lcSSc has a better prognosis, it is unclear whether a higher occurrence of PH in lcSSc reflects survival bias.Objectives:To compare the cumulative PH incidence in disease subsets, after accounting for death as a competing event, in a large multi-center SSc cohort.Methods:Cumulative incidence of PH was studied in 1431 Canadian Scleroderma Research Group (CSRG) database patients (57% lcSSc; follow-up 3.5±2.9 years, range 1-14) by Fine-Gray analysis, unadjusted and adjusted for sex, age and SSc-related autoantibodies (SAS 9.4). Survival curves, predictors of PH development and survival were analyzed by Kaplan-Meier and Cox proportional hazards analyses (SPSS 25.0). Subgroup analysis was performed for PAH.Results:157 SSc patients had PH (including 117 PAH), either confirmed by RHC or postmortem. Compared to those without PH, lcSSc-PH patients had longer disease and older age at SSc diagnosis, while dcSSc-PH patients - more severe peripheral vascular and gastrointestinal involvement. The cumulative incidences of PH/PAH were similar in dcSSc and lcSSc after accounting for death in the adjusted competitive risk model (Table 1; Fig.1). 47% of PH- and 42% of PAH-patients died over a FU period. Male gender (p<0.0001) and anti-Scl-70 (p<0.001) were associated with earlier PH development, while older age (p=0.006) - with PAH (Table 2). ACA-negativity and older age predicted worse PH prognosis.Figure 1.Cumulative incidence curves for PH (A) and PAH (B).Conclusion:Cumulative incidence of PH, after accounting for death as competing event, was comparable in SSc subsets. Vigilance should be considered in males, Scl-70 positive and late age-onset SSc.Table 1.Sub-distribution Hazard ratio of incident PH and PAH.PHPAHHazard ratio (95% CIs)P valuesHazard ratio (95% CIs)P valuesCrude ModelDcSSc vs lcSSc2.03 (1.13, 3.66)0.01861.60 (0.82, 3.16)0.1710Adjusted modelDcSSc vs lcSSc1.82 (0.93, 3.57)0.08181.57 (0.69, 3.59)0.2812Female vs male0.98 (0.42, 2.32)0.96602.10 (0.51, 8.65)0.3040Age1.00 (0.99, 1.02)0.70411.01 (0.98, 1.03)0.5498AntibodiesACA vs negative0.95 (0.46, 1.96)0.89911.08 (0.50, 2.35)0.8391ATA vs negative1.93 (0.84, 4.42)0.11980.59 (0.13, 2.73)0.4970Anti-RNAP vs negative1.24 (0.45, 3.43)0.68411.77 (0.58, 5.44)0.3181Disclosure of Interests:Tatiana Nevskaya: None declared, Yuxuan Jiang: None declared, Mianbo Wang: None declared, Murray Baron: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB
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Hu A, Nevskaya T, Baron M, Pope J. FRI0245 PULMONARY ARTERIAL HYPERTENSION IN SYSTEMIC SCLEROSIS IS NEARLY ALWAYS ACCOMPANIED BY A LOW DIFFUSING CAPACITY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Scleroderma (systemic sclerosis; SSc) has high morbidity and mortality. Pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH) is common with a high mortality (1). SSc patients are screened with pulmonary function tests (diffusing capacity of the lung for carbon monoxide; DLCO) (2).Objectives:The DLCO%predicted was analyzed comparing patients with and without PAH to determine if it is always low at time of PAH diagnosis.Methods:The Canadian Scleroderma Research Group (CSRG) database was used containing more than 1300 SSc patients with a mean disease duration of 8 years. All patients with at least one follow up visit and DLCO recorded at least twice were eligible for enrolment into this nested case control study. Diagnosis of PH was verified using several algorithms within the database including R heart catheterization, use of PH medications and physician response of ‘yes’ to question has this patient been diagnosed with pulmonary hypertension. Sensitivity, specificity and positive (PPV) and negative predictive values (NPV) were calculated for DLC0%predicted <50% and presence of PH/PAH.Results:At time of PH diagnosis, the mean DLCO% predicted was 47% (N=30) vs no PH 73% (N=960) P<0.0001, and proven documented PAH also showed the differences (PAH, N=22 DLCO% predicted 51% vs. PAH negative (N=968) DLCO% pred 72%, P<0.0001) (Table 1). The OR of a DLCO%predicted less than 60 was 4.7 for PAH and 7.6 for PH (both P<0.001) and even higher if DLCO<50% (OR 11.5 for PH and 7.6 for PAH). Table 2 shows the PPV of DLCO at varying levels.Table 1.DLCO comparison between PH+ and PH- SSc patients and between PAH+ and PAH- SSc patients, at the time of diagnosis.PH+(n=30)PH-(n=960)P-valuePAH+(n=22)PAH- (n=968)P-valuemean±SD47.17±17.5372.74±20.79<0.000151.23±17.5572.44±20.99<0.0001Range18-8113-14725-8113-147Table 2.Sensitivity, specificity and predictive values in SSc-PH and -PAH for DLCO at various cut points.ORPPVSpecificityNPVSensitivityDLCO<50%11.5 (CI 95% 5.4-24.8),p<0.000113.2%87.0%98.7%63.3%PHDLCO<60%7.6 (CI 95% 3.3-17.2), p<0.00017.9%73.3%98.9%73.3%DLCO>80%0.06 (CI 95% 0.008-0.46), p=0.0070.3%64.5%95.5%3.3%DLCO<50%7.6 (CI 95% 3.2-17.9), p<0.00018.3%86.4%98.8%54.5%PAHDLCO<60%4.7 (1.9-11.3), p<0.0015.0%72.7%98.9%63.6%DLCO>80%0.1 (0.01-0.7), p=0.0180.3%64.8%96.8%4.5%Conclusion:A low DLCO is associated with a high odds of PH/PAH in SSc and the NPV is very high at both DLCO<50% predicted and <60% predicted. This may aid in determining who should recieve a right heart catheterization in SSc patients.References:[1]Mukerjee D et al (2003) Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach. Ann Rheum Dis 62(11):1088-93[2]Khanna D et al (2013) Recommendations for screening and detection of connective tissue disease-associated pulmonary arterial hypertension. Arthritis Rheum 65(12):3194-201Disclosure of Interests:None declared
