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Blanckaert G, Van Calster J, Jansen J, Vander Mijnsbrugge J, Delbecq AL, De Clerck I, Fils JF, Stalmans P. Efficacy and safety of the implantation of a single-piece angulated foldable IOL in the sulcus. Graefes Arch Clin Exp Ophthalmol 2024:10.1007/s00417-024-06459-0. [PMID: 38602516 DOI: 10.1007/s00417-024-06459-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/21/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
PURPOSE To study the visual results and tolerance of a Zeiss CT Lucia 601P intraocular lens (IOL) implanted in the sulcus after complicated cataract surgery or during IOL exchange for clouded IOL. METHODS In total, 64 patients who underwent sulcus implantation were recalled to the hospital to undergo subjective and objective refraction, best corrected visual acuity measurement, tonometry, optical coherence tomography, laser flare photometry, biometry, and wavefront aberrometry. RESULTS In spite of a large variation in preoperative refraction, the target refraction was obtained within 1.5 diopters in approximately 97% of patients and within 0.5 diopter in 53% of patients. Average BCVA was high (Snellen 0.86) and related to concomitant (mostly retinal) pathologies in eyes with poorer visual performance. Wavefront aberrometry showed no evidence of IOL tilting or decentration after long-term implantation in the sulcus. Tonometry was not different from the fellow eye of the patient (p > 0.5). In 53 patients with bilateral pseudophakia, the laser flare photometry was not significantly different from the fellow eye (p < 0.05). CONCLUSION This study demonstrates that this single-piece angulated foldable acrylic IOL can be considered for implantation in the sulcus. The visual results are favorable, and the IOL can be well-positioned and tolerated in the sulcus. Moreover, there were no safety issues found since there was no evidence of elevated IOP or chronic uveitis.
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Affiliation(s)
| | | | - Joyce Jansen
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | | | - Ann-Laure Delbecq
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | - Ivo De Clerck
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | | | - Peter Stalmans
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.
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Fils JF, Kapessidou P, Van der Linden P, Guntz E. A Monte Carlo simulation study comparing the up and down, biased-coin up and down and continual reassessment methods used to estimate an effective dose (ED 95 or ED 90) in anaesthesiology research. BJA Open 2023; 8:100225. [PMID: 37790993 PMCID: PMC10542596 DOI: 10.1016/j.bjao.2023.100225] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/06/2023] [Indexed: 10/05/2023]
Abstract
Background Dose-finding studies in anaesthesiology aim to target the effective dose (ED) of an anaesthetic agent in a specific population. The common dose-finding designs used are the up and down method (UDM), the biased-coin up and down (BCD), and the continual reassessment method (CRM). Although the advantages of CRM over the UDM and BCD methods have been described in the statistical literature in terms of precision and direct estimation of ED, CRM may also offer attractive properties from an ethical point of view. Methods Based on Monte Carlo simulations, this article aims to compare the three methods with regard to 1) their ability to find as close an estimate as possible for the ED95 or ED90 and 2) the total number of patients needed to treat and the number of failures. Results In contrast to BCD and UDM, CRM does find an estimate for ED95 and ED90. UDM underestimates both ED95 and ED90. BCD is close to the targeted EDs when the starting dose does not exceed the ED of interest, otherwise it overestimates it. CRM with cohorts of two patients is closest to the ED of interest independently of the starting doses. CRM requires between 20 and 50 observations, UDM should include 90 patients, and BCD 100 or 60 observations. Lastly, CRM is associated with fewer failures, compared with BCD and UDM. Conclusions Based on Monte Carlo simulations, our work suggests that the UDM is not an adequate dose-finding method because it underestimates the ED of interest. Compared with BCD, CRM offers the advantages of being more efficient, requires fewer patients to be included, and is associated with fewer failures.
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Affiliation(s)
| | - Panayota Kapessidou
- Department of Anesthesiology, University Hospital Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Emmanuel Guntz
- Department of Anesthesiology, Hôpital Braine-l’Alleud Waterloo, Université Libre de Bruxelles (ULB), Braine-l’Alleud, Belgium
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Van Hoe W, Van Calster J, Jansen J, Vander Mijnsbrugge J, Delbecq AL, Fils JF, Stalmans P. Patient satisfaction after EDOF intraocular lens implantation in vitrectomized eyes. Graefes Arch Clin Exp Ophthalmol 2023; 261:3465-3474. [PMID: 37584791 DOI: 10.1007/s00417-023-06204-z] [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: 02/01/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE To report patient satisfaction after unilateral/bilateral extended depth-of-focus (EDOF) intraocular lens (IOL) implantation in a young population after vitrectomy. METHODS Patients that underwent phaco-vitrectomy or phaco following vitrectomy with an AT LARA EDOF IOL, aged between 18 and 75 years, were asked to fill out a questionnaire to assess overall visual quality, near vision quality, and visual disturbances. The questionnaire was based on the Catquest, NAVQ, and APPLES questionnaires. RESULTS A total of 89 participants (average age 56.7 years) filled out the questionnaire of which 53.9% received a unilateral EDOF IOL. The most common indications for vitrectomy were retinal detachments (38.2%), floaters (36.0%), and epiretinal membranes (16.9%). The Catquest and NAVQ score respectively showed a good overall satisfaction (3.44/4.0), a good intermediate vision (3.55/4.0), and an average near vision (2.75/4.0). The APPLES score showed acceptable visual disturbances. There were no differences between the unilateral and bilateral group, except for a higher spectacle dependency in the unilateral group (40% vs. 10.6%). Participants that underwent vitrectomy in case of floaters reported lower satisfaction rates. Other variables, like the pre-operative refraction, had no impact on both satisfaction and visual disturbances. CONCLUSION Both unilateral and bilateral implantation of the AT LARA EDOF IOL showed a high satisfaction with no differences between both groups, except for a lower spectacle use in the latter. Hence, The AT LARA seems to be a possible choice in patients undergoing vitrectomy at a younger age, even for unilateral use.
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Affiliation(s)
- Willem Van Hoe
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | | | - Joyce Jansen
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | | | - Ann-Laure Delbecq
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium
| | | | - Peter Stalmans
- Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium.
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Willems A, Havaux R, Schmartz D, Fils JF, DE Pooter F, VAN DER Linden P. The choice of perioperative inotropic support impacts the outcome of small infants undergoing complex cardiac surgery: an observational study. Minerva Anestesiol 2023; 89:753-761. [PMID: 37676176 DOI: 10.23736/s0375-9393.23.16622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
BACKGROUND Vaso-inotropic agents are frequently used to prevent and/or treat low cardiac output syndrome in infants undergoing surgery for congenital heart disease. Due to the lack of comparative studies, their use is largely dependent on physician- and center preferences. The aim was to assess the impact of two different inotropic regimens, milrinone-epinephrine versus dobutamine on postoperative morbi-mortality in young children undergoing complex cardiac surgery. METHODS All consecutive children younger than one year of age admitted for complex cardiac surgery (Risk Adjustment in Congenital Heart Surgery-1 [RACHS-1] score ≥3) with cardiopulmonary bypass (CPB) from January 2008 to December 2018 were included. Children received either milrinone in association with low dose epinephrine (milrinone-epinephrine group) or dobutamine (dobutamine group) groups were matched and compared using a propensity score. Our primary outcome was a composite measure including either hospital death and/or the presence of at least two of the following events: respiratory failure, prolonged inotropic support, or renal failure. RESULTS Two hundred and fifty patients were included in the analysis. Children in the milrinone-epinephrine group (N.=184) suffered more frequently from a cyanotic heart disease and had longer surgery, CPB, and aortic cross clamp times than those in the dobutamine group (N.=66). After matching, children in the milrinone-epinephrine group had a higher incidence of severe postoperative morbidity or mortality compared to those in the dobutamine group (27.4 versus 13.9%; P=0.016). Respiratory failure (28% vs. 12%), prolonged inotropic support (71% vs. 35%) and in-hospital death (3 vs. 0%) were more frequent in the milrinone-epinephrine group. CONCLUSIONS In young infants undergoing complex cardiac surgery, milrinone combined with epinephrine is associated with a higher incidence of postoperative morbidity or mortality compared to dobutamine for perioperative inotropic support. Further prospective randomized studies are required to confirm this finding.
