P-339 Fertility outcomes after laparoscopic bladder endometriosis excision using a CO2 laser: 20-year retrospective analysis in an expert center

Study question

To evaluate fertility outcomes after laparoscopic bladder endometriosis (BE) excision in patients presenting with a post operative pregnancy wish or pre-operative infertility.

Summary answer

Surgical excision of BE is followed by high pregnancy rates, with a significant proportion of spontaneous conceptions, even in the infertile population prior to surgery.

What is known already

There are currently no guidelines/consensus concerning management of BE in case of infertility( ART? surgery?) and the impact of BE excision on fertility is still not known. Most publications reporting surgical management of BE include patients with different endometriosis types with a very small number of cases of isolated BE, making it difficult to draw conclusions.

Study design, size, duration

This is a retrospective, unicentric cohort study conducted at Saint Luc University Hospital Brussels, a tertiary referral center for endometriosis. A total number of 207 patients having undergone laparoscopic bladder endometriosis excision using a CO2 laser between January 1998 and December 2018 were included. Only patients having histologically confirmed endometriosis infiltration of the detrusor muscle were included. Patients with small nodular lesions < 5mm or superficial peritoneal endometrial lesions in the vesico-uterine fold were excluded.

Participants/materials, setting, methods

Laparoscopic BE excision was performed by 3 senior surgeons of the team, either with bladder mucosae opening (partial cystectomy) or partial thickness excision (“bladder shaving”) technique. Pregnancy and live birth rates according to prior infertility, conception mode and time to pregnancy were recorded. Primary outcome was postoperative pregnancy rate (PR). Secondary outcomes were conception mode and time to pregnancy. Patients with minimum 1-year follow up (FU) after surgery were included for fertility analysis.

Main results and the role of chance

Forty-three patients had isolated BE, while BE was associated with other forms of endometriosis in 164 cases, including 50.2% posterior DIE. Among the 176 patients having a minimum 1y FU, mean FU was 7.05 (±4.65)y.

Overall, PR among the hundred patients with a postoperative pregnancy wish was 75.8% (100/132): 49 natural conceptions and 51 following ART. Indication for ART were failed natural conception (24/51, 47.1%) or assosiated other cause of infertility (severe male factor, hormonal or tubal) requiring immediate IVF (27/51, 52.9%). PR (81.0% vs 74.8%, p = 0.545) and need for IVF (41.2% vs 53%, p = 0.374) did not statistically differ between patients with isolated or assosiated BE. Total live birth rate was 69.7%.

In patients presenting with preoperative infertility,overall PR was 74.5% with 50% natural pregnancies. In the isolated BE group (n = 11) PR was 81.8% with 55.5% (5/9) natural pregnancies and 44.5% needing ART. No statistical difference were found in PR and need for IVF between the isolated and associated BE group.

Most pregnancies occured in the first 2 years following surgery. Overall cumulative PR was 42% at 1 year, 65% at 2 years and 75% at 5 years respectively with similar distributions in the isolated and associated BE groups.

Limitations, reasons for caution

The main limitation is the retrospective nature of the study, making it difficult to exclude biases. Sample size also remains limited due to the rare incidence of BE, particularly concerning the isolated forms.

Wider implications of the findings

This is the largest reported series of patients treated surgically for BE. Fertility results are excellent for an endometriotic population and BE excision seems to have a positive impact, at least in case of natural conception. First-line surgery may be considered in patients with bladder endometriosis having a pregnancy wish.

Trial registration number

not applicable

Identification of indole-based activators of insulin degrading enzyme

Insulin degrading enzyme (IDE) is a zinc metalloprotease that cleaves numerous substrates among which amyloid-β and insulin. It has been linked through genetic studies to the risk of type-2 diabetes (T2D) or Alzheimer's disease (AD). Pharmacological activation of IDE is an attractive therapeutic strategy in AD. While IDE inhibition gave paradoxal activity in glucose homeostasis, recent studies, in particular in the liver suggest that IDE activators could be also of interest in diabetes. Here we describe the discovery of an original series of IDE activators by screening and structure-activity relationships. Early cellular studies show that hit 1 decreases glucose-stimulating insulin secretion. Docking studies revealed it has an unprecedented extended binding to the polyanion-binding site of IDE. These indole-based pharmacological tools are activators of both Aβ and insulin hydrolysis by IDE and could be helpful to explore the multiple roles of IDE.