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Park R, Nevskaya T, Baron M, Pope J. AB0598 THE INCREASING USE OF IMMUNOSUPPRESSANTS IN EARLY SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Immunosuppression (IS) remains the main treatment for progressing skin involvement, active interstitial lung disease (ILD) and underlying inflammatory joint (IJ) or muscle disease in systemic sclerosis (SSc).Objectives:This study investigated the pattern and trends in immunosuppressive agent use in patients with early SSc diagnosed before and after 2007 to determine whether the changes in the preferred type and combination of IS, timing and predictors of administration took place over the past decade.Methods:397 SSc patients from Canadian Scleroderma Research Group (CSRG) database (183dcSSc, 214 lcSSc) who had baseline and follow-up visits within 3 years (1.8±0.8) after disease onset were included: 82% females, age at diagnosis 53±13 years, disease duration 1.6±0.8 years. Organ involvement was assessed by modified Rodnan skin score, Medsger Disease Severity Score (DSS) and CSRG definitions using bivariate, chi-squared, ANOVA, and adjusted regression analyses.Results:115 dcSSc patients (63%) and 62 lcSSc (29%) received IS, most commonly methotrexate (MTX) (72% dcSSc and 52% lcSSc), followed by mycophenylate mofetil (MMF) and cyclophosphamide (CYC). Within the patients receiving IS, monotherapy prevailed (77% dcSSc and 68% lcSSc); CYC and azathioprine were the preferred choice of IS more frequently in lcSSc compared to dcSSc (p<0.006 and p<0.02, respectively). In dcSSc, IS were predominantly prescribed at years 2 and 3 after the onset of first non-Raynaud’s phenomenon (RP) manifestation, when about half of the patients received IS. The proportion of lcSSc patients receiving IS was significantly lower and distributed more equally through the first three years. After 2007, dcSSc patients received IS more often (74% vs 50%, p=0.001), especially MTX (p=0.02) and MMF (p<0.05), and earlier (peaked at 2 years after disease onset)(Table 1).Table 1.Proportion of patients receiving immunosuppressive treatment at each year after disease onset in SSc diagnosed before and after 2007.Years after the first non-RP symptomlcSScBefore 2007After 2007Total N of pts seen at each year% receiving immune suppressivesTotal N of pts seen at each year% receiving immune suppressivesP-value113154717>0.92242182180.7723491410714>0.9dcSSc1242940430.2862512665650.00013624563540.325IS administration was associated with male gender, ILD, a-Scl-70 positivity, ACA-negativity and IJ disease in lcSSc, and with ACA-negativity and a higher mRSS in dcSSc. Multivariate logistic regression analysis showed that IS treatment could be predicted by ACA-negativity in lcSSc patients (Exp(B) 0.317, p=0.012) and younger age in dcSSc patients (Exp(B) 0.974, p=0.002).Conclusion:Over the past decade, there has been a trend to prescribe IS more often, especially MTX, and earlier in dcSSc patients. MMF has gained favour over CYC. Autoantibody status was the most consistent predictor whether a patient is likely to take IS over the course of the disease.Disclosure of Interests:Ryan Park: None declared, Tatiana Nevskaya: None declared, Murray Baron: None declared, Janet Pope Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly & Company, Merck, Roche, Seattle Genetics, UCB, Consultant of: AbbVie, Actelion, Amgen, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Eicos Sciences, Eli Lilly & Company, Emerald, Gilead Sciences, Inc., Janssen, Merck, Novartis, Pfizer, Roche, Sandoz, Sanofi, UCB, Speakers bureau: UCB
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Semalulu T, Rudski L, Huynh T, Langleben D, Wang M, Fritzler MJ, Pope J, Baron M, Hudson M. An evidence-based strategy to screen for pulmonary arterial hypertension in systemic sclerosis. Semin Arthritis Rheum 2020; 50:1421-1427. [PMID: 32245697 DOI: 10.1016/j.semarthrit.2020.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/20/2020] [Accepted: 02/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Clinical practice guidelines recommend screening all systemic sclerosis (SSc) patients for pulmonary arterial hypertension (PAH) with yearly echocardiograms. There is a paucity of evidence to support these guidelines. RESEARCH QUESTION Can a prediction model identify SSc patients with a very low probability of PAH and therefore not requiring annual screening echocardiogram? STUDY DESIGN AND METHODS We performed a case-control study of 925 unselected SSc subjects nested in a multi-centered, longitudinal cohort. The probability of PAH for each subject was calculated using the results of multivariate logistic regression models. A cut-off was identified for the estimated probability of PAH below which no subject developed PAH (100% sensitivity). RESULTS Study subjects were predominantly female (87.5%), with mean (SD) age 58.6 (11.7) years and disease duration of 18.2 (12.2) years. Thirty-seven subjects developed PAH during 5407.97 person-years of observation (incidence rate 0.68 per 100 person-years). Shortness of breath (SOB), diffusing capacity for carbon monoxide (DLCO) and NT-proBNP were independent predictors of PAH. All SSc-PAH cases had a probability of PAH of >1.1%. Subjects below this cut-off, none of whom had PAH, accounted for 46.2% of the study population. INTERPRETATION A simple prediction model identified subjects at very low probability of PAH who could potentially forego annual screening echocardiogram. This represents almost half of SSc subjects in a general SSc population. This study, which is the first evidence-based study for the rational use of follow-up echocardiograms in an unselected SSc cohort, requires validation. The scoring system is freely available online at http://pahtool.ladydavis.ca.
