1. Inflamm Bowel Dis. 2010 Nov 29. [Epub ahead of print]
Fistulizing perianal Crohn's disease: Contrast-enhanced magnetic resonance
imaging assessment at 1 year on maintenance anti-TNF-alpha therapy.
Savoye-Collet C, Savoye G, Koning E, Dacher JN, Lerebours E.
Rouen University Hospital, Radiology Department, Rouen, France.
BACKGROUND:: The aim of the study was to assess perianal fistulas by magnetic
resonance imaging (MRI) in patients with severe fistulizing Crohn's disease (CD)
using maintenance antitumor necrosis factor alpha (TNF-α) therapy and to
correlate MRI changes with clinical outcome. METHODS:: Perineal MRI before and
after a 1-year scheduled anti-TNF-α maintenance therapy was performed in 20
patients (14 females; mean age = 33.7). The Van Assche score (i.e., number of
fistulas, localization, and extension, importance of T2 hyperintensity, presence
of abscess) was calculated. Fistula track contrast enhancement was also used.
Clinical outcome was defined as no response, response, or remission. RESULTS::
Response and remission were observed in respectively 40% and 35% of cases. The
Van Assche score varied from 13.8 (7-20) to 6.13 (0-12) in patients with a
response or remission (P < 0.05). The T2 hyperintensity follow-up value decreased
in patients in response or remission (P < 0.01). T2 hyperintensity disappeared or
decreased in 14 out of 15 patients in clinical response or remission as compared
to one among the five nonresponding patients (P < 0.01). The decrease in Van
Assche score and hyperintensity value was not significantly different in patients
in remission compared to those with response. Only one patient in clinical
remission had a persisting contrast enhancement on MRI, whereas contrast
enhancement persisted in all other patients not in remission (P = 0.002).
CONCLUSIONS:: The clinical benefit of maintenance anti-TNF-α therapy in perianal
CD is associated with a significant improvement of the Van Assche score,
particularly T2 hyperintensity. The disappearance of contrast enhancement was the
only semiological MR feature associated with remission. (Inflamm Bowel Dis 2010).
PMID: 21117163 [PubMed - as supplied by publisher]
2. J Eur Acad Dermatol Venereol. 2010 Nov 28. doi: 10.1111/j.1468-3083.2010.03921.x.
[Epub ahead of print]
Low doses of methotrexate for the treatment of chronic eczema in the elderly.
Tétart F, Joly P.
Department of Dermatology, Rouen University Hospital, Rouen, France.
PMID: 21114541 [PubMed - as supplied by publisher]
3. Amino Acids. 2010 Nov 28. [Epub ahead of print]
Effects of essential amino acids or glutamine deprivation on intestinal
permeability and protein synthesis in HCT-8 cells: involvement of GCN2 and mTOR
pathways.
Boukhettala N, Claeyssens S, Bensifi M, Maurer B, Abed J, Lavoinne A, Déchelotte
P, Coëffier M.
ADEN EA4311, Institute for Biomedical Research and European Institute for Peptide
Research (IFRMP23), Rouen University, 22 boulevard Gambetta, 76183, Rouen cedex
1, France.
GCN2 and mTOR pathways are involved in the regulation of protein metabolism in
response to amino acid availability in different tissues. However, regulation at
intestinal level is poorly documented. The aim of the study was to evaluate the
effects of a deprivation of essential amino acids (EAA) or glutamine (Gln) on
these pathways in intestinal epithelial cells. Intestinal epithelial cell, HCT-8,
were incubated during 6 h with 1/DMEM culture medium containing EAA, non EAA and
Gln, 2/with saline as positive control of nutritional deprivation, 3/DMEM without
EAA, 4/DMEM without Gln or 5/DMEM without Gln and supplemented with a glutamine
synthase inhibitor (MSO, 4 mM). Intestinal permeability was evaluated by the
measure of transepithelial electric resistance (TEER). Using [L-(2)H(3)]-leucine
incorporation, fractional synthesis rate (FSR) was calculated from the assessed
enrichment in proteins and free amino acid pool by GCMS. Expression of eiF2α
(phosphorylated or not), used as marker of GCN2 pathway, and of 4E-BP1
(phosphorylated or not), used as a marker of mTOR pathway, was evaluated by
immunoblot. Results were compared by ANOVA. Six-hours EAA deprivation did not
significantly affect TEER and FSR but decreased p-4E-BP1 and increased p-eiF2α.
In contrast, Gln deprivation decreased FSR and p-4E-BP1. MSO induced a marked
decrease of TEER and FSR and an increase of p-eiF2α, whereas mTOR pathway
remained activated. These results suggest that both mTOR and GCN2 pathways can
mediate the limiting effects of Gln deprivation on protein synthesis according to
its severity.
