1
|
Cordani R, Lopez R, Barateau L, Chenini S, Nobili L, Dauvilliers Y. Somnambulism. Sleep Med Clin 2024; 19:43-54. [PMID: 38368068 DOI: 10.1016/j.jsmc.2023.10.001] [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] [Indexed: 02/19/2024]
Abstract
Somnambulism, also called sleepwalking, classified as a non-rapid eye movement sleep parasomnia, encompasses a range of abnormal paroxysmal behaviors, leading to sleepwalking in dissociated sleep in an altered state of consciousness with impaired judgment and configuring a kind of hierarchical continuum with confusional arousal and night terror. Despite being generally regarded as a benign condition, its potential severity entails social, personal, and even forensic consequences. This comprehensive review provides an overview on the current state of knowledge, elucidating the phenomenon of somnambulism and encompassing its clinical manifestations and diagnostic approaches.
Collapse
Affiliation(s)
- Ramona Cordani
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Regis Lopez
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Lucie Barateau
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Sofiene Chenini
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France
| | - Lino Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Yves Dauvilliers
- Department of Neurology, Sleep-Wake Disorders Unit, Gui-de-Chauliac Hospital, CHU Montpellier, INSERM Institute of Neurosciences of Montpellier, University of Montpellier, France.
| |
Collapse
|
2
|
Lopez R, Micoulaud-Franchi JA, Peter-Derex L, Dauvilliers Y. Nocturnal agitation: From sleep state dissociation to sleep-related dissociative state. Rev Neurol (Paris) 2023; 179:675-686. [PMID: 37625976 DOI: 10.1016/j.neurol.2023.07.003] [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: 07/20/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023]
Abstract
Nocturnal agitation refers to a broad spectrum of symptoms from simple movements to aggressive behaviors with partial or complete loss of awareness. An accurate identification of its etiology is critical for appropriate therapeutic intervention. In children and young adults, distinguishing between non-rapid eye movement (NREM) sleep parasomnias and psychogenic non-parasomniac manifestations, a condition known as sleep-related dissociative disorder (SRDD), can be challenging. This review aims to summarize current clinical, neurophysiological, and epidemiological knowledge on NREM parasomnia and SRDD, and to present the pathophysiological hypotheses underlying these nocturnal manifestations. Sleepwalking, sleep terror and confusional arousals are the three main presentations of NREM parasomnias and share common clinical characteristics. Parasomniac episodes generally occur 30minutes to three hours after sleep-onset, they are usually short, lasting no more than few minutes and involve non-stereotyped, clumsy behaviors with frequent amnesia. The prevalence of NREM parasomnia decreases from 15-30% in children to 2-4% in adults. Parasomniac episodes are incomplete awakening from the deepest NREM sleep and are characterized by a dissociated brain activity, with a wake-like activation in motor and limbic structures and a preserved sleep in the fronto-parietal regions. SRDD is a less known condition characterized by dramatic, often very long episodes with frequent aggressive and potentially dangerous behaviors. SRDD episodes frequently occur in quiet wakefulness before falling asleep. These dissociative manifestations are frequently observed in the context of psychological trauma. The pathophysiology of SRDD is poorly understood but could involve transient changes in brain connectivity due to labile sleep-wake boundaries in predisposed individuals. We hypothesize that SRDD and NREM parasomnia are forms of sleep-related dissociative states favored by a sleep-wake state dissociation during sleep-onset and awakening process, respectively.
Collapse
Affiliation(s)
- R Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy-Rare hypersomnias, Sleep Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France.
| | - J-A Micoulaud-Franchi
- Service Universitaire de médecine du Sommeil, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; UMR CNRS 6033 SANPSY, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - L Peter-Derex
- Center for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Lyon Neuroscience Research Center, PAM Team, Inserm U1028, CNRS UMR 5292, Lyon, France
| | - Y Dauvilliers
- National Reference Centre for Orphan Diseases, Narcolepsy-Rare hypersomnias, Sleep Unit, Department of Neurology, CHU de Montpellier, University of Montpellier, Montpellier, France; Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France
| |
Collapse
|
3
|
Peter-Derex L, Micoulaud-Franchi JA, Lopez R, Barateau L. Evaluation of hypersomnolence: From symptoms to diagnosis, a multidimensional approach. Rev Neurol (Paris) 2023; 179:715-726. [PMID: 37563022 DOI: 10.1016/j.neurol.2023.07.004] [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: 07/02/2023] [Revised: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 08/12/2023]
Abstract
Hypersomnolence is a major public health issue given its high frequency, its impact on academic/occupational functioning and on accidentology, as well as its heavy socio-economic burden. The positive and aetiological diagnosis is crucial, as it determines the therapeutic strategy. It must consider the following aspects: i) hypersomnolence is a complex concept referring to symptoms as varied as excessive daytime sleepiness, excessive need for sleep, sleep inertia, or drowsiness, all of which warrant specific dedicated investigations; ii) the boundary between physiological and abnormal hypersomnolence is blurred, since most symptoms can be encountered in the general population to varying degrees without being considered as pathological, meaning that their severity, frequency, context of occurrence and related impairment need to be carefully assessed; iii) investigation of hypersomnolence relies on scales/questionnaires as well as behavioural and neurophysiological tests, which measure one or more dimensions, keeping in mind the possible discrepancy between objective and subjective assessment; iv) aetiological reasoning is driven by knowledge of the main sleep regulation mechanisms, epidemiology, and associated symptoms. The need to assess hypersomnolence is growing, both for its management, and for assessing the efficacy of treatments. The landscape of tools available for investigating hypersomnolence is constantly evolving, in parallel with research into sleep physiology and technical advances. These investigations face the challenges of reconciling subjective perception and objective data, making tools accessible to as many people as possible and predicting the risk of accidents.
Collapse
Affiliation(s)
- L Peter-Derex
- Centre for Sleep Medicine and Respiratory Diseases, Croix-Rousse Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon, France; Lyon Neuroscience Research Centre, PAM Team, INSERM U1028, CNRS UMR 5292, Lyon, France.
| | - J-A Micoulaud-Franchi
- Service Universitaire de médecine du Sommeil, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; UMR CNRS 6033 SANPSY, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - R Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France; Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France; Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - L Barateau
- National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France; Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, Montpellier, France; Institute of Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| |
Collapse
|
4
|
Pozzi SA, He Z, Hutchinson J, Jovanovic I, Lopez R, Ogren K, Nattress J, Shy D, Clarke SD. Detecting and characterizing special nuclear material for nuclear nonproliferation applications. Sci Rep 2023; 13:10432. [PMID: 37369729 DOI: 10.1038/s41598-023-36171-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
There is an urgent need for new, better instrumentation and techniques for detecting and characterizing special nuclear material (SNM), i.e., highly enriched uranium and plutonium. The development of improved instruments and techniques requires experiments performed with the SNM itself, which is of limited availability. This paper describes the findings of experiments performed at the National Criticality Experiments Research Center conducted using new instruments and techniques on unclassified, kg-quantity SNM objects. These experiments, performed in the framework of the Department of Energy, National Nuclear Security Administration Consortium for Monitoring, Technology, and Verification, focused on detecting, characterizing, and localizing SNM samples with masses ranging from 3.3 to 13.8 kg, including plutonium and highly enriched uranium using prototype detectors and techniques. The work demonstrates SNM detection and characterization using recently-developed prototype detection systems. Specifically, we present new results in passive detection and imaging of plutonium and uranium objects using gamma-ray and dual particle (fast neutron and gamma-ray) imaging. We also present a new analysis of the delayed neutron emissions during active interrogation of uranium using a neutron generator.
Collapse
Affiliation(s)
- S A Pozzi
- Department of Nuclear Engineering and Radiological Sciences, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - Z He
- Department of Nuclear Engineering and Radiological Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - J Hutchinson
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - I Jovanovic
- Department of Nuclear Engineering and Radiological Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - R Lopez
- Department of Nuclear Engineering and Radiological Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - K Ogren
- Los Alamos National Laboratory, Los Alamos, NM, 87545, USA
| | - J Nattress
- Oak Ridge National Laboratory, Oak Ridge, TN, 37830, USA
| | - D Shy
- Department of Nuclear Engineering and Radiological Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| | - S D Clarke
- Department of Nuclear Engineering and Radiological Sciences, University of Michigan, Ann Arbor, MI, 48109, USA
| |
Collapse
|
5
|
Lewetag RD, Nimani S, Alerni N, Hornyik T, Jacobi SF, Moss R, Menza M, Pilia N, Walz TP, HajiRassouliha A, Perez-Feliz S, Zehender M, Seemann G, Zgierski-Johnston CM, Lopez R, Odening KE. Mechano-electrical interactions and heterogeneities in wild-type and drug-induced long QT syndrome rabbits. J Physiol 2023. [PMID: 37082830 DOI: 10.1113/jp284604] [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: 02/27/2023] [Accepted: 04/18/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Electromechanical reciprocity - comprising electro-mechanical (EMC) and mechano-electric coupling (MEC) - provides cardiac adaptation to changing physiological demands. Understanding electromechanical reciprocity and its impact on function and heterogeneity in pathological conditions - such as (drug-induced) acquired long QT syndrome (aLQTS) - might lead to novel insights in arrhythmogenesis. Our aim is to investigate how electrical changes impact on mechanical function (EMC) and vice versa (MEC) under physiological conditions and in aLQTS. METHODS To measure regional differences in EMC and MEC in vivo, we used tissue phase mapping cardiac MRI and 24-lead ECG vest in healthy (control) and IKr -blocker E-4031-induced aLQTS rabbit hearts. MEC was studied in vivo by acutely increasing cardiac preload, and ex vivo by using voltage optical mapping in beating hearts at different preloads. RESULTS In aLQTS, electrical repolarization (heart rate corrected RT-interval, RTn370) was prolonged compared to control (p<0.0001) with increased spatial and temporal RT heterogeneity (p<0.01). Changing electrical function (in aLQTS) resulted in significantly reduced diastolic mechanical function and prolonged contraction duration (EMC), causing increased apico-basal mechanical heterogeneity. Increased preload acutely prolonged RTn370 in both control and aLQTS hearts (MEC). This effect was more pronounced in aLQTS (p<0.0001). Additionally, regional RT-dispersion increased in aLQTS. Motion-correction allowed to determine APD-prolongation in beating aLQTS hearts, but limited motion correction accuracy upon preload-changes prevented a clear analysis of MEC ex vivo. CONCLUSION Mechano-induced RT-prolongation and increased heterogeneity were more pronounced in aLQTS than in healthy hearts. Acute MEC effects may play an additional role in LQT-related arrhythmogenesis, warranting further mechanistic investigations. KEY POINT SUMMARY Electromechanical reciprocity - comprising excitation-contraction coupling (EMC) and mechano-electric feedback loops (MEC) - is essential for physiological cardiac function. Alterations in electrical and/or mechanical heterogeneity are known to have potentially pro-arrhythmic effects. In this study, we aimed to investigate how electrical changes impact on the mechanical function (EMC) and vice versa (MEC) - both under physiological conditions (control) and in acquired long QT syndrome (aLQTS). We show that changing the electrical function (in aLQTS) results in significantly altered mechanical heterogeneity via EMC and - vice versa - that increasing the preload acutely prolongs repolarization duration and increases electrical heterogeneity, particularly in aLQTS as compared to control. Our results substantiate the hypothesis that LQTS is an 'electro-mechanical' - rather than a 'purely electrical' - disease and suggest that acute MEC effects may play an additional role in LQT-related arrhythmogenesis. Abstract figure legend Electromechanical reciprocity in healthy (control) and acquired long QT syndrome (aLQTS) rabbit hearts. A.-B. Electrical alteration in aLQTS. A. Exemplary ECG traces demonstrating IKr -blocker E-4031-induced RT prolongation in aLQTS. B. Visualization of heart rate corrected RTn370 (each color-coded scale includes 20ms) on rabbits' torso in aLQTS compared to control (n = 6 each). C. Electro-mechanical coupling (EMC). Exemplary myocardial longitudinal velocity curve in base (cm/s) during cardiac cycle in control (blue) and aLQTS (red). Indicated are peak amplitudes (AMPsys, AMPdia) and time-to-diastolic peak (TTPdia). D. Mechano-electrical coupling (MEC). Box plots of preload induced changes in repolarization. Comparison between the timepoints baseline (15 sec before increase in preload) and time of the maximal RTn370 increase peak-preload (around 20 sec after NaCl bolus injection). Heart rate corrected RTn370 demonstrates more pronounced RT-changes in aLQTS compared to control (n = 13 each). This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- R D Lewetag
