Maternal, Fetal and Neonatal Outcomes Related to Recreational Cannabis Use during Pregnancy: Analysis of a Real-World Clinical Data Warehouse between 2010 and 2019

BACKGROUND

Cannabis is the main illicit psychoactive substance used in French childbearing women and very few data are available about adverse events (AEs) related to its use during pregnancy. The aim of this study was to evaluate the association between recreational cannabis use during pregnancy and adverse outcomes from a real-world clinical data warehouse.

METHODS

Data from the Poitiers University Hospital warehouse were analyzed between 1 January 2010 and 31 December 2019. Logistic regression models were used to evaluate associations between outcomes in three prenatal user groups: cannabis alone ± tobacco (C ± T) (n = 123), tobacco alone (T) (n = 191) and controls (CTRL) (n = 355).

RESULTS

Pregnant women in the C ± T group were younger (mean age: 25.5 ± 5.7 years), had lower pre-pregnancy body mass index (22.8 ± 5.5 kg/m2), more psychiatric history (17.5%) and were more likely to benefit from universal free health-care coverage (18.2%) than those in the T and CTRL groups. Cannabis use increases the occurrence of voluntary interruption of pregnancy, at least one AE during pregnancy, at least one neonatal AE, the composite adverse pregnancy outcome over 28, prematurity and small for gestational age.

CONCLUSION

Given the trivialization of recreational cannabis use during pregnancy, there is an urgent need to communicate on AEs of cannabis use during pregnancy.

Combined therapy in children and adolescents with classical Hodgkin's lymphoma: A report from the SFCE on MDH-03 national guidelines

Hodgkin's lymphoma (HL) in children and adolescents is highly curable, but children are at risk of long-term toxicity. The MDH-03 guidelines were established in order to decrease the burden of treatment in good-responder patients, and this report should be considered a step toward further optimization of treatment within large collaborative trials. We report the therapy and long-term outcomes of 417 children and adolescents treated according to the national guidelines, which were applied between 2003 and 2007 in France. The patients were stratified into three groups according to disease extension. Chemotherapy consisted of four cycles of VBVP (vinblastine, bleomycin, VP16, prednisone) in localized stages (G1/95 pts/23%), four cycles of COPP/ABV (cyclophosphamide, vincristine, procarbazine, prednisone, adriamycin, bleomycin, vinblastine) cycles in intermediate stages (G2/184 pts/44%) and three cycles of OPPA (vincristine, procarbazine, prednisone, adriamycin) plus three cycles of COPP in advanced stages (G3/138 pts/33%). Radiation therapy of the involved field was given to 97% of the patients, with the dose limited to 20 Gy in good responders (88%). With a median follow-up of 6.6 years, the 5-year event-free survival (EFS) and overall survival (OS) were 86.7% (83.1-89.7%) and 97% (94.5-98.1%), respectively. EFS and OS for G1, G2, and G3 were 98% and 100%, 81% and 97%, and 87% and 95%, respectively. Low-risk patients treated without alkylating agents and anthracycline had excellent outcomes and a low expected incidence of late effects. Intensification with a third OPPA cycle in high-risk group patients, including stage IV patients, allowed for very good outcomes, without increased toxicity.

A single enhanced phase is sufficient for the initial computed tomography evaluation of retroperitoneal tumors in children

PURPOSE

The goal of this study was to evaluate the incremental value of unenhanced phase in the initial evaluation of retroperitoneal tumors in children by comparison with an enhanced phase alone using computed tomography (CT).

MATERIALS AND METHODS

A total of 53 patients (26 girls, 27 boys) with a total of 53 tumors who had CT examination of the abdomen and pelvis for the initial assessment of retroperitoneal tumor were retrospectively included. All CT examinations were obtained with an unenhanced set of CT images and a set of CT images obtained after intravenous administration of iodinated contrast material. One junior and one senior radiologist independently evaluated the two sets in two separate reading sessions. CT images were analyzed for tumor calcifications, tumor location, vascular encasement, local invasion and tumor content.