PMID: 21113813 [PubMed - as supplied by publisher]
4. Gynecol Obstet Fertil. 2010 Nov 24. [Epub ahead of print]
[A pelvic "blue" node. What's your diagnosis?]
[Article in French]
Baron M, Laberge-Le Couteulx S, Muller M, Muller JM, Razzouk K, Teig B.
Département de chirurgie, centre régional de lutte contre le cancer de
Haute-Normandie, 80, rue d'Amiens, 76038 Rouen cedex, France.
We report a case of 31-year-old woman presented with a chronic pelvic pain and a
3-cm left ovarian cyst on ultrasonography. At the time of laparoscopy, we
observed two blue peritoneal lesions at the pelvic insertion of left round
ligament. Histopathological examination of a biopsy showed a pigmentation due to
a decorative tattoo of the left thigh.
PMID: 21111650 [PubMed - as supplied by publisher]
5. Rev Mal Respir. 2010 Nov;27(9):1009-1012.
[Where should we initiate domiciliary noninvasive ventilation in chronic
respiratory failure patients? A wrong debate?]
[Article in French]
Cuvelier A, Lamia B.
UPRES EA 3830 (IFR MP23), unité de soins intensifs respiratoires, service de
pneumologie, hôpital de Bois-Guillaume, université de Rouen, CHU de Rouen, 76031
Rouen cedex, France.
PMID: 21111269 [PubMed - as supplied by publisher]
6. Intern Med J. 2010 Nov;40(11):795-6. doi: 10.1111/j.1445-5994.2010.02298.x.
A rare case of Henoch-Schönlein purpura with neurological involvement.
Fiaux E, Benhamou Y, Cailleux N, Levesque H.
Department of Internal Medicine, Rouen University Hospital, Rouen, France.
PMID: 21108716 [PubMed - in process]
7. Hum Reprod. 2010 Nov 18. [Epub ahead of print]
Assessment of acrosome and nuclear abnormalities in human spermatozoa with large
vacuoles.
Perdrix A, Travers A, Chelli MH, Escalier D, Do Rego JL, Milazzo JP,
Mousset-Siméon N, Macé B, Rives N.
EA 4308 'Spermatogenesis and Male Gamete Quality', Reproductive Biology
Laboratory - CECOS, Rouen University Hospital, Institute for Biomedical Research,
University of Rouen, 76031 Rouen Cedex, France.
BACKGROUND Spermatozoa with large vacuoles (SLV) may have a negative impact on
embryo development. The origin of these vacuoles is unknown. We evaluated
acrosome and nucleus alterations in isolated SLV, versus unselected spermatozoa.
METHODS We studied 20 patients with teratozoospermia. Spermatozoa from the native
semen sample and spermatozoa presenting a vacuole occupying >13.0% total head
area, isolated under high magnification (×6600), were assessed. Confocal and
transmission electron microscope evaluations were performed on SLV and native
sperm, respectively. Acrosome morphology and DNA fragmentation were analysed
using proacrosin immunolabelling (monoclonal antibody 4D4) and terminal
deoxynucleotidyl transferase-mediated dUTP nick end labelling assay. Chromatin
condensation was evaluated with aniline blue staining. Sperm aneuploidy was
assessed using fluorescence in situ hybridization. RESULTS SLV represented 38.0 ±
5.10% of motile spermatozoa obtained after gradient density centrifugation.
Vacuoles were mainly in the anterior and median sperm head (45.7 ± 2.90 and 46.1
± 3.00%, respectively). Abnormal acrosomes were increased in SLV compared with
unselected spermatozoa (77.8 ± 2.49 versus 70.6 ± 2.62%; P = 0.014). Microscopic
observations showed an exclusively nuclear localization of large vacuoles.
Complete DNA fragmentation was higher in native spermatozoa (P < 0.0001) than
SLV, while chromatin condensation was altered in SLV (P < 0.0001). Aneuploidy and
diploidy rates were increased in SLV (P < 0.0001). CONCLUSIONS Sperm vacuoles
were exclusively nuclear. In our selected teratozoospermic population, aneuploidy
and chromatin condensation defects were the main alterations observed in SLV.
Based on results from this small sample of spermatozoa, we propose a global
impairment of the spermatogenesis process as a common origin of the morphological
alterations.
PMID: 21088015 [PubMed - as supplied by publisher]
8. Arch Pediatr. 2010 Nov 15. [Epub ahead of print]
[Recurrent and metastatic infantile fibrosarcoma: A case report.]