- Department of Cardiology and Angiology I, University Heart Center Freiburg, University Medical Center Freiburg, Freiburg, Germany
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - S Nimani
- Translational Cardiology, Department of Cardiology and Department of Physiology, University Hospital Bern, Bern, Switzerland
| | - N Alerni
- Translational Cardiology, Department of Cardiology and Department of Physiology, University Hospital Bern, Bern, Switzerland
| | - T Hornyik
- Department of Cardiology and Angiology I, University Heart Center Freiburg, University Medical Center Freiburg, Freiburg, Germany
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Translational Cardiology, Department of Cardiology and Department of Physiology, University Hospital Bern, Bern, Switzerland
| | - S F Jacobi
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Congenital Heart Defects and Pediatric Cardiology, University Heart Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Moss
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Fraunhofer Institute for High-Speed Dynamics, Ernst-Mach-Institute EMI, Freiburg, Germany
| | - M Menza
- Department of Radiology, Medical Physics, University Hospital Freiburg, and Faculty of Medicine, University of Freiburg, Germany
| | - N Pilia
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - T Puig Walz
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen and Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Fraunhofer Institute for High-Speed Dynamics, Ernst-Mach-Institute EMI, Freiburg, Germany
| | | | - S Perez-Feliz
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - M Zehender
- Department of Cardiology and Angiology I, University Heart Center Freiburg, University Medical Center Freiburg, Freiburg, Germany
| | - G Seemann
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C M Zgierski-Johnston
- Institute for Experimental Cardiovascular Medicine, University Heart Center Freiburg - Bad Krozingen and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - R Lopez
- Translational Cardiology, Department of Cardiology and Department of Physiology, University Hospital Bern, Bern, Switzerland
| | - K E Odening
- Department of Cardiology and Angiology I, University Heart Center Freiburg, University Medical Center Freiburg, Freiburg, Germany
- Translational Cardiology, Department of Cardiology and Department of Physiology, University Hospital Bern, Bern, Switzerland
| |
Collapse
|
6
|
Veraza R, Andrijauskaite K, Lopez R, Cano I, Cisneros E, Jessop I, Watt M, Morales Garza M, Elgalad A, Bunegin L. Preclinical Evaluation of the VP.S ENCORE™ Cardiac Preservation Device. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.885] [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: 04/05/2023] Open
|
7
|
Vieyra O, Santiago R, Delgado A, Martinez A, Perez R, Osornio V, Garza G, Lopez R, Trujillo L. Laparoscopic resection of colovesical fistula secondary to diverticular disease in sigmoid colon. Technical aspects of one-stage surgery. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
|
8
|
Barateau L, Lopez R, Chenini S, Rassu A, Mouhli L, Dhalluin C, Jaussent I, Dauvilliers Y. Linking clinical complaints and objective measures of Disrupted Nighttime Sleep in Narcolepsy type 1. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.435] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
9
|
Chenini S, Barateau L, Guiraud L, Rollin M, Lopez R, Jaussent I, Beziat S, Dauvilliers Y. Cognitive strategies to improve symptoms of restless legs syndrome. J Sleep Res 2022; 32:e13794. [PMID: 36447357 DOI: 10.1111/jsr.13794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022]
Abstract
Symptoms of restless legs syndrome are relieved by movement. Whether a cognitive task decreases sensory discomfort remains understudied. We aimed to assess the frequency of patients with restless legs syndrome who report decreased sensory discomfort during cognitive activities, and quantify this decrease during a cognitive task. Three-hundred and fifty-eight consecutive adults with restless legs syndrome (age 55.17 ± 14.62 years; 55.87% women; 27.65% treated) answered the question: "Does the intensity of your restless legs syndrome symptoms decrease when you perform activities other than moving your legs?" rated on a nine-point Likert scale (from fully-agree to totally-disagree). A subgroup of 65 consecutive drug-free patients underwent an 80-min suggested immobilisation test at 20:00 hours to quantify legs discomfort on a visual analogue scale before polysomnography, including 40 patients performing a cognitive task (balloon analogue risk task) from the 60 to 80 min. A total of 130 (36.3%) patients reported a decrease, 158 (44.1%) no decrease, and 70 (19.5%) uncertain changes in severity of restless legs syndrome symptoms during cognitive activities, with a similar proportion whether treated or not. Patients experiencing a decrease had less severe restless legs syndrome symptoms. In the suggested immobilisation test, mixed-effect regression models showed that legs discomfort decreased in patients performing the cognitive task while it continued to increase in those without task, with a larger difference in patients reporting a self-reported decrease in restless legs syndrome during cognitive activities. In conclusion, one-third of patients reported a self-reported decrease of restless legs syndrome symptoms during cognitive activities, this improvement in restless legs syndrome was confirmed during a sustained cognitive task. Cognitive strategies could be implemented for the management of restless legs syndrome.
Collapse
Affiliation(s)
- Sofiene Chenini
- Sleep‐Wake Disorders Unit, Department of Neurology Gui‐de‐Chauliac Hospital, CHU Montpellier Montpellier France
- National Reference Network for Narcolepsy, CHU Montpellier Montpellier France
- Institute for Neurosciences of Montpellier University of Montpellier, INSERM Montpellier France
| | - Lucie Barateau
- Sleep‐Wake Disorders Unit, Department of Neurology Gui‐de‐Chauliac Hospital, CHU Montpellier Montpellier France
- National Reference Network for Narcolepsy, CHU Montpellier Montpellier France
- Institute for Neurosciences of Montpellier University of Montpellier, INSERM Montpellier France
| | - Lily Guiraud
- Sleep‐Wake Disorders Unit, Department of Neurology Gui‐de‐Chauliac Hospital, CHU Montpellier Montpellier France
| | - Marie‐Lou Rollin
- Sleep‐Wake Disorders Unit, Department of Neurology Gui‐de‐Chauliac Hospital, CHU Montpellier Montpellier France
| | - Regis Lopez
- Sleep‐Wake Disorders Unit, Department of Neurology Gui‐de‐Chauliac Hospital, CHU Montpellier Montpellier France
- National Reference Network for Narcolepsy, CHU Montpellier Montpellier France
- Institute for Neurosciences of Montpellier University of Montpellier, INSERM Montpellier France
| | - Isabelle Jaussent
- National Reference Network for Narcolepsy, CHU Montpellier Montpellier France
- Institute for Neurosciences of Montpellier University of Montpellier, INSERM Montpellier France
| | - Severine Beziat
- National Reference Network for Narcolepsy, CHU Montpellier Montpellier France
- Institute for Neurosciences of Montpellier University of Montpellier, INSERM Montpellier France
| | - Yves Dauvilliers
- Sleep‐Wake Disorders Unit, Department of Neurology Gui‐de‐Chauliac Hospital, CHU Montpellier Montpellier France
- National Reference Network for Narcolepsy, CHU Montpellier Montpellier France
- Institute for Neurosciences of Montpellier University of Montpellier, INSERM Montpellier France
| |
Collapse
|
10
|
Marturano M, Ayuso S, Ku D, Raible R, Lopez R, Colavita P, Augenstein V, Heniford BT. OC-011 PREOPERATIVE BOTULINUM TOXIN A INJECTION CAN ACHIEVE SIMILAR OUTCOMES AS COMPONENT SEPARATION TECHNIQUES IN COMPLEX ABDOMINAL WALL RECONSTRUCTION WITH DECREASED MORBIDITY– A PROPENSITY-SCORED MATCHED STUDY. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
CST have been effective in closing large defects but at the sacrifice of fascia and muscle and often increasing complication rates. Preoperative BTA has emerged as an adjunct to aid in fascial closure. Little data exist comparing pre-operative BTA versus CST, and our aim was to do so in a matched study.
Materials & Methods
A 3:1 propensity matched study of patients from a single institution hernia database undergoing AWR from 2016 to 2021 with BTA versus CST was performed based on BMI, defect width, hernia volume, and CDC wound classification. Demographics, operative characteristics, and outcomes were evaluated.
Results
35 BTA vs 105 CST matched patients were analyzed. Hernia defects and volume were large for both the CST and BTA groups (mean size:286.2+179.9cm2vs289.7+162.4cm2;p=0.73) (mean volume:1498.3+2043.4cm3vs2914.7+6539.4cm3;p=0.35). CDC wound classifications were equivalent (CDC3 and 4–39.1%vs40.0%;p=0.97). CST was more frequently performed in European Hernia Society M1 hernias (21% vs 2.9%;p=0.01). The BTA group had fewer surgical site occurrences (SSO) (32.4%vs11.4%;p=0.02) and surgical site infections (SSI) (11.7%vs0%;p=0.04). There was no difference in fascial closure (90.5%vs100%;p=0.11)) or recurrence (12.4%vs2.9%;p=0.10) with similar median follow-up (22.8+29.7vs 9.8+12.7months;p=0.13). In multivariate analysis, BTA was associated with lower rates of SSO (OR=5.3; 95% CI [1.4–34.4]).
Conclusion
There was no difference in fascial closure rates or in hernia recurrence between the two groups. Pre-operative BTA can thereby achieve similar outcomes as CST while concurrently decreasing the frequency of SSO. This similarity in outcomes is upheld when comparing BTA to both ACST and PCST separately.
Collapse
Affiliation(s)
- M Marturano
- Surgery, Carolinas Medical Center , Charlotte , United States
| | - S Ayuso
- Surgery, Carolinas Medical Center , Charlotte , United States
| | - D Ku
- Surgery, Carolinas Medical Center , Charlotte , United States
| | - R Raible
- Radiology, Carolinas Medical Center , Charlotte , United States
| | - R Lopez
- Radiology, Carolinas Medical Center , Charlotte , United States
| | - P Colavita
- Surgery, Carolinas Medical Center , Charlotte , United States
| | - V Augenstein
- Surgery, Carolinas Medical Center , Charlotte , United States
| | - B T Heniford
- Surgery, Carolinas Medical Center , Charlotte , United States
| |
Collapse
|
11
|
Boudhabhay I, Lopez R, Zafrani L, Azoulay E, Darmon M, Mariotte E. Impact de l’hypertension artérielle au cours du purpura thrombotique thrombocytopénique chez les patients en réanimation. Nephrol Ther 2022. [DOI: 10.1016/j.nephro.2022.07.252] [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: 10/14/2022]
|
12
|
Barateau L, Chenini S, Rassu AL, Denis C, Lorber Q, Dhalluin C, Lopez R, Jaussent I, Beziat S, Dauvilliers Y. Changes in Sleep Pattern During the COVID-19 Lockdown in Patients With Narcolepsy, Idiopathic Hypersomnia, and Restless Legs Syndrome. Neurology 2022; 99:e1475-e1485. [PMID: 35918167 DOI: 10.1212/wnl.0000000000200907] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/16/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To explore the first COVID-19 lockdown impact on sleep symptoms in patients with narcolepsy, idiopathic hypersomnia (IH) and restless legs syndrome (RLS). METHODS Between March and May 2020, a sample of adult patients regularly followed-up in a Reference Hospital Sleep Unit (299 with narcolepsy, 260 with IH, 254 with RLS) was offered an online survey assessing their sleep-wake habits, daily activities, medication intake, and validated scales: International RLS Study Group questionnaire, Narcolepsy Severity Scale (NSS), IH Severity Scale (IHSS), Epworth Sleepiness Scale (ESS), Insomnia Severity Index, Beck Depression Inventory-II, and European Quality of Life (QoL) scale. The survey was proposed once, and the questions were answered for the pre-lockdown (recall of the month before the confinement) and the lockdown (time of study) periods. RESULTS Overall, 331 patients completed the survey (response rate 40.7%): 102 with narcolepsy, 81 with IH and 148 with RLS. All patients reported later bedtimes, with reduced differences for time in bed (TIB) and total sleep time (TST) over-24h between weekdays and weekends. Narcoleptic patients spent more TIB and increased TST overnight, with more daytime napping. They had more awakenings, higher ESS scores, lower QoL, and no NSS changes. IH patients had also increased TIB, TST overnight and 24-h on weekdays. Nocturnal sleep latency and number of awakenings increased, but with no change in ESS, QoL, and IHSS scores. RLS patients reported a longer nocturnal sleep latency, more awakenings, more naps, a decreased TIB and TST overnight. RLS severity increased while QoL decreased. A significant portion of patients reported disease worsening during lockdown (narcolepsy:39.4%, IH:43.6%, RLS:32.8%), and some patients stopped or lowered their medication (narcolepsy:22.5%, IH:28%, RLS:9.5%). CONCLUSION During the lockdown, all patients reported later bedtimes; those with narcolepsy and IH extended their sleep duration unlike RLS patients. These changes were often associated with negative consequences on QoL. In the current context of recurrent COVID-19 waves, the recent development of teleconsultations should enable physicians to monitor patients with chronic sleep disorders more closely, to recommend optimized sleep schedules and duration, in order to prevent psychological problems and improve their QoL.