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Affiliation(s)
- Ariane Willems
- Pediatric Intensive Care Unit, Department of Pediatrics, Queen Fabiola University Children's Hospital, Brussels, Belgium -
| | - Renaud Havaux
- Department of Anesthesiology, University Hospital Brugmann and Queen Fabiola University Children's Hospital, Brussels, Belgium
| | - Denis Schmartz
- Department of Anesthesiology, University Hospital Brugmann and Queen Fabiola University Children's Hospital, Brussels, Belgium
| | | | - Françoise DE Pooter
- Department of Anesthesiology, University Hospital Brugmann and Queen Fabiola University Children's Hospital, Brussels, Belgium
| | - Philippe VAN DER Linden
- Department of Anesthesiology, University Hospital Brugmann and Queen Fabiola University Children's Hospital, Brussels, Belgium
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Wabelo ON, Schmartz D, Giancursio M, De Pooter F, Caruso G, Fils JF, Van der Linden P. Prospective, randomized, double-blind, double-dummy, active-controlled, phase 3 clinical trial comparing the safety and efficacy of intranasal dexmedetomidine to oral midazolam as premedication for propofol sedation in pediatric patients undergoing magnetic resonance imaging: the MIDEX MRI trial. Trials 2023; 24:518. [PMID: 37568242 PMCID: PMC10422697 DOI: 10.1186/s13063-023-07529-0] [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: 01/13/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Children under 6 years who need magnetic resonance imaging usually require sedation to obtain best quality images, but the optimal sedation protocol remains to be determined. In 2018, we showed a 22% interruption in image acquisition during magnetic resonance imaging when performing a propofol-based sedation using a bolus approach. As non-pharmacological premedication is often insufficient to reduce the anxiety of children related to parental separation, pharmacological premedication may be useful to facilitate the induction of anesthesia. In our institution, effective premedication is obtained oral intake of midazolam, though its administration relies on patients' compliance and could also lead to paradoxical reaction. Dexmedetomidine has a safe profile in the pediatric population and can therefore represent an interesting alternative. The primary objective of this trial is to demonstrate the superiority of intranasal dexmedetomidine compared to oral midazolam as premedication in reducing the occurrence of any event requiring temporary or definitive interruption of the examination to allow anesthesiologist intervention in children undergoing magnetic resonance imaging under propofol sedation. METHODS In this single-center, prospective, randomized, double-blind, double-dummy, active comparator-controlled, superiority trial, we planned to include 250 patients, aged 6 months to 6 years, undergoing a scheduled magnetic resonance imaging requiring the presence of an anesthesiologist. After informed consent, the patients will be randomized to receive either oral midazolam or intranasal dexmedetomidine as premedication. The data will be analyzed in intention to treat, using Kolmogorov-Smirnov Z, chi-square, Wilcoxon, and Mann-Whitney U tests. A P-value < 0.05 will be considered statistically significant. DISCUSSION The MIDEX MRI study will assess the efficacy of intranasal dexmedetomidine compared to oral midazolam to improve the quality of a propofol-based sedation prior to magnetic resonance imaging, without negative repercussion on the postoperative period. TRIAL REGISTRATION ClinicalTrial.gov NCT05192629 . Registered on 14 January 2022. Protocol version 2.1.
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Affiliation(s)
- Olivia Nzungu Wabelo
- Department of Anesthesiology, Hôpital Universitaire de Bruxelles - Hôpital universitaire des enfants Reine Fabiola, Brussels, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Denis Schmartz
- Université Libre de Bruxelles, Brussels, Belgium.
- Department of Anesthesiology, Hôpital Universitaire de Bruxelles - Hôpital Erasme, Brussels, Belgium.
| | - Mario Giancursio
- Department of Anesthesiology, Hôpital Universitaire de Bruxelles - Hôpital universitaire des enfants Reine Fabiola, Brussels, Belgium
| | - Françoise De Pooter
- Department of Anesthesiology, Hôpital Universitaire de Bruxelles - Hôpital universitaire des enfants Reine Fabiola, Brussels, Belgium
| | - Giulia Caruso
- Department of Anesthesiology, Hôpital Universitaire de Bruxelles - Hôpital universitaire des enfants Reine Fabiola, Brussels, Belgium
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Buelens T, Fils JF, Willermain F. Posterior segment spectral domain oct in the differential diagnosis of bilateral temporal optic neuropathy and its correlation with visual acuity. Int Ophthalmol 2022; 42:3877-3889. [PMID: 35809163 DOI: 10.1007/s10792-022-02408-0] [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: 04/08/2021] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify the underlying etiologies and to evaluate the differential diagnostic value of posterior segment spectral domain OCT measurements and their correlation with best-corrected visual acuity (BCVA) in a group of patients with OCT documented bilateral optic neuropathy limited to the temporal quadrants. METHODS Retrospective study. RESULTS We included 61 patients: 35 presented with presumed "classic" acquired mitochondrial optic neuropathy (MON) (18 nutritional, 11 toxic, 6 mixed toxic-nutritional) and 2 with suspected hereditary MON. Nine patients were identified as 'MON mimickers' (especially multiple sclerosis), and 4 were found to have a mixed mechanism, while 11 remained undiagnosed. Across all etiologies, the strongest positive relationship between BCVA and tested OCT parameters was with macular GCL (ganglion cell layer) and GCIPL (combined ganglion cell and inner plexiform layer) volumes rather than peripapillary retinal nerve fiber layer (RNFL) thicknesses (all statistically significant). There was an inverse relationship between BCVA and inner nuclear layer (INL) volumes, with significant differences for BCVA and all tested OCT parameters between eyes with and without INL microcystoid lesions. OCT (absolute values and intereye differences) was not helpful in distinguishing between presumed acquired mitochondrial disease and patients with multiple sclerosis without optic neuritis. However, significantly greater intereye differences in global RNFL and inner plexiform layer and GCIPL volumes were found in patients with a previous history of unilateral optic neuritis. CONCLUSIONS The strongest positive relationship with BCVA was found for macular GCL and GCIPL volumes. OCT could not differentiate between acquired mitochondrial disease and multiple sclerosis without optic neuritis.
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Affiliation(s)
- Tom Buelens
- CHU St Pierre and Brugmann, Department of Ophthalmology, 322 rue Haute, 1000, Brussels, Belgium.
| | | | - François Willermain
- CHU St Pierre and Brugmann, Department of Ophthalmology, 322 rue Haute, 1000, Brussels, Belgium
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7
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Meunier A, Zanlonghi X, Roux AF, Fils JF, Caspers L, Migeotte I, Abramowicz M, Meunier I. Natural history of Usher type 2 with the c.2299delG mutation of USH2A in a large cohort. Ophthalmic Genet 2022; 43:470-475. [PMID: 35345973 DOI: 10.1080/13816810.2022.2051191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The c.2299delG mutation is prevalent and accounts for 24.5% USH2A pathogenic variants, with promising prospects for customized gene therapy. MATERIALS AND METHODS We compared the ocular and auditory phenotypes in a retrospective cohort of 169 Usher type 2 patients, with and without the c.2299delG allele, including visual acuity, slit-lamp examination, optical coherence tomography, kinetic perimetry, and audiometric assessment to define the hearing disability. Statistical methods used were covariate balancing propensity score and adjusted survival curves log-rank test for the analysis of visual acuity. RESULTS We compare 54 Usher patients (31%) carrying at least one c.2299delG allele to 109 patients without this variant. The mean ages at onset of night blindness (14 years) and onset of peripheral vision deficiency (24 years) were similar in both groups, as was the severity of hearing loss (p = 0.731), even in homozygotes (p = 0.136). Based on the covariate balancing propensity score, the c.2299delG carrier patients developed cataract and reached a BCVA of 20/63 earlier than patients without this mutation (mean age 36 versus 42 y.o.; and 52.2 versus 55.1 y.o., respectively). Using adjusted survival curves and a log-rank test based on inverse probability weighting, patients with the c.2299delG variant reach blindness (BCVA <20/400) at 42.3 years old instead of 79.8 years for other USH2A pathogenic variants. CONCLUSIONS We conclude that c.2299delG is associated with a more severe phenotype of the Usher type 2, in homozygotes and in compound heterozygotes.