P1-10-02: Burden of Brain Metastases in HER2−Positive Breast Cancer: Healthcare Use and Costs from a French Observational Retrospective Multicenter Study

Background HER2+ status is associated with poor prognosis and a high incidence of brain metastases (BM) in breast cancer (BC). Addition of HER2−targeted therapies to conventional chemotherapy has significantly improved survival in HER2+ patients (pts). Management of BM implies a multidisciplinary therapeutic approach involving medical oncology, radiation oncology and neurosurgery teams. Nevertheless available data evaluating health resources use and associated costs are limited. Our objective was to describe treatment patterns and healthcare costs associated with HER2+ BMBC patients.

Patients and methods An observational retrospective study was conducted on 207 HER2+ BC pts, newly diagnosed with BM as first site of relapse or as secondary metastases between January 2006 and December 2008. Pts were recruited in 10 hospitals, all funded by a prospective payment system based on Diagnosis Related Groups (DRG). Individual data concerning initial diagnosis, distant and BM relapses, treatments, complications and hospitalization stays were collected during a 2 year — follow-up. DRGs 2007 official tariffs (per-case payment basis) and 2007 expensive innovative drugs tariffs (drugs paid to hospitals by Health Insurance in addition to per-case payments) were used to estimate direct medical costs from the Health Insurance perspective. Survival was estimated using Kaplan Meier method. In the presence of cost-censored data, a partitioned estimator was used to adjust censoring costs (Bang and Tsiatis, Biometrics, 2002).

Results 91.8% (190/207) of BMBC pts received radiation therapy, 84.5% (175/207) received chemotherapy including HER2 targeted treatments and 12.6% (26/207) were treated by neurosurgery. 72.5% (150/207) of pts were hospitalized at least once during the follow-up period. Pts had on average 2.90 hospital stays (range 1–8). The median duration of stay was 9 days (1-221). Complications leading to re-hospitalization were recorded in 45.9% (95/207) of pts. The median overall survival from the diagnosis of BM was 13 m. Hospital healthcare costs were concentrated on the 6 first months following BM diagnosis. Mean cost of BMBC management was 18,480€/patient within the 6 first months and decreased to 16,306€ from 7–12 months, 15,844€ from 13–18 months, and 15,225€ from 19–24 months. The proportion of costs attributed to inpatient hospitalizations stay (treatments and complications) was similar to the one attributed to drugs whatever the period of follow-up. Pts with BM as first site of relapse consumed more healthcare resources compared to pts with secondary BM (38,813€/pt vs 32,253€/pt after one year of follow-up, respectively).

Conclusions Healthcare resources spending is mainly concentrated at the beginning of metastatic disease management, especially for patients with BM as first site of relapse. These results illustrate the use of expensive treatments in the first months following BM diagnosis. Individual data derived from this observational study allowed us to gather more specifically treatment patterns for HER2+ BMBC in order to estimate the costs more accurately.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-10-02.

Plutonium(IV) peroxide formation in nitric medium and kinetics Pu(VI) reduction by hydrogen peroxide

Reduction of plutonium (VI) to Pu(IV) with hydrogen peroxide is a step in industrial processes used to purify plutonium nitrate solutions. This operation must be carefully controlled, in order to avoid any formation of the Pu(IV) peroxide green precipitate and to obtain exclusively Pu(IV). This led us to study the acidity and Pu and H2O2 concentrations influenceson the precipitate appearance and to perform a Pu(VI) reduction kinetic study on a wide range of acidities ([HNO3]: 0.5 to 8 M), plutonium concentrations ([Pu(VI)]: 0.1 to 0.8 M) and [H2O2]/[Pu(VI)] ratio (from 1 to 8). Thus, the domain of Pu(IV) peroxide formation and the reactional paths were established.