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Affiliation(s)
- T Semalulu
- Department of Medicine, McMaster University, Canada
| | - L Rudski
- Department of Medicine, McGill University, Montreal, Canada; Division of Cardiology, Jewish General Hospital, Montreal, Canada
| | - T Huynh
- Department of Medicine, McGill University, Montreal, Canada; Division of Cardiology, McGill University Health Centre, Montreal, Canada
| | - D Langleben
- Department of Medicine, McGill University, Montreal, Canada; Division of Cardiology, Jewish General Hospital, Montreal, Canada; Lady Davis Institute for Medical Research, Montreal, Canada
| | - M Wang
- Lady Davis Institute for Medical Research, Montreal, Canada
| | | | - M J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - J Pope
- St. Joseph's Healthcare, London, Canada
| | - M Baron
- Department of Medicine, McGill University, Montreal, Canada; Division of Rheumatology, Jewish General Hospital, Room A-725, 3755 Côte Sainte-Catherine Road, Montreal, Quebec H3T 1E2, Canada
| | - M Hudson
- Department of Medicine, McGill University, Montreal, Canada; Lady Davis Institute for Medical Research, Montreal, Canada; Division of Rheumatology, Jewish General Hospital, Room A-725, 3755 Côte Sainte-Catherine Road, Montreal, Quebec H3T 1E2, Canada.
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Baron M, Perrouin-Verbe MA, Lacombe S, Paret F, Le Normand L, Cornu JN. Efficacy and tolerance of botulinum toxin injections after sacral nerve stimulation failure for idiopathic overactive bladder. Neurourol Urodyn 2020; 39:1012-1019. [PMID: 32108383 DOI: 10.1002/nau.24326] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/13/2019] [Accepted: 01/17/2020] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Management of idiopathic overactive bladder (iOAB) after the failure of sacral nerve modulation (SNM) is very challenging. To the best of our knowledge, no study has evaluated the use of botulinum toxin A (BoNT-A) after SNM failure for iOAB. The aim of this study is to evaluate the tolerance and efficacy of BoNT-A injection after the failure of SNM for iOAB. METHODS We conducted a retrospective multicentric analysis of all patients who had received either onabotulinumtoxinA or abobotulinumtoxinA intradetrusor injection for iOAB after SNM failure, between January 2004 and December 2017. The primary outcome was the percentage of success of first BoNT-A injection (either resolution of their urinary incontinence or their frequency or more than 50% reduction in frequency). Secondary outcomes were results of urodynamic studies, complications, total number of injections, causes of withdrawal, and subsequent treatment. RESULTS Seventy-six patients (62 female) were included. The percentage of success of first BoNT-A injection was 43.4% (n = 33). All overactive bladder symptoms were significantly improved on the 3-day bladder diary. Twenty-eight patients (36.8%) were put under clean intermittent self-catheterization transitory. After a mean follow-up of 57.7 (±38.5) months, median number of injections was 2 (1-15). Overall, 42 patients (55.2%) stopped injections during follow-up. The estimated 36-months discontinuation-free rate was 48.1%. Mean cause of discontinuation was a primary failure (n = 32; 42.1%). CONCLUSION BoNT-A can be used in SNM nonresponders with a success rate of 43.4% but is associated with a high long-term discontinuation rate.
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Affiliation(s)
- Maximilien Baron
- Department of Urology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | | | - Sandy Lacombe
- Clinical Research Department, CMC Beau Soleil, Montpellier, France
| | - Fanny Paret
- Department of Urology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Loïc Le Normand
- Department of Urology, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Jean-Nicolas Cornu
- Department of Urology, Centre Hospitalier Universitaire de Rouen, Rouen, France
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Worcel J, Tarelho M, Baron M, Ponvert C, Bidat E, Benoist G, Lezmi G. Drug-induced enterocolitis syndrome (DIES) in a 10-year-old girl. Arch Pediatr 2019; 27:51-52. [PMID: 31784292 DOI: 10.1016/j.arcped.2019.11.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 08/30/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
We report the case of a child presenting with an adverse drug reaction highly suggestive of drug-induced enterocolitis syndrome (DIES) to amoxicillin (AMX). A 10-year-old girl developed repetitive vomiting and pallor without cutaneous or respiratory symptoms 2h after AMX intake. DIES is not a well-described entity, and very few data are available in the literature. In the absence of an existing definition, the diagnosis of DIES can only be suspected and is based on its homology with food protein-induced enterocolitis (FPIES). The major criterion is the recurrence of repetitive and often incoercible vomiting occurring within 1-4h of ingestion of the culprit food in the absence of IgE-mediated allergic classic skin and respiratory symptoms. Once the diagnosis of DIES to AMX is suspected, an open challenge with AMX should be undertaken with caution, under medical supervision in a day hospital unit because of the risk of severe recurrence. Once the diagnosis is confirmed, AMX should be contraindicated to avoid severe reactions.
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Affiliation(s)
- J Worcel
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - M Tarelho
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - M Baron
- Service de pédiatrie générale, hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - C Ponvert
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - E Bidat
- Service de pédiatrie générale, hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - G Benoist
- Service de pédiatrie générale, hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | - G Lezmi
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-Enfants Malades, AP-HP, Paris, France; Université Paris Descartes, Paris, France.