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Affiliation(s)
- Audrey Meunier
- Department of Ophthalmology, University Hospital Saint-Pierre, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Xavier Zanlonghi
- Centre de compétence Maladies rares, Jules Verne Clinic, Nantes, France
| | - Anne-Françoise Roux
- Laboratory of Molecular Genetics, University of Montpellier, Montpellier University Hospital, Montpellier, France.,Institute for Neurosciences of Montpellier, INSERM, University of Montpellier, Montpellier, France
| | | | - Laure Caspers
- Department of Ophthalmology, University Hospital Saint-Pierre, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Isabelle Migeotte
- Genetic department, IRIBHM, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Marc Abramowicz
- Genetic department, IRIBHM, Université Libre de Bruxelles, Bruxelles, Belgium.,Department of Genetic Medicine and Development, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Isabelle Meunier
- Institute for Neurosciences of Montpellier, INSERM, University of Montpellier, Montpellier, France.,National center in rare diseases Maolya, Genetics of Sensory Diseases, University Hospital, Sensgene Care Network, Montpellier, France
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Goffard P, Leloup R, Vercruysse Y, Fils JF, Gautier PE, Kapessidou Y. Comparison of equipotent doses of intrathecal hyperbaric prilocaine 2% and hyperbaric bupivacaine 0.5% for elective caesarean section: A prospective, randomised, controlled, two-centre clinical trial. Eur J Anaesthesiol 2022; 39:227-235. [PMID: 34101713 DOI: 10.1097/eja.0000000000001548] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elective caesarean section is performed mainly under spinal anaesthesia using hyperbaric bupivacaine combined with opioids. Despite rapid onset, good quality anaesthesia, bupivacaine provides a long duration of motor block and is related to maternal hypotension. Current policies appeal for implementation of enhanced recovery procedures after caesarean section. Hyperbaric prilocaine is an intermediate-acting local anaesthetic known for its efficacy in ambulatory surgery. Evidence on the clinical relevance of intrathecal prilocaine use for caesarean section is currently lacking. OBJECTIVES We aimed to investigate whether hyperbaric prilocaine would offer a shorter motor block and recovery than bupivacaine, when comparing equipotent doses. We also assessed the characteristics of sensory block, maternal haemodynamics and side effects for both mother and newborn. DESIGN Prospective, randomised, double-blind, controlled, two-centre, clinical trial. SETTING One university teaching hospital and one general teaching hospital in Brussels, Belgium. PATIENTS American Society of Anesthesiologists' physical status 2 parturients (n = 40) undergoing caesarean section under spinal anaesthesia. INTERVENTIONS Patients were randomly assigned to receive spinal anaesthesia using hyperbaric prilocaine 50 mg or hyperbaric bupivacaine 10 mg, both given with sufentanil 2.5 μg and morphine 100 μg. An epidural catheter was introduced as a backup in case of failure. MAIN OUTCOMES The primary outcome was the motor block regression (modified Bromage scale 1 to 6). Secondary outcomes included sensory block characteristics, first unassisted ambulation, maternal side effects, newborns' parameters and overall satisfaction. RESULTS Median [IQR] motor block was significantly shorter in the hyperbaric prilocaine group (110 [104 to 150] min versus 175 [135 to 189] min, P = 0.001). First unassisted ambulation was achieved earlier after prilocaine (204.5 [177 to 246.5] min versus 314 [209.25 to 400] min, P = 0.007), and the incidence of maternal hypotension was significantly higher with bupivacaine (P = 0.033). No supplementary epidural analgesia was needed. CONCLUSION Prilocaine provides shorter motor block, faster recovery and better haemodynamic stability than bupivacaine while offering equivalent surgical anaesthesia. TRIAL REGISTRATION Clinicaltrials.gov: NCT02973048, EudraCT: 2016-003010-26.
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Affiliation(s)
- Philippe Goffard
- From the Department of Anaesthesiology and Pain Medicine, University Hospital Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels (PG, RL, YV, YK), Ars Statistica, Nivelles (J-FF) and Department of Anaesthesiology, Clinique Sainte Anne-Saint Remi, CHIREC, Brussels, Belgium (PEG)
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Ponthieux F, Dauby N, Maillart E, Fils JF, Smet J, Claus M, Besse-Hammer T, Bels DD, Corazza F, Nagant C. Tocilizumab-Induced Unexpected Increase of Several Inflammatory Cytokines in Critically Ill COVID-19 Patients: The Anti-Inflammatory Side of IL-6. Viral Immunol 2022; 35:60-70. [PMID: 35085462 DOI: 10.1089/vim.2021.0111] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Early evidence during the coronavirus disease 2019 (COVID-19) pandemic indicated high levels of interleukin (IL)-6 in patients with severe COVID-19. This led to the off-label use of tocilizumab (TCZ) during the first wave of the pandemic. While the monoclonal antibody blocks IL-6 pathway, its effect on other inflammatory cytokines remains poorly described. To better understand the effect of TCZ on the biological inflammatory profile, we monitored a large panel of inflammatory cytokines in critically ill COVID-19 patients receiving off-label TCZ. Twenty-three patients with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were included in the study, among which 15 patients received TCZ and 8 patients did not. Serum samples were collected for 8 days, before and following TCZ administration or hospital admission for the control group. Serum profile of 12 cytokines (IL-1β, -2, -4, -6, -8, -10, -12, -13, -17, -18, tumor necrosis factor α (TNF-α), interferon-gamma (IFN-γ), and sIL-6R were assessed in these two groups. Although the increased IL-6 concentrations after TCZ infusion were expected, we observed an unexpected increase in IL-1β, -2, -4, -10, -12p70, -18, and sIL-6R levels in the treated patients with maximal values reaching 2 to 4 days after TCZ. In contrast, no change in cytokine levels was observed in the control group. Our results suggested that some inflammatory pathways escape IL-6R blockade and even appeared amplified. This finding highlights an old observation of the anti-inflammatory effects of IL-6 as already suggested over 20 years ago. Clinical Trial Registration number: NCT04346017.
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Affiliation(s)
- Fanny Ponthieux
- Immunology Department, LHUB-ULB, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université libre de Bruxelles (ULB), Brussels, Belgium
- Institute for Medical Immunology, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Evelyne Maillart
- Department of Infectious Disease, Brugmann University Hospital, Brussels, Belgium
| | | | - Julie Smet
- Immunology Department, LHUB-ULB, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Marc Claus
- Department of Intensive Care, Centre Hospitalier Universitaire Saint-Pierre, Université libre de Bruxelles (ULB), Brussels, Belgium
| | | | - David De Bels
- Department of Intensive Care, Brugmann University Hospital, Brussels, Belgium
| | - Francis Corazza
- Immunology Department, LHUB-ULB, Université libre de Bruxelles (ULB), Brussels, Belgium
- Laboratory of Translational Research, Brugmann University Hospital, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Carole Nagant
- Immunology Department, LHUB-ULB, Université libre de Bruxelles (ULB), Brussels, Belgium
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Javorcikova Z, Dangoisse M, Nikis S, Lechat JP, Gillain A, Fils JF, Van der Linden P. The place of S-ketamine in fibromyalgia treatment (ESKEFIB): study protocol for a prospective, single-center, double-blind, randomized, parallel-group, dose-escalation controlled trial. Trials 2021; 22:853. [PMID: 34838114 PMCID: PMC8627027 DOI: 10.1186/s13063-021-05814-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 11/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background Fibromyalgia is a chronic multidimensional pain disease with no curative treatment currently available. Its management relies on a multimodal approach involving pharmacologic and non-pharmacologic elements. Because a suggested factor in its etiology is a central sensitization phenomenon involving the N-methyl-D-aspartate receptor (NMDAR), NMDAR antagonists have been proposed as a treatment target. Ketamine and its levogyre form, S-ketamine, have been used to treat chronic pain for many years without consensus about their therapeutic efficiency. We aim to assess the efficacy of S-ketamine as a co-treatment for fibromyalgia. Methods This prospective, randomized, single-center, double-blind, parallel-group, dose-escalation trial will compare a co-treatment with S-ketamine (intervention) to a control treatment without S-ketamine (control). It will consist of two successive cohorts with 2:1 randomization ratio (S-ketamine at two different doses: control) with 105 participants in each cohort. The protocol follow-up time will be 12 weeks, including 3 visits for the treatment (week 0, week 2, and week 4) and 3 visits for follow-up (week 6, week 9, and week 12). Our primary outcome, pain relief and/or better patient function, will be assessed with the Brief Pain Inventory questionnaire. The statistical analysis will be performed on an intention-to-treat basis. If the primary outcome is reached at the end of follow-up in the first cohort with low-dose S-ketamine (0.2 mg/kg), the trial will end. If not, the trial will continue with the second cohort and high-dose S-ketamine (0.4 mg/kg). Discussion The challenge of our trial is the inclusion of a large number of participants in comparison to other trials involving ketamine or S-ketamine infusions for chronic pain management. The originality of our protocol is to include functionality in addition to pain relief as a primary outcome because these two endpoints are not linked in a linear way. For some patients, functional status is more important than pain relief. Trial registration EudraCT reference: 2020-000473-25, ClinicalTrials.gov: NCT04436250, first posted June 18, 2020; last updated July 21, 2020. Protocol version 2.2 issued on September 30, 2020, after a revision by the ethics committee. https://clinicaltrials.gov/ct2/show/NCT04436250 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05814-4.