RESULTS

Calcifications were present in 24/53 tumors (45%). On the enhanced set, the senior radiologist was able to detect calcifications in 22/24 tumors (92%) and the junior radiologist in 20/24 tumors (83%), yielding sensitivities of 92% and 83%, and specificities of 96.5% and 100%, respectively. Inter-observer agreement was excellent (Kappa=0.89). Tumor location was correctly determined by the senior radiologist in 53/53 tumors (100%) and 37/53 tumors (70%) by the junior radiologist. Using the unenhanced set, the senior radiologist was able to assess vascular encasement in 26/53 tumors (49%) against 21/53 (39%) for the junior radiologist. For tumor content, agreement between the enhanced and combined unenhanced and enhanced CT was 77% for both radiologists.

CONCLUSION

Enhanced CT performs as well as unenhanced CT for evidencing calcifications and is therefore sufficient for the initial assessment of retroperitoneal tumor in children.

Syndrome d'Evans : étude rétrospective de la société d'hématologie et d'immunologie pédiatrique (36 cas)

Evans' Syndrome (ES) is defined as the combination of immune thrombocytopenia (ITP) and autoimmune haemolytic anemia (AIHA), in the absence of any known underlying etiology. Pathophysiology, epidemiology and outcome remain unclear.

POPULATION

Thirty-six children (20 male, 16 female), who were diagnosed in the SHIP french centres (Société d'hématologie et d'immunologie pédiatrique) between 1990 and 2002 with ES, were included in this retrospective study.

RESULTS

Median age at diagnosis was 4 years. In 21 children, ES occurred in the setting of consanguinity, family history of autoimmune/inflammatory disease, associated autoimmune disorder or immunoregulatory abnormalities (serum imunoglobulins, peripheral blood lymphocytes subsets, low level of the C3-C4 complement components, nuclear antibodies). Several successive treatments were used in this serie (median: 3, range: 0-10) including corticosteroid therapy (35/36), intravenous immunoglobulins (32/36), immunosuppressive agents (14/36), splenectomy (9/36) and anti CD 20 monoclonal antibodies (6/36). Patients with a low level of serum immunoglobulins were more often non-responders to corticosteroidtherapy/intravenous immunoglobulins and required more frequently further therapy (P=0.03). Three patients died (intracranial bleeding, N=2, Guillain-Barre syndrome; N=1).

CONCLUSION

ES was a severe, life-threatening disease, requiring aggressive immunosuppressive therapy in as many as half the patients. Our forthcoming study aims to (i) describe homogeneously-studied and prospectively-analysed cohort of childhood ES, (ii) separate ES from specific immune deficiency (especially fas gene mutations), generalised autoimmune/inflammatory disorders and genetic diseases, (iii) identify well-defined ES subsets, (iv) establish prognostic factors and optimal treatment within these subsets.

Carboplatin-epirubicin regimen for the treatment of hepatoblastoma

BACKGROUND

In order to lower the long-term toxicity of chemotherapy for hepatoblastoma patients, a prospective study was designed based on pre-operative chemotherapy combining carboplatin and epirubicin (CE).

PROCEDURES

Patients under 16 years of age with an epithelial hepatic tumor diagnosed by ultrasound or CT scan and a high serum alpha-foetoprotein (AFP) level were eligible. Patients were treated with a pre-operative chemotherapy regimen combining carboplatin 600 mg/m(2) and epirubicin 80 mg/m(2). Tumor resectability was assessed after four courses given at 3-week intervals. After surgery, patients were given two more courses of CE. Response was assessed based on a drop in serum AFP and tumor shrinkage.

RESULTS

Between July 1988 and August 1995, 27 patients with a hepatoblastoma were included. The initial PRETEXT group according to the SIOPEL classification was: group 2 (5 pts), group 3 (15 pts), group 4 (5 pts), and 2 pts were not assessed. Six patients had lung metastases. Response was partial response (PR) in 20/27 (74%) patients, disease was stable in 3 and 4 had progressive disease (PD). A complete surgical resection was performed in 21 pts. Five-year overall and disease-free survival (DFS) were respectively 56% (95%CI: 37-72%) and 63% (95%CI: 44-78%). During the same time period, 7 pts with a hepatocellular carcinoma were treated according to this protocol. Only one achieved a PR. Toxicity was mostly hematologic with > or =grade 3 leukopenia in 23% of the courses, > or =grade 3 thrombocytopenia in 29% of the courses and anemia in 22%.