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Baron M, Auble A, Cornu JN. Predictors of Device-Related Complications After Exchange of the Pressure Regulating Balloon in Men with an Artificial Urinary Sphincter. Urology 2019; 136:278. [PMID: 31756368 DOI: 10.1016/j.urology.2019.10.025] [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] [Received: 10/14/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Maximilien Baron
- Department of Urology, Centre Hospitalier Universitaire de Rouen, Rouen, France.
| | - Annabelle Auble
- Department of Urology, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Jean-Nicolas Cornu
- Department of Urology, Centre Hospitalier Universitaire de Rouen, Rouen, France
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Salituri J, Patey N, Takano T, Fiset P, Del Rincon S, Berkson L, Baron M, Hudson M, Baron M, Hudson M, Gyger G, Pope J, Larché M, Khalidi N, Masetto A, Sutton E, Robinson D, Rodriguez-Reyna T, Smith D, Thorne C, Fortin P, Fritzler M. Mammalian target of rapamycin is activated in the kidneys of patients with scleroderma renal crisis. Journal of Scleroderma and Related Disorders 2019; 5:152-158. [DOI: 10.1177/2397198319885488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022]
Abstract
Objectives: Scleroderma renal crisis is a rare but serious complication affecting 2%–15% of patients with systemic sclerosis. Despite treatment with angiotensin-converting enzyme inhibitors, outcomes for scleroderma renal crisis patients are still poor. The cellular signaling mechanisms in scleroderma renal crisis are not yet known. Mammalian target of rapamycin, comprised of the subunits mTORC1 and mTORC2, has been shown to be activated in vascular lesions of renal transplant patients with anti-phospholipid antibody syndrome. Given the similarities between the pathophysiology of scleroderma renal crisis and anti-phospholipid antibody syndrome, we hypothesized that the mammalian target of rapamycin pathway would also be activated in the renal vasculature of patients with scleroderma renal crisis. Methods: We retrospectively analyzed renal biopsies of five patients with scleroderma renal crisis in the Canadian Scleroderma Research Group cohort. Immunostaining was performed using anti-P-S6RP antibodies to evaluate the phosphorylation of mTORC1, and anti-Rictor and anti-S473 to determine activation of mTORC2. Results: Four of the five patients showed mTORC1 activation in arteriolar endothelial cells, and three of the five patients showed mTORC1 activation in the arterial endothelial cells. Two of four samples showed Rictor expression in the arteriolar and arterial endothelial cells, showing mTORC2 activation. There was no expression of mTORC1 or mTORC2 in samples from two healthy controls. Conclusion: We demonstrate that both mTORC1 and mTORC2 are activated in renal biopsies with typical histologic features of scleroderma renal crisis. Dual mammalian target of rapamycin inhibitors are currently available and in development. These findings could inform further research into novel treatment targets for scleroderma renal crisis.
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Affiliation(s)
| | - Natalie Patey
- Department of Pathology, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | - Tomoko Takano
- Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Pierre Fiset
- Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | | | - Laeora Berkson
- Department of Medicine, McGill University, Montreal, QC, Canada
- Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada
| | - Murray Baron
- Department of Medicine, McGill University, Montreal, QC, Canada
- Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada
| | - Marie Hudson
- Department of Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute, Montreal, QC, Canada
- Division of Rheumatology, Jewish General Hospital, Montreal, QC, Canada
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Aublé A, Baron M, Grise P, Pfister C, Cornu J. Neuromodulation sacrée et troubles de vidange: étude rétrospective monocentrique. Prog Urol 2019. [DOI: 10.1016/j.purol.2019.08.205] [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: 11/15/2022]
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Choquet S, Baron M, Soussain C, Houillier C, Gyan E, Soubeyran P, Cassoux N, Touitou V, Bodaghi B, Hoang-Xuan K, Leblond V. TEMOZOLOMIDE IN RELAPSE/REFRACTORY PRIMARY VITREO-RETINAL LYMPHOMA (R/R PVRL): A SIMPLE, CHEAP, EFFECTIVE AND WELL TOLERATED TREATMENT. RESULT OF THE LARGEST STUDY ON R/R PVRL, FROM THE LOC NETWORK. Hematol Oncol 2019. [DOI: 10.1002/hon.79_2630] [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: 11/08/2022]
Affiliation(s)
- S. Choquet
- Clinical Haematology; APHP, Pitie-Salpetriere; Paris France
| | - M. Baron
- Clinical Haematology; APHP, Pitie-Salpetriere; Paris France
| | - C. Soussain
- Clinical Haematology; Institut Curie, Rene Huguenin; Saint-Cloud France
| | - C. Houillier
- Neuro-Oncology; Pitie Salpetriere Hospital; Paris France
| | - E. Gyan
- Clinical Haematology; CHRU Trousseau; Chambray-lès-Tours France
| | - P. Soubeyran
- Clinical Haematology; Institut Bergonié; Bordeaux France
| | - N. Cassoux
- Ophtalmology; Institut Curie; Paris Paris France
| | - V. Touitou
- Ophtalmology; Pitie Salpetriere Hospital; Paris France
| | - B. Bodaghi
- Ophtalmology; Pitie Salpetriere Hospital; Paris France
| | - K. Hoang-Xuan
- Neuro-Oncology; Pitie Salpetriere Hospital; Paris France
| | - V. Leblond
- Clinical Haematology; APHP, Pitie-Salpetriere; Paris France
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Tannyhill R, Baron M, Troulis M. Do american oral and maxillofacial surgery chief residents feel competent to practice the full scope of the specialty? Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.577] [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: 11/29/2022]
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Baron M, Peyronnet B, Aublé A, Hascoet J, Castel-Lacanal E, Miget G, Le Doze S, Prudhomme T, Manunta A, Cornu JN, Gamé X. Long-Term Discontinuation of Botulinum Toxin A Intradetrusor Injections for Neurogenic Detrusor Overactivity: A Multicenter Study. J Urol 2019; 201:769-776. [DOI: 10.1016/j.juro.2018.10.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | - Evelyne Castel-Lacanal
- Department of Physical Medicine and Rehabilitation, University of Toulouse, Toulouse, France
| | - Gabriel Miget
- Department of Physical Medicine and Rehabilitation, University of Rouen, Rouen, France