Collapse
Affiliation(s)
- Lucie Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France .,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France.,Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - Sofiene Chenini
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
| | - Anna Laura Rassu
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France
| | - Claire Denis
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
| | - Quentin Lorber
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
| | - Cloé Dhalluin
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
| | - Regis Lopez
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France.,Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - Isabelle Jaussent
- Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - Séverine Beziat
- Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France.,National Reference Centre for Orphan Diseases, Narcolepsy, Idiopathic Hypersomnia, and Kleine-Levin Syndrome, Montpellier, France.,Institute for Neurosciences of Montpellier, University of Montpellier, INSERM, Montpellier, France
| |
Collapse
|
13
|
Marsol-Vall A, Ainsa S, Lopez R, Ferreira V. Development and validation of a method for the analysis of halophenols and haloanisoles in cork bark macerates by stir bar sorptive extraction heart-cutting two-dimensional gas chromatography negative chemical ionization mass spectrometry. J Chromatogr A 2022; 1673:463186. [DOI: 10.1016/j.chroma.2022.463186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022]
|
14
|
Weibel S, Bicego F, Muller S, Martz E, Costache ME, Kraemer C, Bertschy G, Lopez R, Weiner L. Two Facets of Emotion Dysregulation Are Core Symptomatic Domains in Adult ADHD: Results from the SR-WRAADDS, a Broad Symptom Self-Report Questionnaire. J Atten Disord 2022; 26:767-778. [PMID: 34189990 DOI: 10.1177/10870547211027647] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Emotional dysregulation (ED) in adult ADHD is frequent but definition and tools for its evaluation are not consensual. Our aim was to determine the core ADHD symptomatic domains via the Self-Reported Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS) following its validation in a large clinical sample of adults with ADHD and controls. METHOD Three hundred sixty-nine adult patients with ADHD and 251 healthy participants completed the SR-WRAADDS and questionnaires about ADHD, depression, and ED. We analyzed the psychometric properties of the SR-WRAADDS and a factor analysis yielded symptomatic domains. RESULTS The SR-WRAADDS has good reliability. The 30 symptoms were best organized in a four-factor solution: attention/disorganization, hyperactivity/restlessness, impulsivity/emotional outbursts, and emotional lability. CONCLUSIONS The symptomatic structure of the SR-WRAADDS includes two distinct dimensions related to ED: "impulsivity/emotional outbursts" and "emotional lability." The SR-WRAADDS is a reliable and clinically useful tool that assesses all ADHD symptom domains, including facets of ED.
Collapse
Affiliation(s)
- Sébastien Weibel
- University Hospital of Strasbourg, France.,Inserm U1114, Strasbourg, France
| | | | | | | | | | - Charlotte Kraemer
- University Hospital of Strasbourg, France.,Private Practice, Strasbourg, France
| | - Gilles Bertschy
- University Hospital of Strasbourg, France.,Inserm U1114, Strasbourg, France
| | - Regis Lopez
- National Reference Centre for Orphan Diseases, Narcolepsy- Rare hypersomnias, Sleep Unit, Department of Neurology, CHU Montpellier, Univ Montpellier, Montpellier, France; University of Montpellier, France
| | - Luisa Weiner
- University Hospital of Strasbourg, France.,Laboratoire de psychologie des cognition, University of Strasbourg, France
| |
Collapse
|
15
|
Macmurdo M, Lopez R, Udeh BL, Zein J. Beyond tobacco - the secondary impact of substance misuse in chronic obstructive lung disease. J Asthma 2022; 59:223-229. [PMID: 33158365 PMCID: PMC8353598 DOI: 10.1080/02770903.2020.1847932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/01/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
BackgroundChronic obstructive lung disease, specifically chronic asthma and COPD, impacts more than 500 million adults worldwide, and is associated with high healthcare spending and significant disease-related morbidity. While the direct impact of substance use disorder is well documented, little is known about the indirect impact of substance misuse within this patient population. The healthcare cost and indirect morbidity secondary to substance misuse in obstructive lung disease has yet to be quantified.ObjectiveTo determine the indirect impact of substance misuse on disease severity, healthcare utilization and healthcare costs in patients with chronic obstructive lung disease across the United States.MethodsUtilizing data from the 2012-2015 National Readmissions Database (NRD) patients with a diagnosis of COPD or asthma were identified. Documented substance misuse, rates of hospitalization, frequency of hospital readmission, markers of admission severity and cost were assessed utilizing weighted regression analysis.ResultsA total of 1,087,226 patients with an index admission for asthma or COPD were identified. Substance misuse was documented in 4.0% of patients. Substance misuse was associated with a 30% increase in odds of readmission and a higher cost per index admission. The additional index admission costs totaled $24 million for our cohort.Conclusion Substance misuse is associated with an increase in healthcare utilization and healthcare cost in patients with chronic obstructive lung disease. Targeting substance misuse in this patient population has the potential for significant cost savings to the healthcare system.
Collapse
Affiliation(s)
- M Macmurdo
- Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA
| | - R Lopez
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - B L Udeh
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Neurological Institute Center for Outcomes Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J Zein
- Cleveland Clinic, Respiratory Institute, Cleveland, Ohio, USA
| |
Collapse
|
16
|
Leu-Semenescu S, Maranci JB, Lopez R, Drouot X, Dodet P, Gales A, Groos E, Barateau L, Franco P, Lecendreux M, Dauvilliers Y, Arnulf I. Comorbid parasomnias in narcolepsy and idiopathic hypersomnia: more REM than NREM parasomnias. J Clin Sleep Med 2022; 18:1355-1364. [PMID: 34984974 PMCID: PMC9059608 DOI: 10.5664/jcsm.9862] [Citation(s) in RCA: 2] [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] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess the frequency, determinants and clinical impact of clinical NREM and REM parasomnias in adult patients with narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH) compared to healthy controls. METHODS Familial and past and current personal parasomnias were assessed by questionnaire and medical interviews in 710 patients (220 NT1, 199 NT2, and 221 IH) and 595 healthy controls. RESULTS Except for sleep-related eating disorder (SRED), current NREM parasomnias were rare in all patient groups and controls. SRED was more frequent in NT1 patients (7.9%, vs. 1.8% in NT2 patients, 2.1% in IH patients and 1% in controls) and associated with disrupted nighttime sleep (odds ratio [OR] = 3.9) and nocturnal eating in full awareness (OR = 6.9) but not with sex. Clinical REM sleep behavior disorder (RBD) was more frequent in NT1 patients (41.4%, half being violent) than in NT2 patients (13.2%) and affected men more often than women (OR = 2.4). It was associated with disrupted nighttime sleep, depressive symptoms and antidepressant use. Frequent (>1/week) nightmares were reported by 39% of patients with NT1, 29% with NT2 and 27.8% with IH (vs. 8.3% in controls) and were associated with depressive symptoms in narcolepsy. No parasomnia (except sleep-related hallucinations) worsened daytime sleepiness. CONCLUSIONS In patients with central disorders of hypersomnolence, comorbid NREM parasomnias (except SRED) are rare and do not worsen sleepiness. In contrast, REM parasomnias are prevalent (especially in NT1) and associated with male sex, disrupted nighttime sleep, depressive symptoms and antidepressant use.
Collapse
Affiliation(s)
- Smaranda Leu-Semenescu
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Jean-Baptiste Maranci
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sorbonne University, Paris, France
| | - Regis Lopez
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier.,Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Xavier Drouot
- Clinical Neurophysiology Department, La Miletrie University Hospital, Poitiers, France
| | - Pauline Dodet
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Ana Gales
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Elisabeth Groos
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome
| | - Lucie Barateau
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier.,Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Patricia Franco
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Pediatric Sleep Unit, Mother-Children Hospital, Hospices Civils de Lyon, University Lyon1, France, Integrative Physiology of Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, University Lyon 1, Lyon, France
| | - Michel Lecendreux
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Pediatric Sleep Center, Hospital Robert-Debré, AP-HP, Paris, France
| | - Yves Dauvilliers
- National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sleep Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier.,Institute for Neurosciences of Montpellier (INM), Montpellier University, INSERM, Montpellier, France
| | - Isabelle Arnulf
- Sleep Disorders, Pitié-Salpêtrière University Hospital, AP-HP-Sorbonne, F-75013 Paris, France.,National Reference Center for Orphan Diseases, Narcolepsy, Idiopathic hypersomnia and Kleine-Levin Syndrome.,Sorbonne University, Paris, France
| |
Collapse
|
17
|
Chenini S, Barateau L, Guiraud L, Denis C, Rassu AL, Lopez R, Jaussent I, Dauvilliers Y. Depressive Symptoms and Suicidal Thoughts in Restless Legs Syndrome. Mov Disord 2022; 37:812-825. [PMID: 34985142 DOI: 10.1002/mds.28903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Whether depression and suicide thoughts relate to restless legs syndrome (RLS) or comorbidities associated with RLS remain unclear. OBJECTIVES To determine frequency of depressive symptoms and suicidal thoughts in patients with RLS and their change after RLS treatment, associated clinical and polysomnographic factors, and current major depressive episode (MDE) frequency and suicide risk in RLS. METHODS Overall, 549 untreated patients with RLS and 549 age-, sex-, and education level-matched controls completed a standardized evaluation, including the Beck Depression Inventory-II that has one item on suicide thoughts. Patients underwent a polysomnographic recording and completed the Urgency, Premeditation, Perseverance, Sensation Seeking Impulsive Behavior scale. In a subgroup of 153 patients, current MDE and suicide risk were assessed with the face-to-face Mini-International Neuropsychiatric Interview (MINI). A subgroup of 152 patients were evaluated in untreated and treated conditions. RESULTS The frequency of depressive symptoms (32.5%) and suicidal thoughts (28%) was 10-fold and 3-fold higher, respectively, in patients with RLS than controls. Current MDE (10.5%) and suicidal risk (19.9%) (MINI) were also high. Moderate-to-severe depressive symptoms were associated with young age, female sex, insomnia symptoms, and urgency dimension. The suicide risk was associated with depression, impulsiveness, and RLS severity. RLS treatment improved depressive symptoms but not suicidal thoughts. CONCLUSION The rate of depressive symptoms, depression, and suicidal thoughts/risk was higher in patients with RLS, with key associations with insomnia symptoms, urgency dimension, and RLS severity. These results emphasize the importance of detecting these symptoms in current practice and of evaluating their change after treatment, especially in young women, to improve RLS management. © 2022 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Sofiene Chenini
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France.,National Reference Network for Narcolepsy, CHU Gui de Chauliac, Montpellier, France.,INM, Université de Montpellier, INSERM, Montpellier, France
| | - Lucie Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France.,National Reference Network for Narcolepsy, CHU Gui de Chauliac, Montpellier, France.,INM, Université de Montpellier, INSERM, Montpellier, France
| | - Lily Guiraud
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Claire Denis
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France
| | - Ana Laura Rassu
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France.,National Reference Network for Narcolepsy, CHU Gui de Chauliac, Montpellier, France.,INM, Université de Montpellier, INSERM, Montpellier, France
| | - Regis Lopez
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France.,National Reference Network for Narcolepsy, CHU Gui de Chauliac, Montpellier, France.,INM, Université de Montpellier, INSERM, Montpellier, France
| | - Isabelle Jaussent
- National Reference Network for Narcolepsy, CHU Gui de Chauliac, Montpellier, France.,INM, Université de Montpellier, INSERM, Montpellier, France
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU, Montpellier, France.,National Reference Network for Narcolepsy, CHU Gui de Chauliac, Montpellier, France.,INM, Université de Montpellier, INSERM, Montpellier, France
| |
Collapse
|
18
|
Lopez R, Snair M, Arrigain S, Schold JD, Hustey F, Walker LE, Phelan MP. Sex-based differences in timely emergency department evaluations for patients with drug poisoning. Public Health 2021; 199:57-64. [PMID: 34560476 DOI: 10.1016/j.puhe.2021.08.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/21/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Unintentional poisoning was the leading cause of injury-related death in the United States in 2017. Prescribed and illicit drugs are the most common cause of poisoning, and timely management in the emergency department (ED) is important. Our aim was to identify any disparities in wait times associated with sex for drug poisoning-related ED visits. STUDY DESIGN We examined ED visits using data from the 2009-2017 National Hospital Ambulatory Medical Care Survey (NHAMCS). METHODS Drug poisoning-related visits were identified using the International Classification of Diseases, Ninth or Tenth Revision, Clinical Modification codes. Delayed assessment was defined as wait times exceeding the recommended triage time. Weighted logistic regression was used. RESULTS The average age was 36 years (standard error = 1.1), 54% female, 87% White and 29% had delayed assessment. Most common drugs were psychotropics (45%) and opioids (32%). Adjusting for race, payment source, urgency, multiple drug types and NSAIDs, females who had poisoning by substances other than opioids had 2.1 times higher likelihood of having a delayed assessment compared with males (odds ratio [95% confidence interval]: 2.1 [1.03-4.2]), although there was no difference between sexes among visits with opioid poisoning (P = 0.27). Neither race (P = 0.23) nor payment source (P = 0.22) were associated with delayed assessment, and the sex association was consistent across these groups. CONCLUSIONS Females with non-opioid drug poisoning were more likely to have delayed assessment than men. None of the other demographic factors demonstrated a correlation. Identifying more populations vulnerable to delays in the ED can help guide the development of interventions and policies to expedite care and attenuate existing disparities.