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Affiliation(s)
- Zuzana Javorcikova
- Grand Hôpital de Charleroi, Site Notre-Dame, Grand Rue 3, B-6000, Charleroi, Belgium.
| | - Michel Dangoisse
- Grand Hôpital de Charleroi, Site Notre-Dame, Grand Rue 3, B-6000, Charleroi, Belgium
| | - Stéphane Nikis
- Grand Hôpital de Charleroi, Site Sainte-Thérèse, Rue Trieu Kaisin 134, 6061, Charleroi, Belgium
| | - Jean-Paul Lechat
- Grand Hôpital de Charleroi, Site Notre-Dame, Grand Rue 3, B-6000, Charleroi, Belgium
| | - Aline Gillain
- Grand Hôpital de Charleroi, Site Notre-Dame, Grand Rue 3, B-6000, Charleroi, Belgium
| | | | - Philippe Van der Linden
- Grand Hôpital de Charleroi, Site Notre-Dame, Grand Rue 3, B-6000, Charleroi, Belgium.,Université Libre de Bruxelles, Brussels, Belgium
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Van der Linden PJ, Verdoodt H, Métallo E, Plasman C, Fils JF, Schmartz D. Does propofol mode of administration influence psychomotor recovery time after sedation for colonoscopy: A prospective randomized assessor-blinded trial. Saudi J Anaesth 2021; 15:390-395. [PMID: 34658725 PMCID: PMC8477760 DOI: 10.4103/sja.sja_196_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 11/04/2022] Open
Abstract
Background Propofol sedation has become increasingly popular for colonoscopy. Different modes of propofol administration have been described, but their influence on psychomotor recovery time remains largely unknown. This prospective randomized assessor-blinded study tested the hypothesis that target-controlled infusion system (TCI) combined with sedation depth monitoring should be associated with a more stable sedation than intermittent bolus application with clinical monitoring of sedation depth, resulting in a faster psychomotor skills recovery. Methods One hundred sixty-four patients undergoing colonoscopy were randomized to receive propofol with the former (TCI group) or the latter (bolus group) mode of administration. Psychomotor skill recovery was assessed using the Choice Reaction Time (CRT) performed before and every ten minutes after waking up from propofol sedation. Clinical recovery was also assessed using the modified Post-anesthetic Discharge Scoring System (PADS). Results Induction and wake up times were longer in the TCI group, where patients received more propofol than those in the bolus group. Evolution of CRT was similar in both groups. Twenty minutes after arrival in the post-anesthesia care unit, 35 (49%) of patients in the TCI group and 43 (54%) in the bolus group achieved CRT values equal or shorter than their baseline values. Interestingly, according to the PADS score, most of the patients were considered fit for discharge at that moment. Incidence of adverse event was not different between groups. Conclusion In the conditions of our study characterized by short procedure duration, target-controlled infusion of propofol does not offer any benefit in terms of psychomotor skills recovery over intermittent bolus application.
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Affiliation(s)
- Philippe J Van der Linden
- Department of Anesthesiology, Centre Hospitalo-Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Nivelles, Belgium
| | - Hans Verdoodt
- Department of Anesthesiology, Centre Hospitalo-Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Nivelles, Belgium
| | - Etienne Métallo
- Department of Anesthesiology, Centre Hospitalo-Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Nivelles, Belgium
| | - Chantal Plasman
- Department of Anesthesiology, Centre Hospitalo-Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Nivelles, Belgium
| | | | - Denis Schmartz
- Department of Anesthesiology, Centre Hospitalo-Universitaire (CHU) Brugmann, Université Libre de Bruxelles, Nivelles, Belgium
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12
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Badr DA, Picone O, Bevilacqua E, Carlin A, Meli F, Sibiude J, Mattern J, Fils JF, Mandelbrot L, Lanzone A, De Luca D, Jani JC, Vivanti AJ. Severe Acute Respiratory Syndrome Coronavirus 2 and Pregnancy Outcomes According to Gestational Age at Time of Infection. Emerg Infect Dis 2021; 27:2535-2543. [PMID: 34352196 PMCID: PMC8462348 DOI: 10.3201/eid2710.211394] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We conducted an international multicenter retrospective cohort study, PregOuTCOV, to examine the effect of gestational age at time of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on obstetric and neonatal outcomes. We included all singleton pregnancies with a live fetus at 10 weeks' gestation in which pregnancy outcomes were known. The exposed group consisted of patients infected with SARS-CoV-2, whereas the unexposed group consisted of all remaining patients during the same period. Primary outcomes were defined as composite adverse obstetric outcomes and composite adverse neonatal outcomes. Of 10,925 pregnant women, 393 (3.60%) were infected with SARS-CoV-2 (exposed group). After matching for possible confounders, we identified statistically significant increases in the exposed group of composite adverse obstetric outcomes at >20 weeks' gestation and of composite adverse neonatal outcomes at >26 weeks' gestation (p<0.001). Vaccination programs should target women early in pregnancy or before conception, if possible.
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Baleanu F, Iconaru L, Charles A, Kinnard V, Fils JF, Moreau M, Karmali R, Surquin M, Benoit F, Mugisha A, Paesmans M, Laurent MR, Bergmann P, Body JJ. Independent External Validation of FRAX and Garvan Fracture Risk Calculators: A Sub-Study of the FRISBEE Cohort. JBMR Plus 2021; 5:e10532. [PMID: 34532617 PMCID: PMC8441269 DOI: 10.1002/jbm4.10532] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/04/2021] [Accepted: 06/30/2021] [Indexed: 01/24/2023] Open
Abstract
Probabilistic models including clinical risk factors with or without bone mineral density (BMD) have been developed to estimate the 5‐ or 10‐year absolute fracture risk. We investigated the performance of the FRAX and Garvan tools in a well‐characterized population‐based cohort of 3560 postmenopausal, volunteer women, aged 60 to 85 years at baseline, included in the Fracture Risk Brussels Epidemiological Enquiry (FRISBEE) cohort, during 5 years of follow‐up. Baseline data were used to calculate the estimated 10‐year risk of hip and major osteoporotic fractures (MOFs) for each participant using FRAX (Belgium). We computed the 5‐year risk according to the Garvan model with BMD. For calibration, the predicted risk of fracture was compared with fracture incidence across a large range of estimated fracture risks. The accuracy of the calculators to predict fractures was assessed using the area under the receiver operating characteristic curves (AUC). The FRAX tool was well calibrated for hip fractures (slope 1.09, p < 0.001; intercept −0.001, p = 0.46), but it consistently underestimated the incidence of major osteoporotic fractures (MOFs) (slope 2.12, p < 0.001; intercept −0.02, p = 0.06). The Garvan tool was well calibrated for “any Garvan” fractures (slope 1.05, p < 0.001; intercept 0.01, p = 0.37) but largely overestimated the observed hip fracture rate (slope 0.32, p < 0.001; intercept 0.006, p = 0.05). The predictive value for hip fractures was better for FRAX (AUC: 0.841, 95% confidence interval [CI] 0.795–0.887) than for Garvan (AUC: 0.769, 95% CI 0.702–0.836, p = 0.01). The Garvan AUC for “any Garvan” fractures was 0.721 (95% CI 0.693–0.749) and FRAX AUC for MOFs was 0.708 (95% CI 0.675–0.741). In conclusion, in our Belgian cohort, FRAX estimated quite well hip fractures but underestimated MOFs, while Garvan overestimated hip fracture risk but showed a good estimation of “any Garvan” fractures. Both models had a good discriminatory value for hip fractures but only a moderate discriminatory ability for MOFs or “any Garvan” fractures. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Felicia Baleanu
- Department of Endocrinology, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Laura Iconaru
- Department of Endocrinology, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Alexia Charles
- Department of Clinical Research, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Virginie Kinnard
- Department of Geriatrics, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | | | - Michel Moreau
- Data Centre, Institute Jules Bordet Université Libre de Bruxelles Brussels Belgium
| | - Rafik Karmali
- Department of Endocrinology, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Murielle Surquin
- Department of Geriatrics, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Florence Benoit
- Department of Geriatrics, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Aude Mugisha
- Department of Geriatrics, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Marianne Paesmans
- Data Centre, Institute Jules Bordet Université Libre de Bruxelles Brussels Belgium
| | - Michaël R Laurent
- Centre for Metabolic Bone Diseases University Hospitals Leuven Leuven Belgium.,Imelda Hospital Bonheiden Belgium
| | - Pierre Bergmann
- Department of Nuclear Medicine, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
| | - Jean-Jacques Body
- Department of Endocrinology, CHU Brugmann Université Libre de Bruxelles Brussels Belgium
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Willems A, De Groote F, Schmartz D, Fils JF, Van der Linden P. Does a balanced colloid decrease perioperative blood loss in paediatric cardiac surgery: A double-blinded randomized controlled trial? Eur J Anaesthesiol 2021; 38:923-931. [PMID: 33966019 DOI: 10.1097/eja.0000000000001526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Unbalanced fluid solutions cause metabolic acidosis and could be associated with impaired coagulation and increased blood loss. OBJECTIVE To investigate whether the use of a balanced colloid compared with a saline colloid for peri-operative fluid therapy in children undergoing cardiac surgery is associated with decreased blood loss and exposure to blood products. DESIGN Double-blinded randomised controlled trial. SETTING Tertiary children's hospital from 2013 to 2016. PATIENTS Children older than 29 days and younger than 3 years admitted for cardiac surgery with cardiopulmonary bypass (CPB). Exclusion criteria were emergency cardiac surgery, moribund (American Society of Anesthesiologists 5), Jehovah's witnesses, coagulopathy, renal failure, liver injury, intracranial haemorrhage and electrolyte disturbances. From the 128 patients eligible, 88 were included in the study. INTERVENTION Random assignment of patients to either a saline colloid (6% hydroxyethyl starch 130/0.4 in 0.9% NaCl) or a balanced-electrolyte colloid (6% hydroxyethyl starch 130/0.4 in an isotonic solution) for CPB priming and intra- and postoperative fluid therapy during the first postoperative 48 h. MAIN OUTCOME MEASURE The primary outcome measure was calculated blood loss until the third postoperative day (POD3). RESULTS A total of 44 patients were included in each study arm. Calculated blood loss at POD3 was not significantly different between the groups (saline colloid 19.9 [IQR 13.8 to 26.1] ml kg-1 versus balanced colloid 15.9 [IQR 9.0 to 25.3 ml kg-1], P = 0.409). Secondary outcomes related to bleeding, exposure to blood products and coagulation were not different between groups. There was also no difference in length of mechanical ventilation, intensive care and hospital length of stay between groups. CONCLUSION The use of a balanced colloid for peri-operative fluid therapy compared with a saline one is not associated with decreased blood loss or exposure to blood products. TRIAL REGISTRATION EudraCT identifier: 2012-006034-17 and ClinicalTrial.gov identifier: NCT02584868.