[Article in French]
Lagree M, Toutain F, Revillon Y, Gaussin G, Marie-Cardine A, Lemoine F, Vannier
JP.
Service d'hémato-oncologie pédiatrique, CHU Charles-Nicolle, 1, rue de Germont,
76031 Rouen cedex, France.
Infantile fibrosarcoma is a rare malignant tumor that usually occurs during the
1st year of life. It accounts for approximately 5-10% of all sarcomas in infants
younger than 1 year of age. It usually has indolent progression and metastatic
spread is rare. We report the case of a patient who had infantile fibrosarcoma of
the trunk. At birth, the baby presented a soft tissue mass of the scapulothoracic
region. Histopathological examination after complete surgical resection at first
suggested an angioma. Reanalysis of the histology after a metastatic relapse
resulted in the diagnosis of infantile fibrosarcoma, which was confirmed by the
presence of the specific translocation seen in infantile fibrosarcoma
(ETV6/NTRK3). This patient's progression was uncommon because he developed 3
metastatic relapses. The treatment consisted of surgery, chemotherapy, and
radiation therapy. The patient is alive with persistent complete remission. We
discuss the diagnostic and therapeutic issues of infantile fibrosarcoma. There is
a risk of erroneous diagnosis in newborn infants between benign angiomatous tumor
and infantile fibrosarcoma. The fusion transcript ETV6-NTRK3 resulting from the
specific chromosomal translocation t(12;15)(p13;q25) is now a useful diagnostic
tool for infantile fibrosarcoma. Surgery with wide resection is the mainstay of
treatment. However, infantile fibrosarcoma is a chemosensitive tumor. If initial
surgery cannot be done without mutilation or is impossible, preoperative
chemotherapy should be given. The role of radiation therapy is still debated.
PMID: 21084177 [PubMed - as supplied by publisher]
9. Transpl Int. 2010 Nov 16. doi: 10.1111/j.1432-2277.2010.01184.x. [Epub ahead of
print]
Brain death provokes very acute alteration in myocardial morphology detected by
echocardiography: preventive effect of beta-blockers.
Ferrera R, Hadour G, Tamion F, Henry JP, Mulder P, Richard V, Thuillez C, Ovize
M, Derumeaux G.
Inserm, U886, Université de Lyon, Université Lyon 1, Lyon, France Inserm U644,
Université de Rouen, Rouen, France.
Our objective was to evaluate immediate acute changes in myocardial function
during the autonomic storm of brain death (BD). Wistar rats were divided into
four groups (n = 8/group): controls without any treatment, β-blocker (Esmolol®,
10 mg/kg), calcium channel blocker (Diltiazem®, 10 mg/kg), or alpha-blocker
(Prazosin®, 0.3 mg/kg). Treatments were administered intravenously 5 min before
BD induction. Echocardiography (ATL-5000, 8 MHz) was performed to measure left
ventricular (LV) dimensions and fractional shortening at baseline, during BD
induction and 5 min and 15 min after BD. In controls, BD was immediately
associated with an increase in wall thickness and a decrease in LV cavity
dimension. This myocardial wall hypertrophy was completely prevented by
β-blockers, but not with calcium- and alpha-blockers. Extensive myocardial
interstitial edema was found in all groups, except in the β-blocker group.
Myocardial wall hypertrophy was also prevented during a longer follow-up of
180 min after BD in β-blocker group as opposed to controls. In conclusion, BD is
associated with an immediate and severe myocardial damage related to an important
interstitial edema which is prevented by β-blockers.
PMID: 21083628 [PubMed - as supplied by publisher]
10. QJM. 2010 Nov 16. [Epub ahead of print]
Positron emission tomography in the diagnosis of eosinophilic fasciitis.
Cheriet S, Chastan M, Levesque H, Marie I.
From the Department of Internal Medicine, CHU Rouen, 76031 Rouen Cedex, France.
PMID: 21081565 [PubMed - as supplied by publisher]
11. Europace. 2010 Nov 13. [Epub ahead of print]
Complete pacemaker lead fracture potentially due to intra-cardiac mass.
Godin B, Savoure A, Bauer F, Anselme F.
Cardiology Department, Centre Hospitalier Universitaire Charles Nicolle de Rouen,
1, rue de germont, 76031 Rouen Cedex, France.
Seven years after the implantation of a dual-chamber pacemaker, a 74-year-old
woman was referred for syncope. Chest X-ray revealed that the ventricular lead
was completely broken near the tricuspid valve. Fluoroscopy and transthoracic
echocardiography found a calcified mass, moving with the proximal part of the
ventricular lead. Anatomopathology of the atrial tumour remained unknown. Surgery
was considered too invasive a technique to be performed in our patient, who was
suffering from dementia.