Collapse
Affiliation(s)
- R Lopez
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - M Snair
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - S Arrigain
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - J D Schold
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - F Hustey
- Center for Emergency Medicine, Emergency Services Institute, Cleveland Clinic, Cleveland, OH, USA
| | - L E Walker
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
| | - M P Phelan
- Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Center for Emergency Medicine, Emergency Services Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
19
|
Prevost A, Cavallier Z, Alshehri S, Delanoe F, Lauwers F, Lopez R. The external jugular vein axis: a new anatomical landmark for pre-operative prediction of the location of parotid gland tumours. Int J Oral Maxillofac Surg 2021; 51:481-486. [PMID: 34474953 DOI: 10.1016/j.ijom.2021.08.016] [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: 03/05/2021] [Revised: 06/16/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
The relationships between parotid tumours and the facial nerve determine duration of surgical procedure and risks involved. As the division of the facial nerve is not visible using standard imaging techniques, other anatomical landmarks are used to determine the pre-operative location of tumours. This retrospective study aimed to evaluate reliability of the 'external jugular vein axis' compared with other landmarks generally used in imaging, such as the retromandibular vein, Conn's arc, the facial nerve line and the Utrecht line. Forty-eight pre-operative imaging exams of patients who underwent parotid benign tumour surgery between 2010 and 2016 were examined. We determined the location of tumour using the five markers. A pre-operative simulation was compared with the description given by the surgeon intraoperatively, in terms of sensitivity and specificity for each marker. External jugular vein axis and retromandibular vein are the most sensitive markers for locating suprafacial tumours (Se = 1). External jugular vein axis and Conn's arc are the most specific markers for locating suprafacial tumours (Spe = 0.92). External jugular vein axis is reproducible and present on all radiological sections, thereby overcoming any anatomical and nomenclature variations. This landmark appears to be the most representative marker of the dividing branches of the facial nerve.
Collapse
Affiliation(s)
- A Prevost
- Plastic and Maxillo-facial Surgery Department, University Hospital Center of Toulouse, Toulouse, France.
| | - Z Cavallier
- Plastic and Maxillo-facial Surgery Department, University Hospital Center of Toulouse, Toulouse, France
| | - S Alshehri
- Otolaryngology, Head & Neck Surgery, King Khalid University, Kingdom of Saudi Arabia
| | - F Delanoe
- Plastic and Maxillo-facial Surgery Department, University Hospital Center of Toulouse, Toulouse, France
| | - F Lauwers
- Plastic and Maxillo-facial Surgery Department, University Hospital Center of Toulouse, Toulouse, France
| | - R Lopez
- Anatomy Laboratory, Paul Sabatier-Toulouse III University, Toulouse, France
| |
Collapse
|
20
|
Arrighi E, Ruiz de Castilla EM, Peres F, Mejía R, Sørensen K, Gunther C, Lopez R, Myers L, Quijada JG, Vichnin M, Pleasant A. Scoping health literacy in Latin America. Glob Health Promot 2021; 29:78-87. [PMID: 34169760 PMCID: PMC9203673 DOI: 10.1177/17579759211016802] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Studies evaluating the influence of health literacy on patient behavior and outcomes suggest a positive relationship between health literacy and health knowledge, health behaviors, and health status. In Latin American countries, studies assessing health literacy are few, regional, and demonstrate considerable variation, with reported rates of adequate health literacy ranging from 5.0% to 73.3%. In this paper, we examine and explore the state of health literacy and efforts to promote it in Latin America. Key challenges to those efforts include socioeconomic inequality, social/geographic isolation, and cultural-, language-, and policy-related barriers, many of which disproportionately affect indigenous populations and others living in rural areas. Greater use of infographics, videos, and mobile apps may enhance health literacy and patient empowerment, especially when language barriers exist. This paper provides strategies and tools for tailored programming, examples of successful health literacy interventions, and policy recommendations to improve health literacy in Latin America, intending to spur additional discussion and action. Centrally organized collaboration across multiple sectors of society, with community involvement, will enhance health literacy and improve health and well-being across Latin America.
Collapse
Affiliation(s)
- E Arrighi
- Escuela de Pacientes, Buenos Aires, Argentina
| | | | - F Peres
- Sergio Arouca National School of Public Health, Rio de Janeiro, Brazil
| | - R Mejía
- Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina
| | - K Sørensen
- Global Health Literacy Academy, Risskov, Denmark
| | | | - R Lopez
- Merck & Co., Inc., Kenilworth, USA
| | - L Myers
- Merck & Co., Inc., Kenilworth, USA
| | | | | | | |
Collapse
|
21
|
Gallego Valle J, Gil Manso S, Bernaldo de Quiros E, Lopez R, Martinez-Bonet M, Pita A, Pérez-Caballero R, Pardo C, Gil-Jaurena J, Correa-Rocha R, Pion M. TGF-ß1 and IL-2 cytokines do not induce fully functional and stable regulatory T cells from activated thymocytes ex vivo. Cytotherapy 2021. [DOI: 10.1016/s1465324921004370] [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: 11/17/2022]
|
22
|
Bernal O, Lopez R, Montoro E, Avedillo P, Westby K, Ghidinelli M. Introduction and scaling up of new drugs for drug-resistant TB: experiences from the Americas. Int J Tuberc Lung Dis 2021; 24:1058-1062. [PMID: 33126939 DOI: 10.5588/ijtld.20.0111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The number of multidrug-resistant tuberculosis (MDR-TB) cases reported in the Americas has increased by 21.2%, from 3737 in 2016 to 4791 in 2018. The WHO has been recommending changes on the treatment of DR-TB, moving from long-duration treatment with injectables to a short oral regimen with new drugs such as bedaquiline (BDQ) and delamanid (DLM), in selected cases and only under programmatic conditions. Injectables are no longer recommended by the WHO due to lower efficacy and the increasing seriousness of adverse events. The introduction of new oral drugs for DR-TB received a boost with a global donation of BDQ to some eligible countries, which continues with the countries purchasing drugs through the Pan American Health Organization Strategic Fund. The main challenges in the scaling up of new drugs for DR-TB include low DR-TB detection rate, the slow pace in transitioning to molecular testing and delays in the introduction of new oral short regimens for MDR-TB. The Americas need to accelerate the scale up of new oral treatments, improve detection rates, increase molecular diagnosis of resistance, and ensure the registration and introduction of the shorter treatment regimen in national MDR-TB guidelines.
Collapse
Affiliation(s)
- O Bernal
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington DC, USA
| | - R Lopez
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington DC, USA
| | - E Montoro
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington DC, USA
| | - P Avedillo
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington DC, USA
| | - K Westby
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington DC, USA
| | - M Ghidinelli
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization, Washington DC, USA
| |
Collapse
|
23
|
Chenini S, Barateau L, Rassu AL, Lopez R, Guiraud L, Cavaillès C, Jaussent I, Dauvilliers Y. Systematic assessment of autonomic symptoms in restless legs syndrome. Sleep Med 2021; 80:30-38. [PMID: 33548567 DOI: 10.1016/j.sleep.2021.01.017] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To compare the clinical features of autonomic dysfunction using the SCOPA-AUT questionnaire in untreated patients with restless legs syndrome (RLS) with controls, to identify factors associated with more severe autonomic symptoms, and to assess the effect of medication in patients. METHODS The SCOPA-AUT questionnaire that evaluates cardiovascular, gastrointestinal, urinary, thermoregulatory, pupillomotor, and sexual dysfunctions was completed by 409 consecutive untreated patients with RLS (54.1 ± 14.5 y.o; 265 women) and 331 controls (59.0 ± 17.0; 161 women). Clinical and polysomnographic data were assessed in all patients. A subgroup of 57 patients were evaluated a second time after treatment (mostly dopaminergic agonist) after an interval of 0.88 ± 1.42 year. RESULTS Compared to controls, untreated patients with RLS were younger, more often women, obese, with increased cardiovascular diseases (CVD). The SCOPA-AUT total score was higher in patients than controls in unadjusted and adjusted models. Patients had more autonomic symptoms in all subdomains of the scale (except for sexual dysfunction in men). These results were confirmed in a subgroup of 259 cases and age-sex-matched controls. Female gender, obesity, RLS severity, diabetes mellitus, CVD, sleepiness, insomnia and depressive symptoms but neither periodic legs movements during sleep (PLMS) nor objective sleep parameters were associated with high scores. Despite RLS and PLMS improvement, medication did not change total and subdomain scores. CONCLUSIONS Patients with RLS have frequent and large spectrum of autonomic symptoms, without effect of PLMS, sleep fragmentation and medication. These results suggest a global autonomic dysfunction in RLS that should be assessed more systematically in severe patients.
Collapse
Affiliation(s)
- Sofiène Chenini
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; National Reference Network for Narcolepsy, CHU Montpellier, France
| | - Lucie Barateau
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; National Reference Network for Narcolepsy, CHU Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Anna Laura Rassu
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; National Reference Network for Narcolepsy, CHU Montpellier, France
| | - Regis Lopez
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; National Reference Network for Narcolepsy, CHU Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Lily Guiraud
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
| | - Clémence Cavaillès
- Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Isabelle Jaussent
- Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France
| | - Yves Dauvilliers
- Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France; National Reference Network for Narcolepsy, CHU Montpellier, France; Institute for Neurosciences of Montpellier INM, Univ Montpellier, INSERM, Montpellier, France.
| |
Collapse
|
24
|
Pereira F, Lopez R, Brasas M, Alvarez R, Aller A. Synergism between SEM/EDX microanalysis and multivariate analysis for a suitable classification of Roman and Byzantine papyri. Microchem J 2021. [DOI: 10.1016/j.microc.2020.105688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
25
|
Wagner A, Gresh L, Sanchez N, Kuan G, Lopez R, Ojeda S, Balmaseda A, Gordon A. A longitudinal study of influenza among infants in Managua, Nicaragua. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1145] [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: 12/01/2022] Open
|
26
|
Gilbert A, Piazza J, Szecel J, Ancion A, Gensburger M, Lopez R, D'Orio V, Ghuysen A. [Management of emergency department inflows during the COVID-19 outbreak in the CHU of Liege : efficiency of an advanced triage center]. Rev Med Liege 2020; 75:11-17. [PMID: 33211417] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
UNLABELLED In March 2020, the COVID-19 pandemic started to spread among the Belgian territory. Our university hospital was confronted to the very need of specific reorganizations guided by the implementation of the Hospital Emergency Plan.This article aims to describe the experience of the University Hospital of Liège (CHU Liège) during the COVID-19 outbreak and demonstrates the efficiency of advanced triage centers to regulate hospital admissions from the emergency department (ED). METHODS since the beginning of March 2020, the CHU of Liège has implemented specific advanced triage centers to manage patients with SARS-CoV-2 suspected symptoms. The first center was organized inside the hospital but the need of outside structures led to the creation of two centers by the end of March. From March 2 to May 3, data from the different visits at the COVID-19 centers were collected (numbers of admissions, rationale for coming, work up and outcome). RESULTS during the study period, 3,094 patients were admitted to the specific COVID-19 centers of the CHU Liège. This represents 3,431 visits among which 337 were classified as readmission visits. The sensitivity and specificity of the triage centers to determine the need for hospitalization were, respectively, estimated at 87,9 % and 93,4 %. CONCLUSION our experience tends to demonstrate the role of specific COVID-19 triage centers located very close to the EDs aimed at managing COVID-19 suspected patients in order to actually determine their need for subsequent hospitalization.
Collapse
Affiliation(s)
- A Gilbert
- Service des Urgences, CHU Liège, Belgique
| | - J Piazza
- Service des Urgences, CHU Liège, Belgique
| | - J Szecel
- Service des Urgences, CHU Liège, Belgique
| | - A Ancion
- Service des Urgences, CHU Liège, Belgique
| | | | - R Lopez
- Service des Urgences, CHU Liège, Belgique
| | - V D'Orio
- Service des Urgences, CHU Liège, Belgique
| | - A Ghuysen
- Service des Urgences, CHU Liège, Belgique
| |
Collapse
|
27
|
Park JO, Li CP, Chang HM, Shan Y, Bendell J, Garlipp B, Hatoum H, Saez BL, Salminen T, Oettle H, Kocsis J, Lopez R, Dowden S, Karthaus M, Lu B, McGovern D, Banerjee S, Tempero M, Oh DY. 190P Outcomes from the Asian region of the phase III APACT trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) alone for patients (pts) with resected pancreatic cancer (PC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
28
|
Brant A, Batur P, Arrigain S, Lopez R, Farrell R. P55 Demographic and social factors associated with out-of-pocket expenditures for contraceptive prescriptions in the US during medicaid expansion. Contraception 2020. [DOI: 10.1016/j.contraception.2020.07.074] [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]
|
29
|
Crous KY, Campany C, Lopez R, Cano FJ, Ellsworth DS. Canopy position affects photosynthesis and anatomy in mature Eucalyptus trees in elevated CO2. Tree Physiol 2020; 41:tpaa117. [PMID: 32918811 DOI: 10.1093/treephys/tpaa117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/26/2020] [Accepted: 09/10/2020] [Indexed: 06/11/2023]
Abstract
Leaves are exposed to different light conditions according to their canopy position, resulting in structural and anatomical differences with consequences for carbon uptake. While these structure-function relationships have been thoroughly explored in dense forest canopies, such gradients may be diminished in open canopies, and they are often ignored in ecosystem models. We tested within-canopy differences in photosynthetic properties and structural traits in leaves in a mature Eucalyptus tereticornis canopy exposed to long-term elevated CO2 for up to three years. We explored these traits in relation to anatomical variation and diffusive processes for CO2 (i.e., stomatal conductance, gs and mesophyll conductance, gm) in both upper and lower portions of the canopy receiving ambient and elevated CO2. While shade resulted in 13% lower leaf mass per area ratio (MA) in lower versus upper canopy leaves, there was no relationship between leaf Nmass and canopy gap fraction. Both maximum carboxylation capacity (Vcmax) and maximum electron transport (Jmax) were ~ 18% lower in shaded leaves and were also reduced by ~ 22% with leaf aging. In mature leaves, we found no canopy differences for gm or gs, despite anatomical differences in MA, leaf thickness and mean mesophyll thickness between canopy positions. There was a positive relationship between net photosynthesis and gm or gs in mature leaves. Mesophyll conductance was negatively correlated with mean parenchyma length, suggesting that long palisade cells may contribute to a longer CO2 diffusional pathway and more resistance to CO2 transfer to chloroplasts. Few other relationships between gm and anatomical variables were found in mature leaves, which may be due to the open crown of Eucalyptus. Consideration of shade effects and leaf-age dependent responses to photosynthetic capacity and mesophyll conductance are critical to improve canopy photosynthesis models and will improve understanding of long-term responses to elevated CO2 in tree canopies.