CONCLUSION

The CE protocol is feasible and efficient in hepatoblastoma. However, only a randomized study will permit a valid comparison of the efficacy of cisplatin and carboplatin for the treatment of these patients.

Quantitative assessment of regurgitant flow with total digital three-dimensional reconstruction of color Doppler flow in the convergent region: in vitro validation

BACKGROUND

This study was designed to develop and test a total digital 3-dimensional (3D) color flow map reconstruction for proximal isovelocity surface area (PISA) measurement in the convergent region.

METHODS

Asymmetric flow convergent velocity field was created in an in vitro pulsatile model of mitral regurgitation. Image files stored in the echocardiographic scanner memory were digitally transferred to a computer workstation, and custom software decoded the file format, extracted velocity information, and generated 3D flow images automatically. PISA and volume flow rate were calculated without geometric assumption. For comparison, regurgitant volume was also calculated, using continuous wave Doppler, 2-dimensional (2D), and M-mode color flow Doppler with the hemispheric approach.

RESULTS

Flows from 3D digital velocity profiles showed a closed, excellent relation with actual flow rates, especially for instantaneous flow rate. Regurgitant volume calculated with the 3D method underestimated the actual flow rate by 2.6%, whereas 2D and the M-mode method show greater underestimation (44.2% and 32.1%, respectively).

CONCLUSION

Our 3D reconstruction of color flow Doppler images gives more exact information of the flow convergent zone, especially in complex geometric flow fields. Its total digital velocity process allows accurate measurement of convergent surface area and improves quantitation of valvular regurgitation.

[3-dimensional reconstruction technic using power Doppler. In vitro use on normal and stenosed pulmonary artery bifurcations]

Power Doppler imaging is an ultrasonic technique representing circulating red cells as a colour signal independent of their direction and angle of analysis. This noninvasive technique provides a morphological representation of blood flow within a blood vessel. This in vitro study in pulsed flow enabled three-dimensional reconstruction of blood flow in the bifurcation of the pulmonary artery with automatic shifting of the ultrasound probe and an integral digital transfer of the echographic data. The software for treating the images and for volumic reconstruction of the flow is explained. This technique provides a quantitative method of assessing residual intrastenotic flow with a simple computer system.

Use of transcriptional regulatory elements of the MUC1 and ERBB2 genes to drive tumour-selective expression of a prodrug activating enzyme

In order to exploit differences in gene expression between normal and malignant cells for genetic prodrug-activation therapy, we have generated recombinant retroviruses containing the herpes simplex virus thymidine kinase coding region cloned downstream of sequences derived from the 5'-flanking regions of the MUC1 and ERBB2 genes. Transduction with retroviruses containing MUC1 promoters resulted in an increase in GCV sensitivity in MUC1 positive cells. A further increase in GCV sensitivity was achieved when MUC1-positive cells were transduced with retroviruses containing chimeric-MUC1/ERBB2 promoters. No significant sensitization to GCV was observed when MUC1-negative cells were transduced with these recombinant retroviruses. These results suggest that one may be able to develop a tumour-selective therapy by utilizing the transcriptional regulatory regions of the MUC1 and ERBB2 genes to drive the expression of suicide genes.

Diabetic-like retinopathy ameliorated with the aldose reductase inhibitor WAY-121,509

PURPOSE

To evaluate the efficacy of WAY-121,509, a potent new aldose reductase inhibitor (ARI), in preventing the retinopathy that develops in the galactose-fed rat model of diabetic ocular complications.

METHODS

Sprague-Dawley rats were randomized into treatment and duration groups and fed diets with either 50% starch of 50% galactose with or without WAY-121,509 (25 mg/kg body weight per day). Progression of cataracts was monitored by slit-lamp biomicroscopy. After duration of 4, 8, 16, and 24 months, levels of plasma glucose and glycated hemoglobin, as well as erythrocyte and retinal galactose and galactitol, were measured in rats in each group. Retinal vasculatures of the 24-month rats were isolated by elastase digestion and analyzed by computer-assisted morphometry.