PMID: 21076145 [PubMed - as supplied by publisher]
12. Respir Physiol Neurobiol. 2010 Nov 10. [Epub ahead of print]
Cartography of human diaphragmatic innervation: Preliminary data.
Verin E, Marie JP, Similowski T.
Rouen University Hospital, Department of Physiology, 76031 Rouen Cedex, France;
Université de Rouen, UPRES EA 3830, Research Group on Ventilatory Handicap
(GRHV), 76000 Rouen, France.
In humans, anatomy indicates that the phrenic nerve mainly arises from the C4
cervical root, with variable C3 and C5 contributions. How this translates into
functional innervation is unknown. The diaphragm response to electrical
stimulation of C3, C4 and C5 was described in three patients undergoing surgical
laryngeal reinnervation with an upper phrenic root (surface chest electrodes at
anterior, lateral and posterior sites; oesophageal and gastric pressures (Pes and
Pga) to derive transdiaphragmatic pressure (Pdi)). Anatomically, the phrenic
nerve predominantly originated from C4. Phrenic stimulation elicited motor
responses at the three sites in the three patients, as did C4 stimulation. It
produced Pdi values of 9, 11, and 14cmH(2)O in the three patients, respectively,
vs. 9, 9, and 7cmH(2)O for C4. C3 stimulation produced modest Pdi responses,
whereas C5 stimulation could produce Pdi responses close to those observed with
C4 stimulation. These singular observations confirm the dominance of C4 in
diaphragm innervation but suggest than C5 can be of importance.
PMID: 21073984 [PubMed - as supplied by publisher]
13. Clin Neuropathol. 2010 Nov-Dec;29(6):361-4.
Clinical imaging and neuropathological correlations in an unusual case of
cerebrotendinous xanthomatosis.
Wallon D, Guyant-Maréchal L, Laquerrière A, Wevers RA, Martinaud O, Kluijtmans
LA, Yntema HG, Saugier-Veber P, Hannequin D.
Department of Neurology, Rouen University Hospital, France.
david.wallon@chu.rouen.fr
Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive lipid storage
disorder due to a deficiency of the mitochondrial enzyme sterol 27-hydroxylase
(CYP 27) with reduced or no chenodeoxycholic synthesis. This deficiency leads to
an accumulation of cholestanol in different sites such as the eye lens, central
nervous system or tendons. We report a 64-year-old female patient with a
progressive gait disorder associated with cognitive decline since the age of 59.
The patient had no mental retardation, cataract or chronic diarrhea. Her family
reported increasing behavioral modifications 10 years previously. Clinical
examination revealed a spastic paraplegia and bilateral xanthomas on the Achilles
tendons. Cerebral magnetic resonance imaging (MRI) revealed diffuse hyperintense
T2 abnormalities in the pyramidal tracts from the internal capsules to the
cerebral peduncles also Technetium-99m-ECD brain SPECT showed a severe cerebellar
hypoperfusion. Serum cholestanol analysis was 7 µmol/l (N). After 2 years, she
was bedridden and died of aspiration pneumonia. The neuropathological study
confirmed the CTX diagnosis and the sequencing analysis revealed that she was
compound heterozygous for two mutations in the CYP27A1 gene: 1435 C > T (exon 7)
on one allele and a new mutation, 1017 G > C (exon 5) on the other. The interest
of the present case is to report neuropathology findings strongly correlated with
the MRI and SPECT abnormalities.
PMID: 21073839 [PubMed - in process]
14. Neuropathol Appl Neurobiol. 2010 Nov 10. doi: 10.1111/j.1365-2990.2010.01149.x.
[Epub ahead of print]
Recessive RYR1 mutations cause unusual congenital myopathy with prominent nuclear
internalisation and large areas of myofibrillar disorganisation.
Bevilacqua JA, Monnier N, Bitoun M, Eymard B, Ferreiro A, Monges S, Lubieniecki
F, Taratuto AL, Laquerrière A, Claeys KG, Marty I, Fardeau M, Guicheney P,
Lunardi J, Romero NB.