Collapse
Affiliation(s)
- K Y Crous
- Hawkesbury Institute for the Environment, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
| | - C Campany
- Hawkesbury Institute for the Environment, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
- Department of Biology, Shepherd University, P.O. Box 5000, Shepherdstown, West Virginia, 25443, USA
| | - R Lopez
- Hawkesbury Institute for the Environment, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
- Departamento de Sistemas y Recursos Naturales, Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - F J Cano
- Hawkesbury Institute for the Environment, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
- ARC Centre of Excellence for Translational Photosynthesis, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
| | - D S Ellsworth
- Hawkesbury Institute for the Environment, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia
| |
Collapse
|
30
|
Chenini S, Rassu AL, Barateau L, Lopez R, Carlander B, Guiraud L, Jaussent I, Dauvilliers Y. Increased Blood Pressure Dipping in Restless Legs Syndrome With Rotigotine: A Randomized Trial. Mov Disord 2020; 35:2164-2173. [PMID: 32875658 DOI: 10.1002/mds.28224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/14/2020] [Revised: 06/06/2020] [Accepted: 07/06/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The objective of this study was to assess the rotigotine effect on the nocturnal blood pressure (BP) dip by 24-hour ambulatory BP monitoring and on endothelial function in patients with restless legs syndrome (RLS) compared with placebo. METHODS In this double-blind, placebo-controlled trial, 76 adult patients with moderate to severe RLS and periodic legs movements in sleep index ≥10/hour were randomized to rotigotine at optimal dose of 3 mg per day or placebo for 6 weeks. A total of 6 patients had a major protocol deviation. Polysomnography, ambulatory BP monitoring, and endothelial function were assessed at baseline and end point. The primary outcome was the between-group difference in the percentage of BP nondipper profiles at end point. The main secondary outcomes were the mean BP dip, periodic legs movements in sleep index, and endothelial function. RESULTS Of the 70 patients (age, 59.4 ± 11.40; 43 women) randomized to rotigotine (n = 34) and placebo (n = 36), 66 (33 rotigotine, 33 placebo) completed the study. The percentage of BP nondippers at end point was higher in the placebo than in the rotigotine group (systolic BP, 72.22% vs 47.06%; diastolic BP, 47.22% vs 20.59%; P < 0.05). Mean BP dip at end point was higher in the rotigotine than in the placebo group (systolic BP, 11.24 ± 6.15 vs 6.12 ± 7.98; diastolic BP, 15.12 ± 7.09 vs 9.36 ± 10.23; P < 0.05). Endothelial function was comparable between the groups. No significant safety concerns were reported with similar incidences of adverse events between groups. CONCLUSION Rotigotine increased the percentage of BP dipper profiles and the BP dip in patients with RLS. Future studies should assess whether this change is associated with a reduction in the long-term cardiovascular risk in RLS. © 2020 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Sofiene Chenini
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France
| | - Anna Laura Rassu
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France
| | - Lucie Barateau
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France.,University of Montpellier, INSERM U1061, Montpellier, France
| | - Regis Lopez
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France.,University of Montpellier, INSERM U1061, Montpellier, France
| | - Bertrand Carlander
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France
| | - Lily Guiraud
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France
| | | | - Yves Dauvilliers
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Univ Montpellier, Montpellier, France.,University of Montpellier, INSERM U1061, Montpellier, France
| |
Collapse
|
31
|
Gomez Cifuentes JD, Thota PN, Lopez R. Lower prevalence of gastroesophageal reflux disease in patients with noncardiac chest pain on opiates: a cross-sectional study. Dis Esophagus 2020; 33:doaa068. [PMID: 32543668 DOI: 10.1093/dote/doaa068] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - P N Thota
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - R Lopez
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
32
|
Spadola CE, Groton D, Lopez R, Burke SL, Hilditch C, Pandey A, Littlewood K, Zhou ES, Bertisch SM. 1166 Investigating Social Workers’ Sleep Health Knowledge: Opportunities to Promote Sleep Health Among Underserved Populations. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Social workers are often front-line psychosocial providers working with underserved populations, many of whom struggle with sleep. They are uniquely positioned to promote sleep health among individuals experiencing health inequities. However, U.S. accredited social work programs do not require sleep health training. We used both quantitative and qualitative methodologies to investigate social work students’: a) sleep health knowledge; b) self-reported sleep quality; c) prior sleep health education; and d) client discussions about sleep, in order to inform the development of a sleep health training for social work students.
Methods
Twenty-five social work students were recruited via a listserv email sent at a Florida university. Participants were asked to complete the Sleep Beliefs Scale (SBS) and the Pittsburgh Sleep Quality Index (PSQI) and then to participate in a one-hour long focus group (3 groups with 6-11 students/group) conducted by experienced qualitative researchers.
Results
Mean age was 27.0±11.5 yrs, 92.0% were female, and 48.0% were non-Hispanic white, 28.0% African American, 16.0% Hispanic, 8.0% other. Only 28.0% indicated that they had ever discussed sleep with clients. Knowledge of healthy sleep behaviors (assessed via the SBS) was moderate on a 0-20 scale (13.88, S.D.= 2.7). Participants had an average PSQI score of 8.8 (SD.=4.0), reported sleeping an average of 6.0 hours (SD=1.6), and mean sleep efficiency of 87.0% (SD=12.0). Themes from focus group data highlight students’ lack of exposure to sleep health training and a dearth of sleep discussions in clinical practice.
Conclusion
Though social work students acknowledged the importance of sleep health promotion, they reported feeling ill-equipped to promote healthy sleep practices due to lack of sleep education. Sleep health training could allow social workers to confidently promote healthy sleep practices among their clients, recognize when appropriate to refer clients for evaluation for sleep disorders, and improve social workers’ own sleep health. An online educational program was subsequently created by study investigators to meet these aims.
Support
American Academy of Sleep Medicine Foundation
Collapse
Affiliation(s)
| | - D Groton
- Florida Atlantic University, Boca Raton, FL
| | - R Lopez
- Florida Atlantic University, Boca Raton, FL
| | - S L Burke
- Florida International University, Miami, FL
| | - C Hilditch
- 3Fatigue Countermeasures Laboratory, San José State University Research Foundation, Moffett Field, CA
| | - A Pandey
- University of South Florida, Tampa, FL
| | | | - E S Zhou
- Divison of Sleep Medicine, Harvard Medical School, Boston, MA
| | - S M Bertisch
- Divison of Sleep Medicine, Harvard Medical School, Boston, MA
| |
Collapse
|
33
|
Spadola C, Groton D, Lopez R, Burke SL, Hilditch CJ, Pandey A, Littlewood K, Zhou ES, Bertisch SM. 1168 Preliminary Impact of a Sleep Health Educational Module for Social Work Students. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1162] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Social workers are well-positioned to promote healthy sleep behaviors among underserved populations; however sleep health training is rarely integrated into social work curriculums. To address this gap, our interdisciplinary team developed a 2-hour online sleep health educational module for social work students. The module was grounded in best e-learning pedagogical principles, and based on qualitative formative research. We tested the initial impact and acceptability of the module.
Methods
We recruited 32 social work students at a Florida University via a departmental listserve. Pre- to post-intervention changes in the Sleep Beliefs Scale (SBS) and the Sleep Practices and Attitudes Questionnaire (SPAQ) were assessed using Wilcoxon Signed-Rank tests. We conducted qualitative research to assess intervention acceptability,and to inform future iterations of the program.
Results
Mean age was 29.5±11.6 yrs, 100% were female, and primarily Non-Hispanic White (41.9%), followed by African American/Black (35.5%), and Hispanic/Latino (22.6%). Results showed pre/post intervention improvements in both the Sleep Beliefs Scale (14.7±2.2 vs.16.9±2.6 [p=.002]; higher score=higher knowledge) and SPAQ (2.1±0.6 to 1.5±0.6 [p=.001]; lower score=higher importance of sleep) indicating improvements in knowledge surrounding healthy sleep behaviors and the importance of sleep for overall health (respectively). Qualitative data supports the intervention’s acceptability and utility. When asked what participants liked best about the module, responses included: “I was educated and am better prepared to offer some insight to my clients and staff”; “..they offer resources we can use for ourselves and our clients;” and “easy to navigage, and full of useful information.” Suggestions for improvement included shortening the module’s length.
Conclusion
Assessment of an online sleep health educational module indicates a promising impact on sleep health knowledge. A larger study is planned to more definitively evaluate the module’s impact and acceptability among social work students.
Support
American Academy of Sleep Medicine Foundation
Collapse
Affiliation(s)
- C Spadola
- Florida Atlantic University, Boca Raton, FL
| | - D Groton
- Florida Atlantic University, Boca Raton, FL
| | - R Lopez
- Florida Atlantic University, Boca Raton, FL
| | - S L Burke
- Florida International University, Miami, FL
| | - C J Hilditch
- San Jose State University Research Foundation, Moffett Field, CA
| | - A Pandey
- University of South Florida, Tampa, FL
| | | | - E S Zhou
- Dana-Farber Cancer Institute and Boston Children’s Hospital, Boston, MA
| | | |
Collapse
|
34
|
Barateau L, Lopez R, Chenini S, Rassu A, Scholz S, Lotierzo M, Cristol J, Jaussent I, Dauvilliers Y. 0750 Nocturnal Sleep Stability and Cerebrospinal Fluid Orexin-A Levels: Sleep and Wake Bouts. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
The orexin (ORX)/hypocretin system stabilizes sleep-wake regulation by sustaining long periods of wakefulness in humans and animals. We aimed to evaluate the relationships between cerebrospinal fluid (CSF) ORX levels and markers of nocturnal sleep stability assessed by polysomnography (PSG) in humans.
Methods
Nocturnal PSG data and CSF ORX levels of 300 drug-free subjects (55% men, 29.9±15.5 years old, mean ORX levels 155.1±153.7 pg/mL) with a complaint of hypersomnolence were collected in the National Reference Center for Narcolepsy, France. Several markers of nocturnal sleep stability were analyzed: wake (WB), sleep bouts (SB), and sleep/wake transitions. Groups were categorized according to ORX levels: two categories (≤110, >110 pg/mL, the current established threshold of ORX-deficiency), and tertiles (≤26,]26;254], >254 pg/mL); and were compared using logistic regression models. Results were adjusted for age, gender and body mass index.
Results
ORX-deficient subjects had more WB, SB, and sleep-wake transitions than the others. The WB duration was longer and the SB duration shorter in ORX-deficient category. The proportion of the shortest WB (30 sec) was lower in the ORX-deficient category whereas the proportion of WB above 1 min 30 sec was higher. The proportion of SB ≤ 14min was higher among ORX-deficient patients, with opposite results for longer SB. Subsequent analyses performed in the population categorized according to tertiles of CSF ORX-A confirmed all these findings, with a strong dose-response effect of ORX levels in post-hoc comparisons. All results remained highly significant in adjusted statistical models.
Conclusion
This study provides a strong evidence of the direct effect of ORX on nocturnal sleep stabilization in humans. WB and SB are reliable markers of nighttime sleep stability, strongly correlated to CSF ORX-A levels in a dose dependent way. These PSG biomarkers are promising to be applied in clinical and research settings.