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Affiliation(s)
- Ariane Willems
- From the Paediatric Intensive Care Unit, Department of Intensive Care, Leiden University Medical Centre, Leiden, The Netherlands (AW), Department of Anaesthesiology, University Hospital Brugmann and Queen Fabiola University Children's Hospital, Brussels, Belgium (F-DG, DS, P-VdL) and Ars Statistica, Nivelles, Belgium (JF-F)
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15
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Deleers M, Breiman A, Daubie V, Maggetto C, Barreau I, Besse T, Clémenceau B, Ruvoën-Clouet N, Fils JF, Maillart E, Doyen V, Mahadeb B, Jani JC, Van der Linden P, Cannie MM, Hayef N, Corazza F, Le Pendu J, El Kenz H. Covid-19 and blood groups: ABO antibody levels may also matter. Int J Infect Dis 2021; 104:242-249. [PMID: 33326874 PMCID: PMC7832075 DOI: 10.1016/j.ijid.2020.12.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Susceptibility to Covid-19 has been found to be associated with the ABO blood group, with O type individuals being at a lower risk. However, the underlying mechanism has not been elucidated. Here, we aimed to test the hypothesis that Covid-19 patients might have lower levels of ABO antibodies than non-infected individuals as they could offer some degree of protection. METHODS After showing that the viral spike protein harbors the ABO glycan epitopes when produced by cells expressing the relevant glycosyltransferases, like upper respiratory tract epithelial cells, we enrolled 290 patients with Covid-19 and 276 asymptomatic controls to compare their levels of natural ABO blood group antibodies. RESULTS We found significantly lower IgM anti-A + anti-B agglutination scores in blood group O patients (76.93 vs 88.29, P-value = 0.034) and lower levels of anti-B (24.93 vs 30.40, P-value = 0.028) and anti-A antibodies (28.56 vs 36.50, P-value = 0.048) in blood group A and blood group B patients, respectively, compared to controls. CONCLUSION In this study, we showed that ABO antibody levels are significantly lower in Covid-19 patients compared to controls. These findings could indicate that patients with low levels of ABO antibodies are at higher risk of being infected.
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Affiliation(s)
- Marie Deleers
- Department of Transfusion, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Immunology, LHUB-ULB, Brussels, Belgium.
| | - Adrien Breiman
- Université de Nantes, INSERM, CRCINA, Nantes, France; CHU de Nantes, Nantes, France
| | - Valéry Daubie
- Laboratory of Immunology, LHUB-ULB, Brussels, Belgium
| | - Carine Maggetto
- Department of Transfusion, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Isabelle Barreau
- Department of Transfusion, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Immunology, LHUB-ULB, Brussels, Belgium
| | - Tatiana Besse
- Department of Clinical Research, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Béatrice Clémenceau
- Université de Nantes, INSERM, CRCINA, Nantes, France; CHU de Nantes, Nantes, France
| | - Nathalie Ruvoën-Clouet
- Université de Nantes, INSERM, CRCINA, Nantes, France; Oniris, Ecole Nationale Vétérinaire, Agroalimentaire et de l'Alimentation, Nantes, France
| | | | - Evelyne Maillart
- Department of Infectious Diseases, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Virginie Doyen
- Immuno-Allergology Clinic, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Translational Research, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Jacques C Jani
- Department of Obstetrics and Gynaecology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Mieke M Cannie
- Department of Radiology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nabil Hayef
- Department of Pharmacy (Clinical Trials), CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Francis Corazza
- Laboratory of Immunology, LHUB-ULB, Brussels, Belgium; Laboratory of Translational Research, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Hanane El Kenz
- Department of Transfusion, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium; Laboratory of Immunology, LHUB-ULB, Brussels, Belgium
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Guntz E, Vasseur C, Ifrim D, Louvard A, Fils JF, Kapessidou Y. Intrathecal chloroprocaine or hyperbaric prilocaine for ambulatory knee surgery? A prospective randomized study. J Exp Orthop 2021; 8:15. [PMID: 33629206 PMCID: PMC7905001 DOI: 10.1186/s40634-021-00332-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/27/2021] [Indexed: 11/11/2022] Open
Abstract
Purpose The aim of this study was to compare intrathecal 1% chloroprocaine with 2% hyperbaric prilocaine in the setting of ambulatory knee arthroscopy. We hypothesized that complete resolution of the sensory block was faster with chloroprocaine. Methods Eighty patients scheduled for knee arthroscopy were included in this prospective randomized double-blind study. Spinal anesthesia was performed with either chloroprocaine (50 mg) or hyperbaric prilocaine (50 mg). Characteristics of sensory and motor blocks and side effects were recorded. Results Mean time to full sensory block recovery was shorter with chloroprocaine (169 (56.1) min vs 248 (59.4)). The characteristics of the sensory blocks were similar at the T12 dermatome level between the two groups. Differences appeared at T10: the percentage of patients with a sensory block was higher, onset quicker and duration longer with hyperbaric prilocaine. The number of patients with a sensory block at T4 dermatome level in both groups was minimal. Times to full motor recovery were identical in both groups (85 (70–99) vs 86 (76–111) min). Time to spontaneous voiding was shorter with chloroprocaine (203 (57.6) min vs 287.3 (47.2) min). Incidence of side effects was low in both groups. Conclusions When considering the characteristics of the sensory block, the use of chloroprocaine may allow an earlier discharge of patients. Cephalic extension was to a higher dermatomal level and the sensory block at T10 level was of prolonged duration with hyperbaric prilocaine, suggesting that the choice between the two drugs should also be performed based on the level of the sensory block requested by the surgery. This study is registered in the US National Clinical Trials Registry, registration number: NCT030389, the first of February 2017, Retrospectively registered.
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Affiliation(s)
- E Guntz
- Department of Anesthesiology, Hôpital Braine L'Alleud Waterloo, Université Libre de Bruxelles (ULB), 35 rue Wayez, 1420, Braine l'Alleud-Waterloo, Belgium.