| | - Sabine Le Doze
- Department of Physical Medicine and Rehabilitation, Functional Re-Education and Rehabilitation Center Le Normandy, Granville, France
| | | | - Andrea Manunta
- Department of Urology, University of Rennes, Rennes, France
| | | | - Xavier Gamé
- Department of Urology, University of Toulouse, Toulouse, France
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McKinnell JA, Bhaurla S, Marquez-Sung P, Pucci A, Baron M, Kamali T, Bugante J, Schwartz B, Balter S, Terashita D, Butler-Wu S, Gunzenhauser J, Hindler J, Humphries RM. Public Health Efforts Can Impact Adoption of Current Susceptibility Breakpoints, but Closer Attention from Regulatory Bodies Is Needed. J Clin Microbiol 2019; 57:e01488-18. [PMID: 30567751 PMCID: PMC6425187 DOI: 10.1128/jcm.01488-18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/11/2018] [Indexed: 11/20/2022] Open
Abstract
Microbiological testing, including interpretation of antimicrobial susceptibility testing results using current breakpoints, is crucial for clinical care and infection control. Continued use of obsolete Enterobacteriaceae carbapenem breakpoints is common in clinical laboratories. The purposes of this study were (i) to determine why laboratories failed to update breakpoints and (ii) to provide support for breakpoint updates. The Los Angeles County Department of Public Health conducted a 1-year outreach program for 41 hospitals in Los Angeles County that had reported, in a prior survey of California laboratories, using obsolete Enterobacteriaceae carbapenem breakpoints. In-person interviews with hospital stakeholders and customized expert guidance and resources were provided to aid laboratories in updating breakpoints, including support from technical representatives from antimicrobial susceptibility testing device manufacturers. Forty-one hospitals were targeted, 7 of which had updated breakpoints since the prior survey. Of the 34 remaining hospitals, 27 (79%) assumed that their instruments applied current breakpoints, 17 (50%) were uncertain how to change breakpoints, and 10 (29%) lacked resources to perform a validation study for off-label use of the breakpoints on their systems. Only 7 hospitals (21%) were familiar with the FDA/CDC Antibiotic Resistance Isolate Bank. All hospitals launched a breakpoint update process; 16 (47%) successfully updated breakpoints, 12 (35%) received isolates from the CDC in order to validate breakpoints on their systems, and 6 (18%) were planning to update within 1 year. The public health intervention was moderately successful in identifying and overcoming barriers to updating Enterobacteriaceae carbapenem breakpoints in Los Angeles hospitals. However, the majority of targeted hospitals continued to use obsolete breakpoints despite 1 year of effort. These findings have important implications for the quality of patient care and patient safety. Other public health jurisdictions may want to utilize similar resources to bridge the patient safety gap, while manufacturers, the FDA, and others determine how best to address this growing public health issue.
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Affiliation(s)
- James A McKinnell
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - S Bhaurla
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - P Marquez-Sung
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - A Pucci
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - M Baron
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - T Kamali
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - J Bugante
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - B Schwartz
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - S Balter
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - D Terashita
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - S Butler-Wu
- University of Southern California, Los Angeles, California, USA
| | - J Gunzenhauser
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - J Hindler
- Acute Communicable Disease Control Unit, Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - R M Humphries
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Ferdowsi N, Stevens W, Baron M, Nikpour M. Damage indices in rheumatic diseases: A systematic review of the literature. Semin Arthritis Rheum 2019; 49:27-34. [PMID: 30745021 DOI: 10.1016/j.semarthrit.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/27/2018] [Revised: 12/22/2018] [Accepted: 01/14/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the current literature, and evaluate the psychometric properties of disease damage indices in rheumatic diseases. METHODS A search of Medline, EMBASE, and Cochrane Library databases was performed to June 2018 to identify damage indices in all systemic rheumatic diseases. Articles were included in a systematic review if indices were composite (multi-organ) in nature and if adequate detail on methodology was described. Articles pertaining to the validation of these indices were also reviewed in order to assess the psychometric properties of the indices using the Outcome Measures in Rheumatology Arthritis Clinical Trials (OMERACT) filter as a guide. RESULTS Of the 2659 articles retrieved through the search, we identified 7 damage indices in five diseases: idiopathic inflammatory myopathy, systemic lupus erythematosus, systemic vasculitis, Sjӧgren's syndrome and antiphospholipid syndrome. A further 48 articles were identified pertaining to the validation of these damage indices. The methodological process for the development of these indices included expert consensus, item reduction and item weighting methods. The level of validation that these indices have achieved is variable, with only 2 damage indices fulfilling all criteria of the OMERACT filter. CONCLUSIONS To date, there have been 7 composite disease damage indices created in a variety of rheumatic diseases, with the exception of systemic sclerosis (SSc). This review has informed methodology for the development of a disease damage index in SSc.
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Affiliation(s)
- N Ferdowsi
- The University of Melbourne, St Vincent's Hospital, Melbourne, Australia; St Vincent's Hospital, Melbourne, Australia
| | - W Stevens
- St Vincent's Hospital, Melbourne, Australia
| | - M Baron
- Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Canada
| | - M Nikpour
- The University of Melbourne, St Vincent's Hospital, Melbourne, Australia; St Vincent's Hospital, Melbourne, Australia.