With the exception of 0.5 M nitric acid medium, the kinetic curves show two distinct regims: the first one corresponds to an induction period where the Pu(VI) concentration doesn´t change, the second corresponds to a linear decrease of Pu(VI). An increase of the temperature greatly accelerates the Pu(VI) reduction rate while [H2O2]/[Pu(VI)] has almost no influence. The Pu(VI) total reduction time decreases when initial concentration of plutonium increases. By increasing nitric acid concentration from 0.5 M to 6 M, the total Pu(VI) reduction time decreases. This time increases when [HNO3] varies from 6 M to 8 M.

Unusual skeletal muscle metastasis from gastric adenocarcinoma

Patients with gastric adenocarcinoma frequently develop hepatic metastases or peritoneal carcinosis but involvement of the skeletal muscle is extremely rare. We report the case of a 71-year-old man with a painful soft tissue mass in the right shoulder. Two years previously, the patient had been treated for a locally advanced gastric carcinoma (surgery plus chemoradiotherapy). Surgical exploration with biopsy showed skeletal muscle metastasis from the gastric adenocarcinoma in the deltoid muscle. Chemoradiotherapy resulted in complete regression of symptoms from the metastatic lesion. The patient is alive and free of recurrence in the deltoid muscle after a follow-up of 13 months. Based on this case study, the difficulty of diagnosing skeletal muscle metastases, the prognosis and treatment options are discussed.

Membrane associated proteases and their inhibitors in tumour angiogenesis

Cell surface proteolysis is an important mechanism for generating biologically active proteins that mediate a range of cellular functions and contribute to biological processes such as angiogenesis. Although most studies have focused on the plasminogen system and matrix metalloproteinases (MMPs), recently there has been an increase in the identification of membrane associated proteases, including serine proteases, ADAMs, and membrane-type MMPs (MT-MMPs). Normally, protease activity is tightly controlled by tissue inhibitors of MMPs (TIMPs) and plasminogen activator inhibitors (PAIs). The balance between active proteases and inhibitors is thought to determine the occurrence of proteolysis in vivo. High concentrations of proteolytic system components correlate with poor prognosis in many cancers. Paradoxically, high (not low) PAI-1 or TIMP concentrations predict poor survival in patients with various cancers. Recent observations indicate a much more complex role for protease inhibitors in tumour progression and angiogenesis than initially expected. As knowledge in the field of protease biology has improved, the unforeseen complexities of cell associated enzymes and their interaction with physiological inhibitors have emerged, often revealing unexpected mechanisms of action.

Role of plasminogen activator-plasmin system in tumor angiogenesis

New blood formation or angiogenesis has become a key target in therapeutic strategies aimed at inhibiting tumor growth and other diseases associated with neovascularization. Angiogenesis is associated with important extracellular remodeling involving different proteolytic systems among which the plasminogen system plays an essential role. It belongs to the large serine proteinase family and can act directly or indirectly by activating matrix metalloproteinases or by liberating growth factors and cytokines sequestered within the extracellular matrix. Migration of endothelial cells is associated with significant upregulation of proteolysis and, conversely, immunoneutralization or chemical inhibition of the system reduces angiogenesis in vitro. On the other hand, genetically altered mice developed normally without overt vascular anomalies indicating the possibility of compensation by other proteases in vivo. Nevertheless, they have in some experimental settings revealed unanticipated roles for previously characterized proteinases or their inhibitors. In this review, the complex mechanisms of action of the serine proteases in pathological angiogenesis are summarized alongside possible therapeutic applications.

QT interval lengthening in premature infants treated with doxapram

OBJECTIVE

Doxapram, routinely used in premature infants treated for apnea of prematurity unresponsive to methylxanthines, has been related to cardiac conduction disorders. This study was designed to evaluate doxapram cardiac and general tolerance and its relationship to drug plasma concentrations in very premature infants.