| | - C Vasseur
- Department of Anesthesiology, Hôpital Braine L'Alleud Waterloo, Université Libre de Bruxelles (ULB), 35 rue Wayez, 1420, Braine l'Alleud-Waterloo, Belgium
| | - D Ifrim
- Department of Anesthesiology, Hôpital Braine L'Alleud Waterloo, Université Libre de Bruxelles (ULB), 35 rue Wayez, 1420, Braine l'Alleud-Waterloo, Belgium
| | - A Louvard
- Department of Anesthesiology, Hôpital Braine L'Alleud Waterloo, Université Libre de Bruxelles (ULB), 35 rue Wayez, 1420, Braine l'Alleud-Waterloo, Belgium
| | - J F Fils
- Independant Biostatistician - Ars Statistica, Nivelles, Belgium
| | - Y Kapessidou
- Department of Anesthesiology, CHU St Pierre, ULB, 322 rue Haute, 1000, Bruxelles, Belgium
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Noel E, Miglionico L, Leclercq M, Jennart H, Fils JF, Van Rompaey N. Sufentanil sublingual tablet system versus oral oxycodone for management of postoperative pain in enhanced recovery after surgery pathway for total knee arthroplasty: a randomized controlled study. J Exp Orthop 2020; 7:92. [PMID: 33216238 PMCID: PMC7679427 DOI: 10.1186/s40634-020-00306-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/02/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Effectiveness of sufentanil sublingual tablet system (SSTS) compared to oral oxycodone in the management of postoperative pain after total knee arthroplasty (TKA) within an enhanced recovery after surgery (ERAS) protocol. METHODS This pragmatic, parallel, open label, randomized controlled, trial enrolled 72 adult patients scheduled for TKA under spinal anesthesia following ERAS pathway. In addition to multimodal analgesia, patients received SSTS 15 mcg (SSTS group) or oral oxycodone extended release 10 mg twice daily and oral oxycodone immediate-release 5 mg up to four times daily on demand (Oxy group) to control pain during 48 h postoperatively. The primary endpoint was pain measured using a numeric rating scale at 24 h postoperatively. Time to first mobilization, side effects and patient satisfaction were also recorded. RESULTS Median pain score at 24 h at rest was 3 [2-4] for Oxy group vs 2 [1.75-3] for SSTS group (p = 0.272) whereas median pain score on movement was 4 [3-6] vs 3 [2-5] respectively (p = 0.059). No difference in time to first mobilization was found between the two groups. The method of pain control was judged good/excellent for 83.9% of patients in the SSTS group compared with 52.9% in the Oxy group (p = 0.007). The incidence of nausea was 33% in SSTS group and 9% in Oxy group (p = 0.181). CONCLUSIONS In complement to ERAS multimodal analgesia, sublingual sufentanil 15 mcg tablet system did not show clinically significant pain improvement compared to oral oxycodone after total knee arthroplasty. TRIAL REGISTRATION Clinical Trials: NCT04448457 ; retrospectively registered on June 24, 2020. https://clinicaltrials.gov/ct2/show/NCT04448457?cond=sublingual+sufentanil&cntry=BE&draw=2&rank=3.
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Affiliation(s)
- Emmanuel Noel
- Anesthesiology, CHU Tivoli Hospital, Avenue Max Buset, 34, 7100, La Louvière, Belgium.
| | - Luca Miglionico
- Anesthesiology, CHU Tivoli Hospital, Avenue Max Buset, 34, 7100, La Louvière, Belgium
| | - Mickael Leclercq
- Anesthesiology, CHU Tivoli Hospital, Avenue Max Buset, 34, 7100, La Louvière, Belgium
| | - Harold Jennart
- Orthopedic surgery, CHU Tivoli Hospital, La Louvière, Belgium
| | | | - Nicolas Van Rompaey
- Anesthesiology, CHU Tivoli Hospital, Avenue Max Buset, 34, 7100, La Louvière, Belgium
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Badr DA, Mattern J, Carlin A, Cordier AG, Maillart E, El Hachem L, El Kenz H, Andronikof M, De Bels D, Damoisel C, Preseau T, Vignes D, Cannie MM, Vauloup-Fellous C, Fils JF, Benachi A, Jani JC, Vivanti AJ. Are clinical outcomes worse for pregnant women at ≥20 weeks' gestation infected with coronavirus disease 2019? A multicenter case-control study with propensity score matching. Am J Obstet Gynecol 2020; 223:764-768. [PMID: 32730899 PMCID: PMC7384420 DOI: 10.1016/j.ajog.2020.07.045] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/24/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jérémie Mattern
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Andrew Carlin
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne-Gaël Cordier
- Department of Obstetrics and Gynecology, Bicêtre Hospital, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Evelyne Maillart
- Department of Infectious Diseases, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Larissa El Hachem
- Department of Obstetrics and Gynecology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Hanane El Kenz
- Department of Transfusion and Blood Bank, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Marc Andronikof
- Department of Emergency, Antoine Béclère Hospital, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - David De Bels
- Department of Intensive Care, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Charles Damoisel
- Department of Critical Care, Antoine Béclère Hospital, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Thierry Preseau
- Department of Emergency, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Dorothée Vignes
- Department of Immunology and Internal Medicine, Antoine Béclère Hospital, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Mieke M Cannie
- Department of Radiology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Christelle Vauloup-Fellous
- Division of Virology, Paul-Brousse Hospital, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Villejuif, France
| | | | - Alexandra Benachi
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Place Arthur Van Gehuchten 4, Brussels 1020, Belgium.
| | - Alexandre J Vivanti
- Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Clamart, France
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Ghoundiwal D, Delaporte A, Bidgoli J, Forget P, Fils JF, Van der Linden P. Effect of pneumoperitoneum on dynamic variables of fluid responsiveness (Delta PP and PVI) during Trendelenburg position. Saudi J Anaesth 2020; 14:323-328. [PMID: 32934624 PMCID: PMC7458000 DOI: 10.4103/sja.sja_737_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/04/2019] [Accepted: 01/26/2020] [Indexed: 11/29/2022] Open
Abstract
Background and Aims: Pulse pressure variation (ΔPP) is considered as one of the best predictors of fluid responsiveness in patients under mechanical ventilation. Pleth Variability Index (PVI) has been proposed as a noninvasive alternative. However, pneumoperitoneum has been recently suggested as a limitation to their interpretation. The aim of this study was to compare changes in ΔPP and PVI related to autotransfusion associated with a Trendelenburg maneuver before and during pneumoperitoneum. Methods: 50 patients undergoing elective abdominal laparoscopic surgery were enrolled in this prospective observational study. All patients were equipped with an invasive radial artery catheter and a PVI probe. After obtaining a stable signal with both ΔPP and PVI, baseline values were recorded, before and after head-down tilts of 10°, with or without abdominal insufflation (10-12 mmHg). All measurements were made before any fluid challenge under standardized anaesthesia, while patients were paralyzed and mechanically ventilated with 8 mL/kg tidal volume. Results: Changes in ΔPP and PVI associated with the Trendelenburg maneuver before and after insufflation of the pneumoperitoneum were significantly different (P < 0.001). In baseline conditions, the Trendelenburg maneuver was associated with a significant decrease in heart rate while mean arterial pressure remained unchanged. Both ΔPP and PVI decreased. After insufflation of the pneumoperitoneum, the Trendelenburg maneuver was associated with a significant decrease in heart rate and ΔPP and an increase in mean arterial pressure while PVI remained unchanged. Conclusion: Pneumoperitoneum did not alter the response of ΔPP to autotransfusion associated with the Trendelenburg maneuver, which was not the case for the PVI. This latter decreased during Trendelenburg maneuver performed alone and remained unchanged during Trendelenburg maneuver performed after insufflation of the pneumoperitoneum.
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Affiliation(s)
- Djamal Ghoundiwal
- Department of Anaesthesiology, Erasme Hospital, Route de Lennik 808, 1070 Brussels, Belgium
| | - Amelie Delaporte
- Department of Anaesthesiology, Brugmann Hospital, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
| | - Javad Bidgoli
- Department of Anaesthesiology, Brugmann Hospital, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
| | - Patrice Forget
- Anesthesiology and Perioperative Medicine, Vrije Universiteit Brussel (VUB), Laarbeeklaan 101, 1090 Brussels, Belgium
| | | | - Philippe Van der Linden
- Department of Anaesthesiology, Brugmann Hospital, Place A. Van Gehuchten 4, 1020 Brussels, Belgium
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20
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de Wergifosse S, Bevilacqua E, Mezela I, El Haddad S, Gounongbe C, de Marchin J, Maggi V, Conotte S, Badr DA, Fils JF, Guizani M, Jani JC. Cell-free DNA analysis in maternal blood: comparing genome-wide versus targeted approach as a first-line screening test. J Matern Fetal Neonatal Med 2019; 34:3552-3561. [PMID: 31722585 DOI: 10.1080/14767058.2019.1686478] [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] [Indexed: 10/25/2022]
Abstract
Objectives: To evaluate the failure rate and performance of cell-free DNA (cfDNA) testing as a first-line screening method for major trisomies, performed by two laboratories using different analytical methods: a targeted chromosome-selective method (Harmony® prenatal Test) versus a home-brew genome-wide (GW) massively parallel sequencing method (HB-cfDNA test), and to evaluate the clinical value of incidental findings for the latter method.Methods: CfDNA testing was performed in 3137 pregnancies with the Harmony® prenatal Test and in 3373 pregnancies with the HB-cfDNA test. Propensity score analysis was used to match women between both groups for maternal age, weight, gestational age at testing, in vitro fertilization, rate of twin pregnancies and that of aneuploidies. Detection rates for trisomy 21 were compared between the 2 laboratories. For the HB-cfDNA test, cases with rare incidental findings were reported, including their clinical follow-up.Results: The Harmony® prenatal Test failed at the first attempt in 90 (2.9%) of 3114 women and the HB-cfDNA test in 413 (12.2%) of 3373 women. Postmatched comparisons of the women's characteristics indicate a significantly lower failure rate in the Harmony® group (2.8%) than in the HB cfDNA group (12.4%; p < .001). Of the 90 women in whom the Harmony® prenatal Test failed, 61 had a repeat test, which still failed in 10, and of the 413 women in whom the HB-cfDNA test failed, 379 had a repeat test, which still failed in 110. The total failure rate after one or two attempts was therefore 1.3% (39/3114) for Harmony® and 4.3% (144/3373) for the HB cfDNA test. After the first or second Harmony® prenatal Test, a high-risk result was noted in 17 of the 17 cases with trisomy 21, in 5 of the seven cases with trisomy 18, and a no-call in two cases, and in the one case with trisomy 13. The respective numbers for the HB-cfDNA test are 17 of the 18 cases with trisomy 21, and a no-call in one case, 2 of the two cases with trisomy 18, and in 2 of the three cases with trisomy 13, and a no-call in one. Of the 3373 women with the HB-cfDNA test, a rare incidental finding was noted in 28 (0.8%) of the cases, of which only 2 were confirmed on amniocytes (one with microduplication 1q21.1q21.2 and one with a deletion Xp21.1), and in another case a deletion rather than a duplication of the long arm of chromosome 8 was found. In all 28 cases, there was normal clinical follow-up.Conclusions: Comparison of cfDNA testing between these two laboratories showed a four-fold lower failure rate with the Harmony® prenatal Test, with a similar detection rate for trisomy 21. We showed no clinical relevance of disclosing additional findings beyond common trisomies with the GW HB-cfDNA test.