Support
none
Collapse
Affiliation(s)
- L Barateau
- Sleep Disorder Center, Gui de Chauliac Hospital, Montpellier, FRANCE
| | - R Lopez
- Sleep Disorder Center, Gui de Chauliac Hospital, Montpellier, FRANCE
| | - S Chenini
- Sleep Disorder Center, Gui de Chauliac Hospital, Montpellier, FRANCE
| | - A Rassu
- Sleep Disorder Center, Gui de Chauliac Hospital, Montpellier, FRANCE
| | - S Scholz
- Sleep Disorder Center, Gui de Chauliac Hospital, Montpellier, FRANCE
| | - M Lotierzo
- Department of Biochemistry, Montpellier University Hospital, Montpellier, Montpellier, FRANCE
| | - J Cristol
- Department of Biochemistry, Montpellier University Hospital, Montpellier, Montpellier, FRANCE
| | | | - Y Dauvilliers
- Sleep Disorder Center, Gui de Chauliac Hospital, Montpellier, FRANCE
| |
Collapse
|
35
|
Dauvilliers Y, Barateau L, Lopez R, Rassu AL, Chenini S, Beziat S, Jaussent I. Narcolepsy Severity Scale: a reliable tool assessing symptom severity and consequences. Sleep 2020; 43:5717181. [DOI: 10.1093/sleep/zsaa009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/05/2020] [Indexed: 01/11/2023] Open
Abstract
Abstract
Study Objectives
To define clinically relevant Narcolepsy Severity Scale (NSS) score ranges, confirm its main performances and sensitivity to medications, and determine whether items need to be weighted.
Methods
One hundred and forty-three consecutive untreated and 238 treated adults with narcolepsy type 1 (NT1) completed the NSS, a 15-item self-administered questionnaire (score: 0–57) that assesses the severity and consequences of the five major narcolepsy symptoms such as daytime sleepiness, cataplexy, hallucinations, sleep paralysis, and disturbed nighttime sleep (DNS). They also completed the Epworth Sleepiness scale (ESS; daytime sleepiness), Beck Depression Inventory (BDI; depressive symptoms), and EQ5D (quality of life).
Results
The mean symptom number (4.3 vs 3.5), NSS total score (33.3 ± 9.4 vs 24.3 ± 10.2), and number of narcolepsy symptoms (five symptoms: 53.1% vs 24.8%; four symptoms: 26.6% vs 22.7%; three symptoms: 15.4% vs 32.4%; two symptoms: 4.9% vs 20.2%) were significantly different between untreated and treated patients (p < 0.0001). DNS was often the third symptom (95.5 per cent). The symptom number was associated with diagnosis delay, age at onset, and ESS and BDI scores. Comparisons with ESS, BDI and EQ5D showed that NSS item weighting was not necessary to highlight between-group differences. Four NSS severity levels were defined (mild, moderate, severe, and very severe) with between-group differences related to treatment. The probability of having ESS ≥ 16, BDI ≥ 20, and EQ-5D < 60 increased with the severity level.
Conclusion
NSS is valid, reliable, and responsive to treatment in patients with NT1, with four clinically relevant severity score ranges provided. NSS has adequate clinimetric properties for broadening its use for both clinic and research.
Collapse
Affiliation(s)
- Yves Dauvilliers
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
- INSERM 1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
| | - Lucie Barateau
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
- INSERM 1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
| | - Regis Lopez
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
- INSERM 1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
| | - Anna Laura Rassu
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Sofiene Chenini
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Severine Beziat
- National Reference Network for Narcolepsy, Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, University of Montpellier, Montpellier, France
- INSERM 1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
| | - Isabelle Jaussent
- INSERM 1061, Neuropsychiatry: Epidemiological and Clinical Research, University of Montpellier, Montpellier, France
| |
Collapse
|
36
|
Jaussent I, Evangelista E, Barateau L, Lopez R, Chenini S, Delbos C, Béziat S, Dauvilliers Y. Measurement of symptoms in idiopathic hypersomnia: the idiopathic hypersomnia severity scale. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.480] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Barateau L, Chenini S, Lotierzo M, Rassu A, Evangelista E, Lopez R, Dupuy AG, Jaussent I, Dauvilliers Y. Csf and serum ferritin levels in narcolepsy type 1 comorbid with restless legs syndrome. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.067] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
38
|
Barateau L, Lopez R, Jaussent I, Dauvilliers Y. Nocturnal sleep fragmentation and CSF orexin levels in humans: sleep and wake bouts. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.066] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
39
|
Geoffroy P, Micoulaud Franchi JA, Lopez R, Schroder C. The use of melatonin in adult psychiatric disorders: Expert recommendations by the French institute of medical research on sleep (SFRMS). Encephale 2019; 45:413-423. [DOI: 10.1016/j.encep.2019.04.068] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/08/2019] [Indexed: 12/11/2022]
|
40
|
Rassu AL, Chenini S, Barateau L, Lopez R, Evangelista E, Guiraud L, Jaussent I, Dauvilliers Y. Increased blood pressure during the suggested immobilization test in Restless Legs Syndrome. Sleep 2019; 43:5602988. [DOI: 10.1093/sleep/zsz263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/13/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To investigate the relationship between sensory discomfort/motor component and cardiovascular autonomic response by continuous beat-to-beat blood pressure monitoring (CBPM) during the suggested immobilization test (SIT) in patients with restless legs syndrome (RLS).
Methods
Thirty-two drug-free patients with primary RLS (10 men; mean age 60.29 ± 10.81 years) and 17 healthy controls (2 men; mean age 58.82 ± 11.86 years) underwent a 1-hour SIT starting at 8 pm with concomitant CBPM to measure the heart rate (HR) and systolic/diastolic blood pressure (SBP, DBP). In all subjects, the presence of sensory discomfort and motor component during the SIT (S-SIT+ and M-SIT+, respectively) was quantified. Mixed regression models were used to compare the SBP, DBP, and HR profiles during the SIT by taking into account the repeated measures (6 time periods of 10 minutes).
Results
In patients with S-SIT+ (n = 17), SBP (p < 0.0001), DBP (p = 0.0007), and HR (p = 0.03) increased during the SIT compared with other patients and controls. Seventeen patients had M-SIT+ (none among healthy controls). Classifying patients in 4 groups in function of the presence/absence of the SIT sensory and motor components revealed that SDB and DBP increased throughout the SIT in patients with S-SIT+, independently of the motor component (p < 0.0001 and p = 0.0008 for SBD; p < 0.0001 and p = 0.01 for DBP in the S-SIT+/M-SIT− and S-SIT+/M-SIT+ groups, respectively).
Conclusion
During the SIT, BP concomitantly increased only in patients with RLS and sensory discomfort, with or without motor component. This highlights the link between evening sensory RLS symptoms, autonomic activation, and potential long-term cardiovascular consequences.
Collapse
Affiliation(s)
- Anna Laura Rassu
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Sofiène Chenini
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Lucie Barateau
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Regis Lopez
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Elisa Evangelista
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Lily Guiraud
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
| | - Isabelle Jaussent
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| | - Yves Dauvilliers
- Unité du Sommeil, Centre National de Référence pour la Narcolepsie, CHU Montpellier, Hôpital Gui-de-Chauliac, Service de Neurologie, Montpellier, France
- INSERM, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France
| |
Collapse
|
41
|
Weibel S, Menard O, Ionita A, Boumendjel M, Cabelguen C, Kraemer C, Micoulaud-Franchi JA, Bioulac S, Perroud N, Sauvaget A, Carton L, Gachet M, Lopez R. Practical considerations for the evaluation and management of Attention Deficit Hyperactivity Disorder (ADHD) in adults. Encephale 2019; 46:30-40. [PMID: 31610922 DOI: 10.1016/j.encep.2019.06.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 01/17/2019] [Revised: 05/27/2019] [Accepted: 06/07/2019] [Indexed: 12/12/2022]
Abstract
Attention deficit with or without hyperactivity disorder (ADHD) is one of the most frequent neuropsychiatric disorders, and affects 2-4% of adults. In contrast with many European countries, the identification and management of adult ADHD remains underdeveloped in France, and a subject of controversy. This review provides a practical update on current knowledge about ADHD in adults for French-speaking professionals who have to detect or manage adult patients with ADHD. ADHD is classified as a neurodevelopmental disorder in the recent update of the international diagnostic classification. While symptoms and impairment due to ADHD are frequently severe during childhood, they often evolve as children grow older, with frequent persistent disabilities in adulthood. In adulthood, the clinical presentation, as in childhood, involves the symptom triad of inattention, hyperactivity and impulsivity. However, differences are noted: hyperactivity is more often internalized, symptoms of inattention may be masked by anxiety symptoms or obsessive-like compensation strategies. ADHD is often diagnosed during childhood, but it is not rare for the diagnosis to be made later. Failure to recognise symptoms resulting in misdiagnosis, or alternatively well-developed compensation factors could be two underlying reasons for the long delay until diagnosis. Other symptoms, such as emotional deregulation or executive function-related symptoms are also usually observed in adults. In addition, in adults, ADHD is often associated with other psychiatric disorders (in 80% of cases); this makes the diagnosis even more difficult. These disorders encompass a broad spectrum, from mood disorders (unipolar or bipolar), to anxiety disorders, and other neurodevelopmental disorders and personality disorders, especially borderline and antisocial personality disorder. Substance-use disorders are very common, either as a consequence of impulsivity and emotional dysregulation or as an attempt at self-treatment. Sleep disorders, especially restless leg syndrome and hypersomnolence, could share common pathophysiological mechanisms with ADHD. ADHD and comorbidity-related symptoms are responsible for serious functional impairment, in various domains, leading to academic, social, vocational, and familial consequences. The impact on other psychiatric disorders as an aggravating factor should also be considered. The considerable disability and the poorer quality of life among adults with ADHD warrant optimal evaluation and management. The diagnostic procedure for ADHD among adults should be systematic. Once the positive diagnosis is made, the evaluation enables characterisation of the levels of severity and impairment at individual level. A full examination should also assess medical conditions associated with ADHD, to provide personalized care. In recent years, a growing number of assessment tools have been translated and validated in French providing a wide range of structured interviews and standardized self-report questionnaires for the evaluation of core and associated ADHD symptoms, comorbidities and functional impairment. The treatment of ADHD in adults is multimodal, and aims to relieve the symptoms, limit the burden of the disease, and manage comorbidities. The most relevant and validated psychological approaches are psycho-education, cognitive-behavioural therapy and "third wave therapies" with a specific focus on emotional regulation. Cognitive remediation and neurofeedback are promising strategies still under evaluation. Medications, especially psychostimulants, are effective for alleviating ADHD symptoms with a large effect size. Their safety and tolerance are satisfactory, although their long-term clinical benefit is still under discussion. In France, methylphenidate is the only stimulant available for the treatment of ADHD. Unfortunately, there is no authorization for its use among adults except in continuation after adolescence. Hence the prescription, which is subject to the regulations on narcotics, is off-label in France. This article aims to provide practical considerations for the management of ADHD and associated disorders in adults, in this particular French context.
Collapse
Affiliation(s)
- S Weibel
- Service de psychiatrie 2, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; Inserm U1114, Strasbourg, France; Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France.
| | - O Menard
- Service d'addictologie, Hôpital Fontan 2, CHRU de Lille, 59000 Lille, France
| | - A Ionita
- Clinique du château, Nightingale hospitals Paris, 92380 Garches, France
| | - M Boumendjel
- Équipe de liaison et de soins en addictologie (ELSA), service de psychiatrie et d'addictologie, centre de soin de prévention et d'accompagnement en addictologie (CSAPA), Hôpital André Mignot, 78000 Versailles, France
| | - C Cabelguen
- Unité de neuromodulation et de psychiatrie de liaison, centre ambulatoire pluridisciplinaire de psychiatrie et d'addictologie, Centre Hospitalier Universitaire de Nantes, 44000 Nantes, France
| | - C Kraemer
- Service de psychiatrie 2, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - J-A Micoulaud-Franchi
- Service d'explorations fonctionnelles du système nerveux, clinique du sommeil, CHU de Bordeaux, 33000 Bordeaux, France; CNRS, SANPSY, USR 3413, SANPSY, Université de Bordeaux, 33000 Bordeaux, France
| | - S Bioulac
- Service d'explorations fonctionnelles du système nerveux, clinique du sommeil, CHU de Bordeaux, 33000 Bordeaux, France; CNRS, SANPSY, USR 3413, SANPSY, Université de Bordeaux, 33000 Bordeaux, France
| | - N Perroud
- Service des spécialités psychiatrique, département de santé mentale et de psychiatrie, Hôpitaux Universitaires de Genève, 1201 Genève, Switzerland
| | - A Sauvaget
- Addictologie and psychiatrie de liaison, CHU de Nantes, 44000 Nantes, France; Laboratoire "mouvement, interactions, performance" (EA 4334), Faculté Sciences du sport, Université de Nantes, 44000 Nantes, France
| | - L Carton
- Inserm U1171 "Troubles cognitifs dégénératifs et vasculaires", Université de Lille, 59000 Lille, France; Département de pharmacologie médicale, CHRU de Lille, 59000 Lille, France
| | - M Gachet
- Service d'urgence et post-urgence psychiatrique, hôpital Lapeyronie, 34000 Montpellier, France
| | - R Lopez
- Consultation spécialisée TDAH adulte, centre national de référence narcolepsie hypersomnies rares, département de neurologie, Hôpital Gui-De-Chauliac, 34000 Montpellier, France; Inserm U1061, 34000 Montpellier, France.
| |
Collapse
|
42
|
Yébenes JC, Lorencio C, Esteban E, Espinosa L, Badia JM, Capdevila JA, Cisteró B, Moreno S, Calbo E, Jiménez-Fábrega X, Clèries M, Faixedas MT, Ferrer R, Vela E, Medina C, Rodríguez A, Netto C, Armero E, Solsona M, Lopez R, Granes A, Perez-Claveria V, Artigas A, Estany J. Interhospital Sepsis Code in Catalonia (Spain): Territorial model for initial care of patients with sepsis. Med Intensiva 2019; 44:36-45. [PMID: 31542182 DOI: 10.1016/j.medin.2019.05.008] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/10/2019] [Accepted: 05/27/2019] [Indexed: 12/29/2022]
Abstract
Sepsis is a syndromic entity with high prevalence and mortality. The management of sepsis is standardized and exhibits time-dependent efficiency. However, the management of patients with sepsis is complex. The heterogeneity of the forms of presentation can make it difficult to detect and manage such cases, in the same way as differences in training, professional competences or the availability of health resources. The Advisory Commission for Patient Care with Sepsis (CAAPAS), comprising 7 scientific societies, the Emergency Medical System (SEM) and the Catalan Health Service (CatSalut), have developed the Interhospital Sepsis Code (CSI) in Catalonia (Spain). The general objective of the CSI is to increase awareness, promote early detection and facilitate initial care and interhospital coordination to attend septic patients in a homogeneous manner throughout Catalonia.