METHODS

Forty infants (mean +/- SEM, 28.9 +/- 0.3 weeks of gestation) who were given intravenous doxapram, 0.5 to 1 mg/kg per hour, at 15.9 +/- 2.4 days of life were evaluated prospectively. Electrocardiograms were monitored before and during the first 3 days of treatment. QT interval corrected for heart rate (QTc) longer than 440 ms was regarded as clinically pertinent, given that it is considered a significant risk of conduction disorder leading to torsades de pointes and sudden death. Other side effects were recorded. Toxic plasma concentration of doxapram and ketodoxapram was set at >4 mg/L.

RESULTS

A statistically significant but moderate lengthening of QTc interval has been observed from 394 +/- 4 ms before doxapram to 409 +/- 4 ms at 48 and 72 hours of treatment (P =.0065). For 6 patients, QTc interval became longer than 440 ms without any other rhythm or conduction disorder. Digestive disorders were observed in 20 infants but 9 presented with concomitant septicemia. No relationship was found between presence or absence of adverse effects and drug plasma concentrations.

CONCLUSION

Our study enlightened the lengthening effect of doxapram on QTc interval in premature infants with a risk of exceeding the 440 ms threshold that is considered life-threatening. This finding emphasizes the need for electrocardiogram follow-up when using doxapram in neonates.

[Neonatal renal vein thrombosis in a heterozygous carrier of both factor V Leiden and prothrombin mutations]

We report a case of renal vein thrombosis, treated with heparin and thrombolytic therapy, in a patient who was heterozygous for both factor V Leiden and prothrombin mutations.

CASE REPORT

A full-term infant was treated with heparin and fibrinolytics at the fourth day of life because of renal vein thrombosis, inferior vena cava thrombosis and adrenal hemorrhage. After four days of treatment, the repermeabilization was complete but a renal atrophy developed. The investigation for congenital coagulation disorders revealed a heterozygous mutation for both factor V Leiden and prothrombin.

CONCLUSION

Search for inborn blood coagulation disorders should be systematic in the newborn infant with venous thrombosis because of the risk of recurrence, even in the presence of a known acquired risk factor. The thrombolytic treatment improves the prognosis.

An analytical study, anti-inflammatory and analgesic effects of Harpagophytum procumbens and Harpagophytum zeyheri

The iridoids of Harpagophytum procumbens and Harpagophytum zeyheri were studied by CLHP. Harpagoside is the main iridoid for both drugs whereas 8-p-coumaroylharpagide is a representative iridoid of Harpagophytum zeyheri only. The ratio harpagoside/8-p-coumaroylharpagide can be used to distinguish chemically both species. For commercial dried aqueous extracts this ratio is intermediate because they are probably prepared from a mixture of H. procumbens and H. zeyheri drugs. The aqueous extracts of both drugs show similar analgesic and anti-inflammatory properties. Harpagophytum procumbens and Harpagophytum zeyheri should be accepted as sources for the drug Harpagophyti radix.

Thrombomodulin is synthesized by osteoblasts, stimulated by 1,25-(OH)2D3 and activates protein C at their cell membrane

We have previously shown that protein S, a vitamin K-dependent protein, is a bone matrix component synthesized and secreted by osteoblasts. Because protein S is a cofactor of protein C in inhibiting factor Va and VIIIa, we have looked for the presence of the proteins related to the anticoagulant protein C system in human MG 63 osteosarcoma cells and in human adult osteoblast-like cells. Using immunoblotting, we have shown that protein C, factor V, and C4b binding protein are not secreted by these cells. We have shown by enzyme-linked immunoassay, immunocytochemistry, and immunoprecipitation of labeled proteins that thrombomodulin, a transmembrane glycoprotein involved with thrombin in the activation of protein C, is present at the cell surface of osteoblasts. Moreover, using a protein C activation system where thrombin and protein C are added to the cells, we have shown that protein C could be activated at the osteoblast cell surface. This activation of exogenous protein C, reflecting the activity of thrombomodulin, as well as the expression of the thrombomodulin antigen, is regulated by some bone resorption-enhancing factors. 1,25-dihydroxyvitamin D3 and retinoic acid increase thrombomodulin expression and activity in a dose-dependent manner whereas tumor necrosis factor alpha and interleukin 1 decrease these parameters. Because thrombomodulin is known to inhibit single-chain urokinase-type plasminogen activator, a molecule present in the osteoblast microenvironment, these findings suggest that thrombomodulin could play a role in the regulation of bone resorption by modulating the plasmin system.