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Baron M, Marie-Aimée P, Hedli O, Le Normand L, Levesque A, Rigaud J. Gestion de la récidive d’incontinence urinaire après ablation de bandelette sous-urétrale pour douleur pelvienne ou périnéale. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.059] [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: 11/24/2022]
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Gas J, Matillon X, Bart S, Dominique I, Akakpo W, Olivier J, Gambachizde D, Lebacle C, Nedelec M, Baron M, Gondran-Tellier B, Manuguerra A, Perrot E, Bergerat S, Pradére B. Évaluation du burn-out chez les urologues en formation en France. Prog Urol 2018. [DOI: 10.1016/j.purol.2018.07.131] [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: 11/25/2022]
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Baron M, Hausfater P, Yordanov Y. Caractéristiques de la première promotion nationale d’internes du nouveau diplôme d’études spécialisées de médecine d’urgence. Ann Fr Med Urgence 2018. [DOI: 10.3166/afmu-2018-0092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : Depuis novembre 2017, la médecine d’urgence est filiarisée en France. Le profil des internes ayant choisi cette spécialité à l’issue de l’examen classant national, inconnu actuellement, différerait de celui de leurs aînés du diplôme d’études spécialisées complémentaire. Nous avons voulu connaître les caractéristiques des étudiants inscrits en phase socle du nouveau diplôme d’études spécialisées de médecine d’urgence, les motivations de leur choix et leur vision de leur futur exercice.
Méthode : Nous avons mené une étude épidémiologique transversale déclarative à partir d’un questionnaire anonyme envoyé par courriel à tous les internes de phase socle du diplôme de médecine d’urgence affectés en 2017 dans les 28 subdivisions françaises.
Résultats : Trois cent soixante-dix-sept internes ont répondu, dont 51 % de femmes, et l’âge moyen était de 26 ans. Quatrevingt- six pour cent avaient réalisé un stage aux urgences et 44 % un stage ou des gardes en service d’aide médicale urgente. La médecine d’urgence était un premier choix chez 81 % des étudiants et un choix par défaut chez 18 %. Leurs principales motivations étaient la transversalité de la spécialité, les gestes techniques, le contexte aigu, le travail en équipe et les lieux d’exercice variés. La majorité souhaitait exercer à l’hôpital public. Quatre-vingt-douze pour cent envisageaient un exercice partagé entre urgences et service d’aide médicale urgente. Leurs principales craintes concernaient l’absence de réorientation possible et l’épuisement.
Discussion : La très grande majorité des internes du diplôme d’études spécialisées de médecine d’urgence sont venus vers la spécialité par choix. Malgré leur jeune expérience, ils ont des idées bien précises du type de pratique qu’ils souhaiteraient. L’exercice exclusif, qu’il soit aux urgences ou en service mobile d’urgence et de réanimation, ne semble plus être le modèle idéal pour ces jeunes professionnels qui plébiscitent l’exercice partagé.
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Hourié A, Nouhaud FX, Baron M, Rebibo JD, Pfister C, Grise P, Cornu JN. The maximum detrusor pressure as a predictive factor of success after sphincterotomy in detrusor-sphincter dyssynergia. Neurourol Urodyn 2018; 37:2758-2762. [PMID: 30203509 DOI: 10.1002/nau.23759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/24/2018] [Accepted: 05/09/2018] [Indexed: 11/11/2022]
Abstract
AIMS To evaluate the impact of the pre-operative maximum detrusor pressure (MDP) on efficacy outcomes after incontinentation by sphincterotomy or urethral stent placement in male patients with neurogenic detrusor-sphincter dyssynergia (DSD). METHODS A retrospective study was performed in 41 male patients treated between 2006 and 2013 in a tertiary reference center. All patients had a neurogenic DSD confirmed by baseline urodynamic studies, and were unable or secondary failed to practice CISC. Success was defined as a post-void residual volume <150 mL. Influence of MDP on treatment efficacy was evaluated through a Mann-Whitney U-Test. RESULTS Median (range) age was 39 years (20-69). Spinal cord injury was the main underlying condition. Twenty-six patients had a sphincteric stent placement (Memocath®, Bard, Covington) and 15 had surgical sphincterotomy. Treatment was successful in 31 patients (76%). Patients with immediate successful outcomes had a significantly higher mean preoperative MDP (59.6 vs 29.7 cmH2 O; P = 0.002). Patients with MDP over the threshold of 40 cmH2 O had a 90% success rate. These differences were maintained at 6 months, MDP being higher in the success group than in the failure group (59.5 vs 39.8 cmH2 O, respectively, P = 0.008). The technique used (stent placement or incision) had no impact on immediate or 6-month success rates. CONCLUSIONS Our results suggested that MDP is associated with treatment success rate after surgical management of DSD of neurogenic origin by sphincteric stent placement or surgical sphincterotomy. A threshold of 40 mH2 O is associated with higher success rates.
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Affiliation(s)
- Alexandre Hourié
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
| | | | - Maximilien Baron
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
| | - John-David Rebibo
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
| | - Christian Pfister
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
| | - Philippe Grise
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
| | - Jean-Nicolas Cornu
- Department of Urology, Charles Nicolle University Hospital, Rouen Cedex, France
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Hascoet J, Peyronnet B, Forin V, Baron M, Capon G, Prudhomme T, Allenet C, Tournier S, Maurin C, Cornu J, Bouali O, Peycelon M, Arnaud A, Renaux-Petel M, Liard A, Olivari-Philiponnet C, Karsenty G, Manunta A, Gamé X. Intra-detrusor injections of botulinum toxin type a in children with spina bifida: A multicenter study. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.121] [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: 11/28/2022]
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Peyronnet B, Even A, Capon G, De Seze M, Hascoet J, Biardeau X, Baron M, Perrouin-Verbe MA, Boutin JM, Saussine C, Phé V, Lenormand L, Chartier-Kastler E, Cornu JN, Karsenty G, Manunta A, Schurch B, Denys P, Amarenco G, Game X. Intradetrusor Injections of Botulinum Toxin A in Adults with Spinal Dysraphism. J Urol 2018; 200:875-880. [PMID: 29746860 DOI: 10.1016/j.juro.2018.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 05/01/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE The aim of the current study was to determine the outcomes of botulinum toxin A intradetrusor injections in adult patients with spina bifida. MATERIALS AND METHODS All patients with spinal dysraphism who underwent intradetrusor injections of botulinum toxin A from 2002 to 2016 at a total of 14 centers were retrospectively included in analysis. The primary end point was the global success of injections, defined subjectively as the combination of urgency, urinary incontinence and detrusor overactivity/low bladder compliance resolution. Univariate and multivariate analysis was performed to seek predictors of global success. RESULTS A total of 125 patients were included in study. The global success rate of the first injection was 62.3% with resolution of urinary incontinence in 73.5% of patients. All urodynamic parameters had improved significantly by 6 to 8 weeks compared to baseline, including maximum detrusor pressure (-12 cm H2O, p <0.001), maximum cystometric capacity (86.6 ml, p <0.001) and compliance (8.9 ml/cm H2O, p = 0.002). A total of 20 complications (3.6%) were recorded for the 561 intradetrusor botulinum toxin A injections, including 3 muscular weakness complications. The global success rate of the first injection was significantly lower in patients with poor compliance (34.4% vs 86.9%, OR 0.08, p <0.001). On multivariate analysis poor compliance was associated with a lower global success rate (OR 0.13, p <0.001). Female gender (OR 3.53, p = 0.01) and patient age (OR 39.9, p <0.001) were predictors of global success. CONCLUSIONS Intradetrusor botulinum toxin A injections were effective in adult patients with spina bifida who had detrusor overactivity. In contrast, effectiveness was much lower in adult patients with spina bifida who had poor bladder compliance. The other predictors of global success were female gender and older age.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, University of Rennes and French Referral Network of Spina Bifida, Rennes University Hospital, Rennes, France.