Collapse
Affiliation(s)
- J C Yébenes
- Servei de Medicina Intensiva, Hospital de Mataró, Mataró, España.
| | - C Lorencio
- Servei de Medicina Intensiva, Hospital Universitari Dr. Josep Trueta, Girona, España
| | - E Esteban
- Servei de Medicina Intensiva, Hospital Sant Joan de Déu, Barcelona, España
| | - L Espinosa
- Consorci Sanitari de Barcelona, CatSalut-Servei Català de la Salut, Barcelona, España
| | - J M Badia
- Servei de Cirurgia General, Hospital Fundació Asil de Granollers, Granollers, España
| | - J A Capdevila
- Servei de Medicina Interna, Hospital de Mataró, Mataró, España
| | - B Cisteró
- Servei d'Urgències, Corporació Sanitària Parc Taulí, Sabadell, España
| | - S Moreno
- Àrea Bàsica de Salut Gràcia, Barcelona, España
| | - E Calbo
- Servei de Medicina Interna-Malalties Infeccioses, Hospital Mutua de Terrassa, Terrassa, España
| | | | - M Clèries
- Unitat d'Informació i Coneixement, CatSalut-Servei Català de la Salut, Barcelona, España
| | - M T Faixedas
- Oficina Tècnica dels Registres de Codis d'Activació, CatSalut-Servei Català de la Salut, Barcelona, España
| | - R Ferrer
- Servei de Medicina Intensiva, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Vela
- Unitat d'Informació i Coneixement, CatSalut-Servei Català de la Salut, Barcelona, España
| | - C Medina
- Oficina Tècnica dels Registres de Codis d'Activació, CatSalut-Servei Català de la Salut, Barcelona, España
| | - A Rodríguez
- Servei de Medicina Intensiva, Hospital Universitari Joan XXIII, Tarragona, España
| | - C Netto
- Servei d'Urgències, Corporació Sanitària Parc Taulí, Sabadell, España
| | - E Armero
- Servei d'Urgències, Hospital Comarcal de Blanes, Blanes, España
| | - M Solsona
- Servei de Medicina Intensiva, Hospital de Mataró, Mataró, España
| | - R Lopez
- Consorci Sanitari de Barcelona, CatSalut-Servei Català de la Salut, Barcelona, España
| | - A Granes
- Sistema d'Emergències Mèdiques (SEM)
| | | | - A Artigas
- Servei de Medicina Intensiva, Corporació Sanitària Parc Taulí, Sabadell, España
| | - J Estany
- Consorci Sanitari de Barcelona, CatSalut-Servei Català de la Salut, Barcelona, España
| | | |
Collapse
|
43
|
Barateau L, Chenini S, Evangelista E, Jaussent I, Lopez R, Dauvilliers Y. Clinical autonomic dysfunction in narcolepsy type 1. Sleep 2019; 42:5550322. [DOI: 10.1093/sleep/zsz187] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/08/2019] [Indexed: 12/20/2022] Open
Abstract
AbstractStudy Objectives(1) To compare the presence of autonomic symptoms using the validated SCOPA-AUT questionnaire in untreated patients with narcolepsy type 1 (NT1) to healthy controls, (2) to study the determinants of a high total SCOPA-AUT score in NT1, and (3) to evaluate the effect of drug intake on SCOPA-AUT results in NT1.MethodsThe SCOPA-AUT questionnaire that evaluates gastrointestinal, urinary, cardiovascular, thermoregulatory, pupillomotor, and sexual dysfunction was completed by 92 consecutive drug-free adult NT1 patients (59 men, 39.1 ± 15.6 years old) and 109 healthy controls (63 men, 42.6 ± 18.2 years old). A subgroup of 59 NT1 patients completed the questionnaire a second time, under medication (delay between two evaluations: 1.28 ± 1.14 years).ResultsCompared to controls, NT1 patients were more frequently obese, had more dyslipidemia, with no difference for age and gender. The SCOPA-AUT score of NT1 was higher than in controls in crude and adjusted models. Patients experienced more problems than controls in all subdomains. A higher score in NT1 was associated with older age, longer disease duration, altered quality of life and more depressive symptoms, but not with orexin levels and disease severity. Among patients evaluated twice, the SCOPA-AUT score total did not differ according to treatment status, neither did each subdomain.ConclusionWe captured a frequent and large spectrum of clinical autonomic dysfunction in NT1, with impairment in all SCOPA-AUT domains, without key impact of medication intake. This assessment may allow physicians to screen and treat various symptoms, often not spontaneously reported but associated with poor quality of life.
Collapse
Affiliation(s)
- Lucie Barateau
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
- National Reference Network for Narcolepsy, CHU Montpellier, France
- INSERM, U1061, Neuropsychiatrie, Recherche Clinique et Épidémiologique, University of Montpellier, Montpellier, France
| | - Sofiene Chenini
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
- National Reference Network for Narcolepsy, CHU Montpellier, France
| | - Elisa Evangelista
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
- National Reference Network for Narcolepsy, CHU Montpellier, France
- INSERM, U1061, Neuropsychiatrie, Recherche Clinique et Épidémiologique, University of Montpellier, Montpellier, France
| | - Isabelle Jaussent
- INSERM, U1061, Neuropsychiatrie, Recherche Clinique et Épidémiologique, University of Montpellier, Montpellier, France
| | - Regis Lopez
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
- National Reference Network for Narcolepsy, CHU Montpellier, France
- INSERM, U1061, Neuropsychiatrie, Recherche Clinique et Épidémiologique, University of Montpellier, Montpellier, France
| | - Yves Dauvilliers
- Sleep-Wake Disorders Center, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, France
- National Reference Network for Narcolepsy, CHU Montpellier, France
- INSERM, U1061, Neuropsychiatrie, Recherche Clinique et Épidémiologique, University of Montpellier, Montpellier, France
| |
Collapse
|
44
|
Prevost A, Delanoë F, Cavallier Z, Diakité C, Muller S, Lopez R, Briot J, Lauwers F. Universal surgical guide dedicated to mandibular reconstruction by fibula flap: a pilot multicentric feasibility study. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Silbereisen A, Hallak AK, Nascimento GG, Sorsa T, Belibasakis GN, Lopez R, Bostanci N. Regulation of PGLYRP1 and TREM-1 during Progression and Resolution of Gingival Inflammation. JDR Clin Trans Res 2019; 4:352-359. [PMID: 31013451 DOI: 10.1177/2380084419844937] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 12/23/2022] Open
Abstract
INTRODUCTION The triggering receptor expressed on myeloid cells 1 (TREM-1) signaling pathway is stimulated by bacteria and, together with its putative ligand peptidoglycan recognition protein 1 (PGLYRP1), propagates proinflammatory responses. OBJECTIVES We aimed to evaluate the TREM-1/PGLYRP1/interleukin (IL)-1β regulation in response to biofilm accumulation and removal in an experimental human gingivitis model. METHODS The study (n = 42 participants, mean age: 23.8 ± 3.7 y) comprised a recruitment step (day -14) followed by experimentally induced biofilm formation (induction [I] phase, day 0 to +21) and a 2-wk resolution (R) phase (day +21 to +35). Plaque was recorded by the Modified Quigley and Hein Plaque Index (TQHPI), while records of gingival inflammation were based on the Modified Gingival Index (MGI). Unstimulated whole saliva supernatants (n = 210, 5 time points) were tested for TREM-1, PGLYRP1, and IL-1β by enzyme-linked immunosorbent assay. RESULTS During the I-phase, concentrations of all analytes showed a tendency for downregulation at day +7 compared to day 0. TREM-1 (P = 0.019) and PGLYRP1 (P = 0.007) increased significantly between day +7 and day +21. Although all analyte levels decreased during the R-phase, the difference was not significant except TREM-1 being at borderline significance (P = 0.058). Moreover, TREM-1, PGLYRP1, and IL-1β showed significant positive correlations (P < 0.0001) with each other. The study participants were grouped into "fast" and "slow" responders based on clinical gingival inflammation scores. At each time point, fast responders showed significantly higher concentrations of TREM-1 (P < 0.025), PGLYRP1 (P < 0.007), and IL-1β (P < 0.025) compared to slow responders. Mixed-effects multilevel regression analyses revealed that PGLYRP1 (P = 0.047) and IL-1β (P = 0.005) showed a significant positive association with the MGI scores. CONCLUSION The study demonstrated that TREM-1 and PGLYRP1 are regulated in response to biofilm accumulation and removal, and fast responders demonstrated higher levels of these analytes compared to slow responders. KNOWLEDGE TRANSFER STATEMENT The results of this study demonstrated the suitability of salivary TREM-1 and PGLYRP1 to reflect biofilm accumulation and removal and PGLYRP1 to monitor the progression and resolution of inflammation in gingivitis-susceptible individuals (fast responders). Combined with conventional risk factors, the molecular toolbox proposed here should be further validated in future studies to confirm whether it can be used for population-based monitoring and prevention of gingivitis.
Collapse
Affiliation(s)
- A Silbereisen
- Section of Periodontology and Dental Prevention, Division of Oral Diseases of Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A K Hallak
- Section of Periodontology and Dental Prevention, Division of Oral Diseases of Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - G G Nascimento
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - T Sorsa
- Section of Periodontology and Dental Prevention, Division of Oral Diseases of Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - G N Belibasakis
- Section of Periodontology and Dental Prevention, Division of Oral Diseases of Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - R Lopez
- Section of Periodontology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - N Bostanci
- Section of Periodontology and Dental Prevention, Division of Oral Diseases of Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
46
|
Al Attas RA, Alzahrani S, Lopez R, Liacini A, Al Qahtani Z, Al Otaibi A, Kebasi S, Al Aqool A. It's About Everything: Validation and Optimization of 96-Well Tray Flow Cytometry Crossmatch. Transplant Proc 2019; 51:492-496. [PMID: 30879575 DOI: 10.1016/j.transproceed.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Flow cytometric crossmatch (FCXM) is widely used in many centers as part of pretransplant risk assessment to detect donor-specific anti-HLA antibodies. The limited number of crossmatches that can be performed during on-call work-up for deceased donors within reasonable time remains the main obstacle to accommodating the majority of highly sensitized listed patients to be tested by the standard tube FCXM method. This limitation often directs the organs to nonsensitized patients and deprives highly sensitized patients who could be compatible if their sera were included in the crossmatch test. The goal of this study is to optimize a 96-well tray FCXM protocol that allows more sera to be crossmatched without prolonging the overall procedural time while maintaining quality and sensitivity of the assay. The new method was validated against use of the standard tube method and included total of 63 crossmatches performed simultaneously by both methods using 20 donors' cells with patients' sera, pooled positive controls tested on different dilutions, and commercial negative control. In the new protocol we modify various assay parameters including tube platform, incubation time, amount of reagent antibody cocktail, and cell volumes. An overall concordance of 98% was achieved with the protocols with slight improvement in sensitivity (2 negative B-cell reactions converted to positive in presence of weak donor-specific antibodies and mild T-cell reactivity could be picked up at 1:80 diluted positive control by the tray method only). The median channel fluorescence values of the 2 methods were essentially equivalent for both T and B crossmatches (r2 of 0.98 and 0.97, respectively). In conclusion, 96-well tray assay has the potential to increase the probability of highly sensitized patients receiving transplants by allowing increased number of crossmatches to be performed with significant reduction in turnaround time and assay cost. Furthermore, the enhanced sensitivity of the assay will provide more accurate information about sensitization status and strength of donor-specific antibodies to treating physicians, allowing them to choose the best therapeutic option and to provide better patient care.