Protein-S, a vitamin K-dependent protein, is a bone matrix component synthesized and secreted by osteoblasts

Protein-S is a vitamin K (Vit K)-dependent protein synthesized by hepatocytes, megakaryocytes, and endothelial cells and plays an important role in the regulation of hemostasis. Two cases of free protein-S congenital deficiency were recently reported to be associated with osteopenia. We hypothesized that this osteopenia could be the result of a bone deficit of protein-S synthesized by bone cells. Using enzyme-linked immunoassay, immunocytochemistry, immunoblotting, and immunoprecipitation after labeling with [35S]methionine, we have shown that this protein is secreted by three human osteosarcoma cell lines and by human adult osteoblast-like cells. In addition, protein-S was present in protein extracts of human bone matrix. Protein-S secreted by MG 63 cells increased linearly from 1-7 days of culture, was biologically active, and was regulated by warfarin, as previously described for the other cell types secreting protein-S. Vit K had no direct effect on protein-S secretion or activity, but could overcome the effects of warfarin. In conclusion, in addition to osteocalcin and matrix gamma-carboxyglutamic acid (Gla) protein, osteoblasts secrete another Vit K-dependent protein, which is a constituent of the bone matrix. Our data suggest that osteopenia occurring in patients with congenital protein-S deficiency might be related to a deficiency of protein-S secretion by the osteoblasts. This finding raises the intriguing possibility that protein-S might play a role in bone turnover and bone mass.

Immunological screening of SPARC/Osteonectin in nonmineralized tissues

SPARC/Osteonectin is a major bone-related protein that is also present in nonmineralized tissues and in platelets. As compared to bone SPARC/Osteonectin, SPARC/Osteonectin from platelets presents a slightly lower electrophoretic mobility in SDS-PAGE and a 100-fold decreased affinity for a unique monoclonal antibody, Mab2 (Malaval et al. 1991). To check the tissular diversity of SPARC/Osteonectin, protein extracts from bovine bone, nonmineralized tissues, and platelets were screened by immunoblotting and immunoradiometric assay, with Mab2 and three other monoclonal antibodies recognizing distinct epitopes. The SPARC/Osteonectin secreted by a human osteosarcoma cell line (MG63) was also tested. In all the nonmineralized tissues tested (gut, bone marrow, tendon, mesentery, artera, lens, skin, liver, and cornea), SPARC/Osteonectin presents the same immunoreactivity and electrophoretic mobility as in bone. The heavier molecular weight and Mab2-negative form present in platelets seems to be unique to this cell type. Osteosarcoma cell extracts and conditioned media give the same results as bone extracts, indicating that the low molecular weight and Mab2-positive form of SPARC/Osteonectin present in most tissues does not result from proteolytic cleavage in the matrix, but is secreted as such. Bone and platelet SPARC/Osteonectin present different patterns of sensitivity to glycosidases, suggestive of a difference in N-glycosylation. However, these treatments do not affect the decreased affinity of Mab2 for platelet SPARC/Osteonectin, which is not likely to be related to difference in N-glycosylation.