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Affiliation(s)
- Sidonie de Wergifosse
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium.,Department of Obstetrics and Gynecology, University Hospital St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Elisa Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Iris Mezela
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Sarah El Haddad
- Department of Obstetrics and Gynecology, University Hospital St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Gounongbe
- Department of Obstetrics and Gynecology, University Hospital St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Valeria Maggi
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Stéphanie Conotte
- Department of Blood Transfusion, University Hospital Brugmann, Brussels, Belgium
| | - Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Meriem Guizani
- Department of Obstetrics and Gynecology, University Hospital St Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Willems A, De Groote F, Dumoulin M, Fils JF, Van der Linden P. Aprotinin versus tranexamic acid in children undergoing cardiac surgery: an observational study. Eur J Cardiothorac Surg 2019; 56:688-695. [PMID: 30928999 DOI: 10.1093/ejcts/ezz088] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The upcoming release of aprotinin in paediatric cardiac surgery prompted a re-evaluation of its use in comparison to tranexamic acid (TXA) focusing on their effect on exposure to blood transfusions as well as severe postoperative morbidity or mortality. METHODS This retrospective study was conducted in a tertiary children hospital from 2002 to 2015. Patients receiving aprotinin (Aprotinin group: 2002-2007) were compared with those receiving TXA group (2008-2015) using propensity score analysis. Primary outcome measures were 'exposure to blood products' and 'severe postoperative morbidity or mortality'. High-risk subgroups that included neonates, complex (Risk Adjusted Classification for Congenital Heart Surgery-1 ≥ 3) and redo surgery were also analysed. RESULTS The study included 2157 patients, 1136 in the Aprotinin group and 1021 in the TXA group. Exposure to blood products was significantly higher in the Aprotinin group (78% vs 60%; P < 0.001) as well as in the complex and redo surgery subgroups. Incidence of mortality and/or severe morbidity was higher in the Aprotinin group (33% vs 28%; P = 0.007), as well as in the neonate group. However, cardiopulmonary bypass priming volume and intraoperative fluid balance were significantly decreased, and the use of modified ultrafiltration significantly increased in the TXA group. CONCLUSIONS In our population, children receiving aprotinin were more frequently transfused and were at a higher risk of developing severe postoperative morbidity or mortality than those receiving TXA. Subgroups at high risk of bleeding or inflammation did not seem to benefit from aprotinin. These differences might be explained by a safer profile of TXA, but also attributed to major changes in our patient blood management strategies over years.
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Affiliation(s)
- Ariane Willems
- Paediatric Intensive Care Unit, Department of Intensive Care, Leids Universitair Medisch Centrum, Leiden, Netherlands
| | - Françoise De Groote
- Department of Anaesthesiology, University Hospital Brugmann, Queen Fabiola University Children's Hospital, Brussels, Belgium
| | - Melanie Dumoulin
- Department of Anaesthesiology, University Hospital Brugmann, Queen Fabiola University Children's Hospital, Brussels, Belgium
| | | | - Philippe Van der Linden
- Department of Anaesthesiology, University Hospital Brugmann, Queen Fabiola University Children's Hospital, Brussels, Belgium
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22
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Vissers G, Goorens CK, Vanmierlo B, Bonte F, Mermuys K, Fils JF, Goubau JF. Ivory arthroplasty for trapeziometacarpal osteoarthritis: 10-year follow-up. J Hand Surg Eur Vol 2019; 44:138-145. [PMID: 30227766 DOI: 10.1177/1753193418797890] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 02/03/2023]
Abstract
This prospective study investigates long-term functional outcome after total trapeziometacarpal joint replacement with the Ivory arthroplasty for trapeziometacarpal joint osteoarthritis. Clinical outcome, overall function, pain, and radiologic outcome after a minimum of 10 years were evaluated for 26 Ivory arthroplasty in 24 patients. Two patients had bilateral arthroplasties. The female to male ratio was 22:2, and the mean age was 71 years (range 57-83). The mean follow-up period was 130 months (range 120-142). Overall functioning as defined by the QuickDASH score and visual analogue pain score improved by 50% and 81%, respectively, when compared with the preoperative status. However, these outcomes deteriorated beyond 5 years after surgery. Long-term results suggest the Ivory arthroplasty to be a reliable treatment for trapeziometacarpal osteoarthritis since it improves overall function and reduces pain up to 10 years postoperatively. However, revision within 10 years after surgery was needed in four of 26 cases. Level of evidence: II.
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Affiliation(s)
- Gino Vissers
- 1 Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Chul Ki Goorens
- 2 Department of Orthopaedics and Traumatology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Bert Vanmierlo
- 1 Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Francis Bonte
- 1 Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan Hospital, Bruges, Belgium
| | - Koen Mermuys
- 3 Department of Radiology, AZ Sint-Jan Hospital, Bruges, Belgium
| | | | - Jean F Goubau
- 1 Department of Orthopaedics and Traumatology, Upper Limb Unit, Orthoclinic, AZ Sint-Jan Hospital, Bruges, Belgium.,2 Department of Orthopaedics and Traumatology, Vrije Universiteit Brussel, Brussels, Belgium
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23
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Faron G, Balepa L, Parra J, Fils JF, Gucciardo L. The fetal fibronectin test: 25 years after its development, what is the evidence regarding its clinical utility? A systematic review and meta-analysis. J Matern Fetal Neonatal Med 2018; 33:493-523. [PMID: 29914277 DOI: 10.1080/14767058.2018.1491031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: The identification of women at risk for preterm birth should allow interventions which could improve neonatal outcome. Fetal fibronectin, a glycoprotein which acts normally as glue between decidua and amniotic membranes could be a good marker of impending labour when its concentration in cervicovaginal secretions between 22 and 36 weeks of gestation is ≥50 ng/mL. Many authors worldwide have tested this marker with many different methodologies and clinical settings, but conclusions about its clinical use are mixed. It is time for a comprehensive update through a systematic review and meta-analysis.Methods: We searched PubMed, Cochrane Library, and Embase, supplemented by manual search of bibliographies of known primary and review articles, international conference papers, and contact with experts from 1-1990 to 2-2018. We have selected all type of studies involving fetal fibronectin test accuracy for preterm delivery. Two authors independently extracted data about study characteristics and quality from identified publications. Contingency tables were constructed. Reference standards were preterm delivery before 37, 36, 35, 34, and 32 weeks, within 28, 21, 14, or 7 d and within 48 h. Data were pooled to produce summary likelihood ratios for positive and negative tests results.Results: One hundred and ninety-three primary studies were identified allowing analysis of 53 subgroups. In all settings, none of the summary likelihood ratios were >10 or <0.1, thus indicating moderate prediction, particularly in asymptomatic women and in multiple gestations.Conclusions: The fetal fibronectin test should not be used as a screening test for asymptomatic women. For high-risk asymptomatic women, and especially for women with multiple pregnancies, the performance of the fetal fibronectin test was also too low to be clinically relevant. Consensual use as a diagnostic tool for women with suspected preterm labor, the best use policy probably still depends on local contingencies, future cost-effectiveness analysis, and comparison with other more recent available biochemical markers.