| | - Alexia Even
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France
| | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Marianne De Seze
- Department of NeuroUrology, Clinique Saint-Augustin, Bordeaux, France
| | - Juliette Hascoet
- Department of Urology, University of Rennes and French Referral Network of Spina Bifida, Rennes University Hospital, Rennes, France
| | | | | | | | | | | | - Véronique Phé
- Department of Urology, Médecine Sorbonne Universite, Paris, France
| | - Loic Lenormand
- Department of Urology, University of Nantes, Nantes, France
| | | | | | - Gilles Karsenty
- Department of Urology, University of Marseille, Marseille, France
| | - Andrea Manunta
- Department of Urology, University of Rennes and French Referral Network of Spina Bifida, Rennes University Hospital, Rennes, France
| | - Brigitte Schurch
- Department of NeuroUrology, University of Lausanne, Lausanne, Switzerland
| | - Pierre Denys
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, Garches, France
| | - Gérard Amarenco
- Sorbonne Université, GRC 01 GREEN, Assistance publique-hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - Xavier Game
- Department of Urology, University of Toulouse, Toulouse, France
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Hascoet J, Peyronnet B, Forin V, Baron M, Capon G, Prudhomme T, Allenet C, Tournier S, Maurin C, Cornu JN, Bouali O, Peycelon M, Arnaud A, Renaux-Petel M, Liard A, Karsenty G, Manunta A, Game X. Intradetrusor Injections of Botulinum Toxin Type A in Children With Spina Bifida: A Multicenter Study. Urology 2018. [PMID: 29522865 DOI: 10.1016/j.urology.2018.02.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To assess the effectiveness of intradetrusor injections of botulinum toxin type A (IDBTX-A) in children with spina bifida. METHODS All patients aged less than 16 years old who underwent IDBTX-A between 2002 and 2016 at 6 institutions were included in a retrospective study. Our primary endpoint was the success rate of IDBTX-A defined as both clinical improvement (no incontinence episodes between clean intermittent catheterizations [CICs], absence of urgency, and less than 8 CICs per day) and urodynamic improvement (resolution of detrusor overactivity and normal bladder compliance for age) lasting ≥12 weeks. Predictive factors of success were assessed through univariate analysis. RESULTS Fifty-three patients with a mean age of 8.5 years were included. All patients were under CIC and 88.7% had received anticholinergics with either poor efficacy or bothersome adverse events. The global success rate of the first injection (clinical and urodynamic) was 30%. Patients with closed spinal dysraphism had a significantly better success rate than patients with myelomeningocele (P = .002). The clinical success rate was 66% and was significantly associated with maximum urethral closure pressure (34 cm H2O vs 54.4 cm H2O, P = .02). The urodynamic success rate was 34%. Maximum cystometric capacity (P <.0001) and compliance (P = .01) significantly improved after the first IDBTX-A and maximum detrusor pressure tended to decrease (P = .09) except in the subgroup of patients with poor compliance. After a mean follow-up of 3.7 years, 23 patients (43.4%) required augmentation cystoplasty. Excluding 6 patients who were lost to follow-up, 38.3% of patients were still undergoing botulinum toxin injections at last follow-up. CONCLUSION In this series, despite the fact that IDBTX-A enabled clinical improvement in 66% patients, urodynamic outcomes were poor resulting in a low global success rate (30%).