Differential susceptibility to a trematode parasite among genotypes of the Mytilus edulis/galloprovincialis complex

We show that parasitism by the trematode Prosorhynchus squamatus in parental and introgressed Mytilus edulis/galloprovincialis (Bivalvia) mussels occurs in individuals with a predominantly M. edulis genome. This result suggests that the restricted specificity of P. squamatus is dependent on genetic factor(s) present in M. edulis. Because of its strong pathogenic effects (i.e. total castration and possible death), this parasite may be a source of intense selection against M. edulis genomes when they are present in a site. As a consequence, it may favour the geographic extension of the M. galloprovincialis genome. Previous studies have indicated that, in hybrid zones, recombinant genotypes are more susceptible to parasitic infections than either parental genotype. We demonstrate that this is not the case for the M. edulis/M. galloprovincialis system, and that the parental genotype alone determines susceptibility.

Behavioral effects resulting from sub-chronic treatment of rats with extract of fresh stabilized cola seeds

The aim of our study was to compare the effects of a sub-chronic treatment with fresh cola seed extract and pure caffeine in the male rat. The activity tests (open-field) and reactivity (tail-tap, resistance to capture), show that fresh cola has an effect on behavior similar to that of caffeine. However, the effects of cola are more gradual than those of caffeine. Furthermore, cola administration leads to an increase in the fall latency observed during the grasping test. These results suggest that the fresh cola seed has both psychostimulating properties similar to those of caffeine, and an original effect on muscular tonus.

[Trematodes of fish from Lebanese coasts. I. Pseudopycnadena fischthali n.g. n.sp. (Trematoda, Opistholebetidae), a parasite of Diplodus (Teleostei) from Lebanese coasts]

Description of a new species of Trematode Opistholebetidae, intestinal parasite of Diplodus sargus and Diplodus vulgaris from Lebanese coasts. Erection of a new genus Pseudopycnadena.

Study of Caffein - Catechin Association in Lyophilized Fresh Seeds and in Stabilized Extract of Cola nitida

Caffein-catechin association has been demonstrated in lyophilized fresh seeds and in stabilized extract of COLA NITIDA (Vent.) A. Chev. by using various analytical techniques which have made it possible to determine specifically the concentrations of free caffein versus associated caffein. Associated caffein varies from 0% in dried seeds to 91% in lyophilized fresh seeds and in stabilized extract of COLA. It was possible to simulate these quantitative variations of associated caffein by using an experimental model with a saturated aqueous solution of caffein and various amounts of catechin. Infrared spectrophotometric studies have shown the hydrogen bond type of the association. The differences of pharmacological effects of fresh and dried seeds may be due to the varying concentrations of associated and free caffein.

[Recent tracheobronchial ruptures caused by closed injuries of the thorax. Diagnosis and complications in 18 cases]

Tracheo-bronchial ruptures are serious complications of thoracic trauma. The authors report their experience of 18 cases: 3 tracheal ruptures, 3 tears in the tracheal or bronchial membrane, 11 unilateral bronchial ruptures and 1 bilateral bronchial rupture. Diagnostic endoscopy was performed immediately in 9 cases, with a delay of 2 to 3 days in 6 cases and with a longer delay (15th, 23rd and 25th days) in 3 cases. The treatment was non-operative in the 3 cases with membranous tears. The other patients were operated by resection of the contused area and end-to-end anastomosis of the ruptured extremities: within 24 hours following the diagnosis in 10 cases, and after a delay in the 5 other cases. The post-operative course was uncomplicated in 13 cases; 1 patient developed a bronchial stenosis requiring pneumonectomy and 4 patients died, including 2 from infective lesions due to delay in the diagnosis.

[The helminthofauna of Teleostei from Madagascar. A review of the genus Pseudolamellodiscus Yamaguti, 1953 (Monogenea) (author's transl)]

Two new species of the genus Pseudolamellodiscus Yamaguti, 1953 (Monogenea, Diplectanidae): P. forsterii n. sp. and P. jelloi, branchial parasites of Sphyraena forsteri and Sphyraena jello respectively are described as well as two other species of the genus, P. pshyraenae Yamaguti, 1953 and P. nossibei Euzet and Razarihelisoa, 1959. The diagnosis of the genus has been modified.