Collapse
Affiliation(s)
- R A Al Attas
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia.
| | - S Alzahrani
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - R Lopez
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - A Liacini
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Z Al Qahtani
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - A Al Otaibi
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - S Kebasi
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - A Al Aqool
- Histocompatibility and Immunogenetic Laboratory, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| |
Collapse
|
47
|
Dauvilliers Y, Evangelista E, Barateau L, Lopez R, Chenini S, Delbos C, Beziat S, Jaussent I. Measurement of symptoms in idiopathic hypersomnia. Neurology 2019; 92:e1754-e1762. [DOI: 10.1212/wnl.0000000000007264] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/07/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo validate the Idiopathic Hypersomnia Severity Scale (IIHSS), a self-report measure of hypersomnolence symptoms, consequences, and responsiveness to treatment.MethodsThe 14-item IHSS (developed and validated by sleep experts with patients' feedback) was filled in by 218 participants (2.3% missing data). Among the 210 participants who fully completed the IHSS, there were 57 untreated and 43 treated patients with idiopathic hypersomnia (IH) aged 16 years or older, 37 untreated patients with narcolepsy type 1 (NT1), and 73 controls without sleepiness. IHSS psychometric properties, discriminant diagnostic validity, and score changes with treatment were assessed.ResultsThe IHSS showed good internal consistency and content validity. Factor analysis indicated a 2-component solution with good reliability expressed by satisfactory Cronbach α values. IHSS scores were reproducible without changes in the test–retest evaluation (13 treated and 14 untreated patients). Convergent validity analysis showed that IHSS score was correlated with daytime sleepiness, depressive symptoms, and quality of life in patients with IH. The IHSS score was lower in treated than untreated patients (5–8 unit difference, without ceiling effect). The cutoff value for discriminating between untreated and treated patients was 26/50 (sensitivity 55.8%, specificity 78.9%). IHSS scores were higher in drug-free IH patients than NT1 and controls. The best cutoff value to differentiate between untreated IH patients and controls was 22 (sensitivity 91.1%, specificity 94.5%), and 29 with NT1.ConclusionsThe IHSS is a reliable and valid clinical tool for the quantification of IH symptoms and consequences that might be useful for patient identification, follow-up, and management.
Collapse
|
48
|
Borras J, El-Qutob D, Lopez R, Enrique E. Hypothesized Epitope Localization in Hypersensitivity Reactions to Iodinated Contrast Media. J Investig Allergol Clin Immunol 2019; 29:82-83. [PMID: 30785115 DOI: 10.18176/jiaci.0341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J Borras
- Unit of Allergy, Consorcio Hospitalario Provincial, Castellon, Spain
| | - D El-Qutob
- Unit of Allergy, Hospital Universitario de la Plana in Vila-Real, Spain
| | - R Lopez
- Section of Allergy, Hospital General Universitari de Castelló, Castellon, Spain
| | - E Enrique
- Medical Research Institute Hospital La Fe, Valencia, Spain
| |
Collapse
|
49
|
Brasó-Maristany F, Griguolo G, Llombart-Cussac A, Pascual T, Paré L, Bermejo B, Oliveira M, Morales S, Martinez N, Vidal M, Pernas S, Lopez R, Muñoz M, Galvan P, Garau I, Manso L, Alarcón J, Martínez E, Villagrasa P, Cortés J, Prat A. Abstract P6-17-07: Gene signatures and subtype changes during HER2 dual blockade in PAM50 HER2-enriched HER2-positive breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: HER2-positive (HER2+) breast cancer (BC) is composed of 4 molecular subtypes: Luminal A and B, HER2-enriched (HER2-E) and Basal-like. Among them, the HER2-E is highly sensitive to anti-HER2 treatment. However, ˜60% of HER2-E tumors do not achieve a pathological complete response (pCR) following neoadjuvant dual HER2 blockade without chemotherapy. Here, we aimed to better understand the molecular changes of the HER2-E subtype during anti-HER2 treatment.
Methods: Gene expression was evaluated in 101 patients with HER2-E tumors from the PAMELA neoadjuvant phase II trial (Lancet Oncol 2017). Briefly, women with HER2+ BC were treated with lapatinib and trastuzumab (and hormonal therapy if hormone receptor [HR]-positive) for 18 weeks. The median time between the last dose of treatment and surgery was 35 days (range=213; interquartile range=16). Expression of the PAM50 genes and 6 PAM50 signatures (Luminal A, Luminal B, HER2-E, Basal-like, normal-like and the PAM50 proliferation score) were determined using the nCounter platform at baseline (n=101), after 2 weeks of treatment (n=96) and in residual tumors (non-pCR) at surgery (n=57). Same analyses were done in 2 HER2+/HER2-E cell line models (BT474 [HR+] and SKBR3 [HR-]) following in vitro treatment with trastuzumab in combination with lapatinib. Biological changes between 2 time-points were determined by paired t-tests with a false discovery rate (FDR) <5%.
Results: After 2 weeks of treatment, 85.7% and 94.6% of the 56 genes/signatures were found differentially expressed (FDR<5%) in HER2-E/HR+ (n=35) and HER2-E/HR- (n=61) tumors, respectively. The two gene lists were highly correlated (correlation coefficient=0.93). Overall, a significant relative increase in Luminal A and normal-like signature scores, and a relative decrease in proliferation, HER2-E and Luminal B signature scores, were observed between baseline and week 2. Interestingly, a PAM50 subtype switch to Luminal A was observed in 31.6% and 4.8% of HER2-E/HR+ and HER2-E/HR- tumors. In BT474 and SKBR3, all genes/signatures were also found differentially expressed (FDR<5%) following 72h of dual HER2 blockade. The in vitro findings recapitulated the in vivo findings in 80-86% of the genes/signatures. Similar to tumors, a switch to a Luminal A subtype following dual HER2 blockade was observed in BT474 but not in SKBR3. Finally, 92.9% of the 56 genes/signatures were found differentially expressed (FDR<5%) in residual tumors at surgery compared to week 2. Contrary to the findings in the first 2 weeks of treatment, a general rebound effect in gene expression was observed between week 2 and surgery. Similarly, a rebound effect was observed in 60% of the genes/signatures in BT474 after removing anti-HER2 therapy for 72h, leading to a subtype switch from Luminal A back to HER2-E.
Conclusions: Dual HER2 blockade in the HER2-E subtype induces large biological changes that lead to a more low-proliferative Luminal A phenotype both in tumors and in vitro models, especially in HER2-E/HR+ disease. These phenotypic changes are reversible upon stopping anti-HER2 treatment. This finding supports the use of maintenance anti-HER2 treatment +/- endocrine therapy (if HR+) in advanced HER2+ BC.
Citation Format: Brasó-Maristany F, Griguolo G, Llombart-Cussac A, Pascual T, Paré L, Bermejo B, Oliveira M, Morales S, Martinez N, Vidal M, Pernas S, Lopez R, Muñoz M, Galvan P, Garau I, Manso L, Alarcón J, Martínez E, Villagrasa P, Cortés J, Prat A. Gene signatures and subtype changes during HER2 dual blockade in PAM50 HER2-enriched HER2-positive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-07.
Collapse
Affiliation(s)
- F Brasó-Maristany
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - G Griguolo
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - A Llombart-Cussac
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - T Pascual
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - L Paré
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - B Bermejo
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - M Oliveira
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - S Morales
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - N Martinez
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - M Vidal
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - S Pernas
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - R Lopez
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - M Muñoz
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - P Galvan
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - I Garau
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - L Manso
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - J Alarcón
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - E Martínez
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - P Villagrasa
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - J Cortés
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| | - A Prat
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Institut Català d'Oncología, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago / CIBERONC, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain
| |
Collapse
|
50
|
Griguolo G, Holgado E, Cortés J, Fasani R, Pascual T, Paré L, Bermejo B, Oliveira M, Morales S, Martinez N, Vidal M, Pernas S, Lopez R, Muñoz M, Galvan P, Garau I, Manso L, Alarcón J, Martínez E, Villagrasa P, LLombart-Cussac A, Prat A, Nuciforo P. Abstract P6-17-08: Dynamics of tumor-infiltrating lymphocytes (TILs) during neoadjuvant dual HER2 blockade in HER2-positive (HER2+) breast cancer in the absence of chemotherapy. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: TILs in HER2+ breast cancer (BC) predict 1) prognosis in early setting, 2) complete pathological response (pCR) following neoadjuvant antiHER2-based therapy and 3) response to trastuzumab and pembrolizumab in the metastatic setting. However, less is known regarding changes in TILs during antiHER2-based treatment.
Methods: Stromal TILs where evaluated centrally using H/E slides in tumor samples from the PAMELA (NCT01973660) neoadjuvant phase II trial. Briefly, 151 women with HER2+ BC were treated with lapatinib and trastuzumab, and hormonal therapy if HR positive, for 18 weeks. TIL levels were determined at baseline (n=148), after 2 weeks of treatment (n=134) and at surgery (n=137). Expression of 560 genes, including immune-related genes (e.g. CD8A, CD4, PD1 and PDL1) was measured at the same timepoints (baseline n=151, 2-weeks n=144, surgery n=144) using the nCounter platform. Intrinsic subtyping at baseline was determined using the PAM50 gene expression predictor. Changes in TILs between 2 time-points were determined by paired t-tests. Correlation of TILs with gene expression was assessed by quantitative SAM analysis using a False Discovery Rate <1%. All statistical tests were two-sided and considered significant when p<0.05. All statistical analyses were carried out using the R software.
Results: Compared to baseline, a significant increase in TILs was observed at week 2 in HR- (p<0.001) and HER2-enriched (HER2-E) tumors (p=0.001), but not in HR+ (p=0.133) and non-HER2-E tumors (p=0.067). Within HR- and HER2-E tumors, increase in TILs at week 2 from baseline was observed regardless of pathological response at surgery (pCR and HR- [p=0.008]; RD and HR- [p=0.037]; pCR and HER2-E [p=0.010]; RD and HER2-E [p=0.056]). Compared to week 2, a significant decrease in TILs at surgery was observed in HR- (p=0.002) and HER2-E (p=0.003) tumors, but not in HR+ (p=0.616) and non-HER2-E tumors (p=0.578). Within HR- and HER2-E tumors, a significant decrease in TILs between week 2 and surgery was observed in tumors achieving pCR (p=0.004 and p=0.005), while, in tumors not achieving pCR, no significant tendency was observed (26.4% and 33.0% of tumors showed an increase and a decrease of TILs between week 2 and surgery). Nonetheless, the vast majority of residual tumors (non-pCR) at surgery had TILs above ≥5%: 34.3% 5-10%, 21.0% 10-20%, 15.2% 20-40% and 11.4% ≥40%. Finally, TILs scoring was found highly enriched (FDR<1%) for immune-related genes tracking activated CD8 T-cells (i.e. CD8A, CD3G, LAG3 and PD1). Expression of these immune genes consistently correlated with TIL levels across the 3 time-points.
Conclusions: In early HER2+ BC, a general increase in TILs is observed following 2 weeks of dual HER2 blockade. This observation is mostly observed in HR- and HER2-E subtype, but regardless of pathological response at surgery. After 2 weeks of treatment, TILs consistently decrease in patients achieving a pCR, whereas two main patterns of TILs expression are observed in patients with residual disease at surgery. Nonetheless, most residual tumors at surgery are inflamed (i.e. TILs ≥5%) and might be good candidates for clinical trials evaluating adjuvant immune checkpoint inhibitors.
Citation Format: Griguolo G, Holgado E, Cortés J, Fasani R, Pascual T, Paré L, Bermejo B, Oliveira M, Morales S, Martinez N, Vidal M, Pernas S, Lopez R, Muñoz M, Galvan P, Garau I, Manso L, Alarcón J, Martínez E, Villagrasa P, LLombart-Cussac A, Prat A, Nuciforo P. Dynamics of tumor-infiltrating lymphocytes (TILs) during neoadjuvant dual HER2 blockade in HER2-positive (HER2+) breast cancer in the absence of chemotherapy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-08.
Collapse
Affiliation(s)
- G Griguolo
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - E Holgado
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - J Cortés
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - R Fasani
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - T Pascual
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - L Paré
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - B Bermejo
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - M Oliveira
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - S Morales
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - N Martinez
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - M Vidal
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - S Pernas
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - R Lopez
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - M Muñoz
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - P Galvan
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - I Garau
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - L Manso
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - J Alarcón
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - E Martínez
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - P Villagrasa
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - A LLombart-Cussac
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - A Prat
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| | - P Nuciforo
- Hospital Clinic de Barcelona / IDIBAPS, Barcelona, Spain; University of Padova, Padova, Italy; Hospital Universitario Ramón y Cajal, Madrid, Spain; Molecular Oncology Group, Vall d´Hebron Institute of Oncology, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Vall d'Hebrón University Hospital, Barcelona, Spain; Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain; Institut Catala d'Oncologia, Hospitalet, Hospitalet del Llobregat, Spain; Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain; Hospital Son Llàtzer, Palma de Mallorca, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain; Hospital Universitario Son Espases, Palma de Mallorca, Spain; Consorcio Hospitalario Provincial de Castellón, Castellón de la Plana, Spain; Hospital Universitario Arnau de Vilanova de Valencia, Valencia, Spain
| |
Collapse
|