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Affiliation(s)
- Gilles Faron
- Department of Obstetrics and Prenatal Medicine, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lisa Balepa
- Department of Obstetrics and Prenatal Medicine, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - José Parra
- Department of Statistics, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Leonardo Gucciardo
- Department of Obstetrics and Prenatal Medicine, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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24
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Bevilacqua E, Jani JC, Letourneau A, Duiella SF, Kleinfinger P, Lohmann L, Resta S, Cos Sanchez T, Fils JF, Mirra M, Benachi A, Costa JM. Cell-Free DNA Analysis in Maternal Blood: Differences in Estimates between Laboratories with Different Methodologies Using a Propensity Score Approach. Fetal Diagn Ther 2018; 45:302-311. [PMID: 29898450 DOI: 10.1159/000489124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/11/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the failure rate and performance of cell-free DNA (cfDNA) testing, mainly in terms of detection rates for trisomy 21, performed by 2 laboratories using different analytical methods. METHODS cfDNA testing was performed on 2,870 pregnancies with the HarmonyTM Prenatal Test using the targeted digital analysis of selected regions (DANSR) method, and on 2,635 pregnancies with the "Cerba test" using the genome-wide massively parallel sequencing (GW-MPS) method, with available outcomes. Propensity score analysis was used to match patients between the 2 groups. A comparison of the detection rates for trisomy 21 between the 2 laboratories was made. RESULTS In all, 2,811 patients in the Harmony group and 2,530 patients in the Cerba group had no trisomy 21, 18, or 13. Postmatched comparisons of the patient characteristics indicated a higher no-result rate in the Harmony group (1.30%) than in the Cerba group (0.75%; p = 0.039). All 41 cases of trisomy 21 in the Harmony group and 93 cases in the Cerba group were detected. CONCLUSIONS Both methods of cfDNA testing showed low no-result rates and a comparable performance in detecting trisomy 21; yet GW-MPS had a slightly lower no-result rate than the DANSR method.
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Affiliation(s)
- Elisa Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium,
| | - Alexandra Letourneau
- AP-HP, Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Université Paris-Sud, Clamart, France
| | - Silvia F Duiella
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Serena Resta
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Teresa Cos Sanchez
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Alexandra Benachi
- AP-HP, Hôpital Antoine Béclère, Service de Gynécologie-Obstétrique et Médecine de la Reproduction, Université Paris-Sud, Clamart, France
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25
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Lalmand M, Wilwerth M, Fils JF, Van der Linden P. Continuous Ropivacaine Subfascial Wound Infusion Compared With Intrathecal Morphine for Postcesarean Analgesia: A Prospective, Randomized Controlled, Double-Blind Study. Anesth Analg 2017; 125:907-912. [PMID: 28368941 DOI: 10.1213/ane.0000000000001892] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND After cesarean delivery, postoperative pain management allows early rehabilitation and helps prevent postpartum depression and chronic pain. Our present prospective, randomized controlled, double-blind study assessed the duration and effect of intrathecal analgesia and continuous ropivacaine wound infiltration versus a control group after cesarean delivery. The primary outcome was analgesia duration, defined as time to first morphine request. Secondary outcomes were cumulative postoperative morphine consumption, number of patients who did not require IV morphine, incidence of adverse effects, and time to first ambulation. METHODS A total of 192 full-term parturients undergoing elective cesarean delivery were randomly allocated into 3 groups (control, morphine, and catheter). All patients received spinal anesthesia with 10 mg bupivacaine 0.5% hyperbaric bupivacaine (2 mL) + 5 μg of sufentanil (1 mL) and a multiholed catheter inserted into the wound. In the control group, NaCl 0.9% was administered intrathecally (0.1 mL) and through the catheter. The morphine group received 100 μg morphine (0.1 mL) intrathecally and NaCl 0.9% infused through the wound catheter. The catheter group received 0.1 mL NaCl 0.9% intrathecally and ropivacaine 0.2% infused in the catheter. Each patient received a 15-mL bolus of the dedicated solution through the catheter, which was connected to an elastomeric pump infusor delivering the same solution at a rate of 10 mL/h for 30 hours. All patients also received multimodal analgesia including acetaminophen and diclofenac. Analgesia duration was defined as the time from spinal injection (T0) to first IV morphine requirement (T1) administered via a patient-controlled IV analgesia pump. Statistical data analyses included use of the Kruskal-Wallis rank-sum test followed by the post hoc Tukey test and χ test. RESULTS The duration of postoperative analgesia was increased with intrathecal morphine (380 minutes; 215-1527) and ropivacaine wound infusion (351 minutes; 227-594) compared with the control (247 minutes; 182-338) with effect sizes of 0.171 (0.043-0.293) for morphine versus control and 0.164 (0.052-0.271) for catheter versus control. There was no difference between the morphine group and catheter group (effect size, 0.007; -0.118 to 0.132). Cumulative postoperative morphine consumption was also significantly lower in the morphine group and catheter group compared with the control group. The incidence of adverse effects did not differ between groups. CONCLUSIONS After elective cesarean delivery, 100 μg intrathecal morphine and ropivacaine wound infusion both increased the duration and effect of postcesarean analgesia without increased incidence of side effects.
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Affiliation(s)
- Manon Lalmand
- From the *Department of Anesthesiology, Université Libre de Bruxelles, Centre Hospitalier Universitaire Brugmann, Place Van Gehuchten, Brussels, Belgium; and †Ars Statistica, Nivelles, Belgium
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26
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Lê PQ, Ferster A, Dedeken L, Vermylen C, Vanderfaeillie A, Rozen L, Heijmans C, Huybrechts S, Devalck C, Cotton F, Ketelslegers O, Dresse MF, Fils JF, Gulbis B. Neonatal screening improves sickle cell disease clinical outcome in Belgium. J Med Screen 2017; 25:57-63. [DOI: 10.1177/0969141317701166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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
Objectives To compare the outcomes of sickle cell disease patients diagnosed through neonatal screening with those who were not. Methods In an observational multicenter study in Belgium, 167 screened and 93 unscreened sickle cell disease patients were analyzed for a total of 1116 and 958 patient-years of follow-up, respectively. Both groups were compared with propensity score analysis, with patients matched on three covariates (gender, genotype, and central Africa origin). Bonferroni correction was applied for all comparisons. Results Kaplan–Meier estimates of survival without bacteremia were significantly higher in the screened group than the unscreened group (94.47%; [95% CI, 88.64–97.36%] versus 83.78% [95% CI, 72.27–90.42%]), p = 0.032. Non-significant differences between both groups were reported for survival without acute chest syndrome, acute anemia, cerebral complication, severe infection, and vaso-occlusive crisis. Significantly lower hospitalization rate and days per 100 patient-years were observed in the screened compared with the unscreened group (0.27 vs. 0.63 and 1.25 vs. 2.82, p = 0.0006 and <0.0001). Conclusion These data confirm the benefit of a neonatal screening programme in reducing bacteremia and hospitalization.
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Affiliation(s)
- Phu-Quoc Lê
- Hemato-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Alina Ferster
- Hemato-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Laurence Dedeken
- Hemato-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | | | - Anna Vanderfaeillie
- Pediatrics, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Laurence Rozen
- Laboratory of Hematology and Hemostasis, Centre Hospitalier Universitaire de Brugmann, Brussels, Belgium
| | - Catherine Heijmans
- Hemato-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Sophie Huybrechts
- Hemato-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | - Christine Devalck
- Hemato-Oncology, Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
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Willems A, Datoussaid D, Tucci M, Sanchez Torres C, De Villé A, Fils JF, Van der Linden P. Impact of On-Bypass Red Blood Cell Transfusion on Severe Postoperative Morbidity or Mortality in Children. Anesth Analg 2016; 123:420-9. [DOI: 10.1213/ane.0000000000001425] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Vandenberghe C, Bentein K, Michon R, Chebat JC, Tremblay M, Fils JF. An examination of the role of perceived support and employee commitment in employee-customer encounters. Journal of Applied Psychology 2007; 92:1177-87. [PMID: 17638475 DOI: 10.1037/0021-9010.92.4.1177] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The authors examined the relationships between perceived organizational support, organizational commitment, commitment to customers, and service quality in a fast-food firm. The research design matched customer responses with individual employees' attitudes, making this study a true test of the service provider-customer encounter. On the basis of a sample of matched employee-customer data (N = 133), hierarchical linear modeling analyses revealed that perceived organizational support had both a unit-level and an employee-level effect on 1 dimension of service quality: helping behavior. Contrary to affective organizational commitment, affective commitment to customers enhanced service quality. The 2 sub-dimensions of continuance commitment to the organization--perceived high sacrifice and perceived lack of alternatives--exerted effects opposite in sign: The former fostered service quality, whereas the latter reduced it. The implications of these findings are discussed within the context of research on employee-customer encounters.
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