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Affiliation(s)
| | | | - Véronique Forin
- Department of Pediatric Physical Therapy and Rehabilitation, Trousseau Hospital, Paris, France
| | | | - Grégoire Capon
- Department of Urology, University of Bordeaux, Bordeaux, France
| | | | - Clément Allenet
- Department of Urology, University of Bordeaux, Bordeaux, France
| | - Simon Tournier
- Department of Pediatric Physical Therapy and Rehabilitation, Trousseau Hospital, Paris, France
| | - Charlotte Maurin
- Department of Urology, University of Marseille, Marseille, France
| | | | - Ourdia Bouali
- Department of Pediatric Surgery, University of Toulouse, Toulouse, France
| | | | - Alexis Arnaud
- Department of Pediatric Surgery, University of Rennes, Rennes, France
| | | | - Agnès Liard
- Department of Pediatric Surgery, University of Rouen, Rouen, France
| | - Gilles Karsenty
- Department of Urology, University of Marseille, Marseille, France
| | - Andrea Manunta
- Department of Urology, University of Rennes, Rennes, France
| | - Xavier Game
- Department of Urology, University of Toulouse, Toulouse, France
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Liu YP, Rajamanikham V, Baron M, Patel S, Mathur SK, Schwantes EA, Ober C, Jackson DJ, Gern JE, Lemanske RF, Smith JA. Association of ORMDL3 with rhinovirus-induced endoplasmic reticulum stress and type I Interferon responses in human leucocytes. Clin Exp Allergy 2017; 47:371-382. [PMID: 28192616 DOI: 10.1111/cea.12903] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/11/2017] [Accepted: 02/06/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Children with risk alleles at the 17q21 genetic locus who wheeze during rhinovirus illnesses have a greatly increased likelihood of developing childhood asthma. In mice, overexpression of the 17q21 gene ORMDL3 leads to airway remodelling and hyperresponsiveness. However, the mechanisms by which ORMDL3 predisposes to asthma are unclear. Previous studies have suggested that ORMDL3 induces endoplasmic reticulum (ER) stress and production of the type I interferon (IFN)-regulated chemokine CXCL10. OBJECTIVE The purpose of this study was to determine the relationship between ORMDL3 and rhinovirus-induced ER stress and type I IFN in human leucocytes. METHODS ER stress was monitored by measuring HSPA5, CHOP and spliced XBP1 gene expression, and type I IFN by measuring IFNB1 (IFN-β) and CXCL10 expression in human cell lines and primary leucocytes following treatment with rhinovirus. Requirements for cell contact and specific cell type in ORMDL3 induction were examined by transwell assay and depletion experiments, respectively. Finally, the effects of 17q21 genotype on the expression of ORMDL3, IFNB1 and ER stress genes were assessed. RESULTS THP-1 monocytes overexpressing ORMDL3 responded to rhinovirus with increased IFNB1 and HSPA5. Rhinovirus-induced ORMDL3 expression in primary leucocytes required cell-cell contact, and induction was suppressed by plasmacytoid dendritic cell depletion. The degree of rhinovirus-induced ORMDL3, HSPA5 and IFNB1 expression varied by leucocyte type and 17q21 genotype, with the highest expression of these genes in the asthma-associated genotype. CONCLUSIONS AND CLINICAL RELEVANCE Multiple lines of evidence support an association between higher ORMDL3 and increased rhinovirus-induced HSPA5 and type I IFN gene expression. These associations with ORMDL3 are cell type specific, with the most significant 17q21 genotype effects on ORMDL3 expression and HSPA5 induction evident in B cells. Together, these findings have implications for how the interaction of increased ORMDL3 and rhinovirus may predispose to asthma.
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Affiliation(s)
- Y-P Liu
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - V Rajamanikham
- Department of Biostatistics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - M Baron
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - S Patel
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - S K Mathur
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - E A Schwantes
- Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - C Ober
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - D J Jackson
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - J E Gern
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - R F Lemanske
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - J A Smith
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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De Vergie S, Gaschignard N, Baron M, Branchereau J, Luyckx F, Butel T, Perrouin-Verbe MA, Bouchot O, Rigaud J. [Long-term outcomes of prostate cancer patients with lymph nodes metastasis after radical prostatectomy and pelvic lymph node dissection]. Prog Urol 2017; 28:25-31. [PMID: 29221663 DOI: 10.1016/j.purol.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 07/09/2017] [Revised: 09/29/2017] [Accepted: 10/19/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate biochemical recurrence-free survival (RFS) and to identify useful predictors of such survival in localized prostate cancer patients (cN0) and pelvic lymph node metastasis (pN+) treated with radical prostatectomy and pelvic lymph node dissection. PATIENTS AND METHODS This multicenter and retrospective study, assessed overall survival (OS), cancer specific survival (CSS) and biochemical recurrence-free survival (RFS), between January 2005 until December 2010 with 5 years of distance. We evaluated factors predicting long-term RFS in node positive prostate cancer patients. RESULTS Thus, 30 patients were included. Median follow-up was 89.9±27.4 months. After surgery, patients were treated with surveillance (n=4, 13.5%), adjuvant hormone therapy (n=22, 73%) or combination of radio and hormone therapy, (n=4, 13.5%). During the follow-up, 50% of patients had biochemical recurrence, with a mean time period of 38±30 months. Five and 10-year RFS were 57% and 41% respectively. Extra lymph nodes extension (P=0.00021) and pathological margin status (P=0.0065) were independent predictors of 5-year RFS. CONCLUSION Biochemical RFS of patients treated with radical prostatectomy and subclinical lymph node metastatic disease is adequate and multifactorial. However, this study identifies pathological margin status and extra lymph node extension as independent factors of b RFS. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- S De Vergie
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - N Gaschignard
- Service d'urologie, centre hospitalier de la Roche/Yon, 85000 La Roche/Yon, France
| | - M Baron
- Service d'urologie, centre hospitalier de Saint-Nazaire, 44600 Saint-Nazaire, France
| | - J Branchereau
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F Luyckx
- Service d'urologie, centre hospitalier de la Roche/Yon, 85000 La Roche/Yon, France
| | - T Butel
- Service d'oncologie pédiatrique, institut Gustave-Roussy, 94805 Villejuif, France
| | - M-A Perrouin-Verbe
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - O Bouchot
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - J Rigaud
- Service d'urologie, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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Malval B, Rebibo JD, Baron M, Nouhaud FX, Pfister C, Cornu JN, Grise P. Long-term outcomes of I-Stop TOMS™ male sling implantation for post-prostatectomy incontinence management. Prog Urol 2017; 27:1084-1090. [DOI: 10.1016/j.purol.2017.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
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Baron M, Atmani K, Gourcerol G. Effet de la sensibilisation vésicale et de la stimulation nociceptive colique sur l’activation chronique des centres neuronaux médullaires chez la souris. Prog Urol 2017. [DOI: 10.1016/j.purol.2017.07.165] [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: 11/25/2022]
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