RESULTS

Mature, diabetic-like cataracts developed within 5 weeks in all the galactose-fed, untreated rats, but only nonprogressive anterior cortical opacities were present in lenses of 85% of the ARI-treated galactosemic animals after 3 months. Plasma glucose remained the same in all groups. Erythrocyte and retinal galactose and glycated (galactosylated) hemoglobin were elevated with galactosemia and were unaffected by ARI treatment. Erythrocyte and retinal galactitol levels were decreased by 91% and 95%, respectively, with inhibitor treatment. At 24 months, capillary length, width, density, the number of microaneurysms, and the percent of capillary length involved in intraretinal microvascular abnormalities, expressed as hypercellular channels with diameters > 20 microns, were significantly increased by galactosemia and were attenuated in the galactose-fed, ARI-treated group.

CONCLUSIONS

A dose of WAY-121,509 sufficient to reduce retinal polyol levels by 95% ameliorated the development of galactose-induced cataracts and diabetic-like retinopathy but was insufficient to prevent early lens opacifications or all the diabetic-like retinal microangiopathies.

Use of polymerase chain reaction to detect Toxoplasma

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Improved detection of HBV DNA by PCR after microwave treatment of serum

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Definition of the human renal cell carcinoma phenotype using monoclonal and polyclonal antibodies: a tumor marker study

Previous studies have demonstrated a high level of heterogeneity associated with human renal cell carcinoma (RCC). In order to probe further this heterogeneity monoclonal antibodies were produced after immunization of mice with extracts of fresh renal tumor specimens. Four monoclonal antibodies designated LD-M1, LD-M2, LD-M5, and LD-M8 were generated and characterized immunohistochemically on a panel of tissue sections. The LD monoclonal antibodies strongly stained paraffin sections obtained from 77 to 100% of cases of RCC. Testing the sections with a library of polyclonal and monoclonal antibodies resulted in the definition of the following immunohistochemical phenotype of RCC: positive with the LD-M1, LD-M2, Ld-M5, LD-M8, Uro-2, Uro-7, Uro-10, cytokeratin, keratin, TPA, vimentin, Fx1A, retinol binding protein, CALLA and B72 antibodies; negative with the prekeratin, desmin, A5.48, uromucoid, and CEA antibodies. The pattern of immunohistochemical activity indicates that some RCC tumor cells contain epitopes associated with distal tubules in addition to previously documented antigens present in proximal tubules. Using a solid-phase competition radioimmunoassay it was observed that the serum of patients with renal cell carcinoma contains a circulating LD-M5-reactive tumor-associated antigen.

Uveitis in the dog and cat: causes, diagnosis and treatment

Uveitis is an ocular disease frequently encountered in dogs and cats. Its importance relates to the fact that it can induce severe ocular pain and or result in permanent loss of vision. In addition, uveitis can be the first or only manifestation of a systemic, life-threatening disease. Since uveitis can present in a manner similar to a number of other ocular conditions, it behooves the clinician to first establish a prompt, accurate diagnosis in order to give the appropriate prognosis and treatment.The first part of this review includes applied anatomy and physiology of the uveal tract, followed by a description of the various etiological factors found in uveitis. The second part deals with clinical signs and findings in anterior and posterior uveitis and with the sequelae of this ocular inflammatory process. Lastly, the third part contains therapeutic guidelines and a list of comprehensive reviews on this major topic in veterinary ophthalmology.

Experimental ocular cryptococcosis. Preliminary studies in cats and mice

Ocular cryptococcosis was produced in cats by the intracarotid injection of Cryptococcus neoformans. Infected eyes developed a progressive, multifocal chorioretinitis which was comparable to that found in the naturally occurring feline disease. The severity of the ocular disease, the development of infection in the fellow eye, and the degree of systemic involvement were shown to be related to the number of organisms inoculated. Mice infected intracerebrally with the same organism developed optic nerve meningitis. The pathogenesis of the ocular lesions thus produced is discussed.

A review of psychotropic medications and the glaucomas

Four general groups of psychotropic drugs are examined with respect to possible adverse effects upon intraocular pressure. After a brief discussion of the various mechanisms of the glaucomas, both general and specific information is provided and discussed concerning antipsychotic, antidepressant, antiparkinsonian and antianxiety preparations of a variety of chemical structures and utilities. The consensus of the authors is that with certain basic safeguards virtually all of the medications studied are acceptably safe to prescribe even in patients with diagnosed glaucoma.