Institut de Myologie, Unité de Morphologie Neuromusculaire, Groupe
Hospitalier-Universitaire Pitié-Salpêtrière, 75013 Paris, France Departamento de
Neurología y Neurocirugía, HCUCH and Instituto de Ciencias Biomédicas, Facultad
de Medicina, Universidad de Chile, Santiago, Chile. Laboratoire de Biochimie et
Génétique Moléculaire and Centre de Référence des Maladies Neuro-Musculaires. CHU
Grenoble, 38043 Grenoble, France. INSERM U836, Grenoble Institut Neurosciences,
38700 La Tronche, France. UPMC-INSERM UMR S974, CNRS UMR 7215, Institut de
Myologie, GHU Pitié-Salpêtrière, 75013 Paris, France. Groupe
Hospitalier-Universitaire Pitié-Salpêtrière, AP-HP, Centre de référence des
maladies neuromusculaires Paris-Est, 75013 Paris, France. INSERM UMR S787, CHU
Pitié-Salpêtrière, 75013 Paris, France. Garrahan National Paediatric Hospital,
Department of Neuropaediatrics, Buenos Aires, Argentina. Garrahan National
Paediatric Hospital, Department of Pathology, Buenos Aires, Argentina. FLENI
Institute for Neurological Research, Department of Neuropathology, Buenos Aires,
Argentina. Pathology Laboratory, Rouen University Hospital, Rouen, France. INSERM
UMR S956, CHU Pitié-Salpêtrière, 75013 Paris, France.
Aims To report the clinical, pathological and genetic findings in a group of
patients with a previously not described phenotype of congenital myopathy due to
recessive mutations in the gene encoding the type 1 muscle ryanodine receptor
channel (RYR1). Methods Seven unrelated patients shared a predominant axial and
proximal weakness of varying severity, with onset during the neonatal period,
associated with bilateral ptosis and ophthalmoparesis, and unusual muscle
biopsies features at light and electron microscopic levels. Results Muscle biopsy
histochemistry revealed a peculiar morphological pattern characterised by
numerous internalised myonuclei in up to 51% of fibres and large areas of
myofibrillar disorganisation with undefined borders. Ultrastructurally, such
areas frequently occupied the whole myofibre cross-section and extended to a
moderate number of sarcomeres in length. Molecular genetic investigations
identified recessive mutations in the ryanodine receptor (RYR1) gene in six
compound heterozygous patients and one homozygous patient. Nine mutations are
novel and four have already been reported either as pathogenic recessive
mutations or as changes affecting a residue associated with dominant malignant
hyperthermia susceptibility. Only two mutations were located in the C-terminal
transmembrane domain whereas the others were distributed throughout the
cytoplasmic region of RyR1. Conclusion Our data enlarge the spectrum of RYR1
mutations and highlight their clinical and morphological heterogeneity. A
congenital myopathy featuring ptosis and external ophthalmoplegia, concomitant
with the novel histopathological phenotype showing fibres with large, poorly
delimited areas of myofibrillar disorganisation and internal nuclei, is highly
suggestive of an RYR1-related congenital myopathy.
PMID: 21062345 [PubMed - as supplied by publisher]
15. Rheumatology (Oxford). 2010 Nov 8. [Epub ahead of print]
Gene profiling predicts rheumatoid arthritis responsiveness to IL-1Ra (anakinra).
Bansard C, Lequerré T, Derambure C, Vittecoq O, Hiron M, Daragon A, Pouplin S,
Daveau M, Boyer O, Tron F, Le Loët X, Salier JP.
Inserm Unité 905, Institut Fédératif de Recherche Multidisciplinaire sur les
Peptides 23, Institute for Biomedical Research, University of Rouen, Faculté de
Médecine-Pharmacie, Department of Rheumatology, Rouen University Hospital and
Consortium EGERIE, Rouen, France.
Objectives. The overall non-response rate to biologics remains 30-40% for
patients with RA resistant to MTX. The objective of this study was to predict
responsiveness to the anakinra-MTX combination by peripheral blood mononuclear
cell gene profiling in order to optimize treatment choice. Methods. Thirty-two
patients treated with anakinra (100 mg/day s.c.) and MTX were categorized as
responders when their 28-joint DAS (DAS-28) had decreased by ≥1.2 at 3 months.
Pre-treatment blood samples had been drawn. Results. For seven responders and
seven non-responders, 52 microarray-identified mRNAs were expressed as a function
of the response to treatment, and unsupervised hierarchical clustering correctly
separated responders from non-responders. The levels of seven of these 52
transcripts, as assessed by real-time, quantitative RT-PCR, were able to
accurately classify 15 of 18 other patients (8 responders and 10 non-responders),
with 87.5% specificity and 77.8% negative-predictive value for responders. Among
the 52 genes, 56% were associated with IL-1β. Conclusion. This predictive gene
expression profile was obtained with a non-invasive procedure. After further
validation in other cohorts of patients, it could be proposed and used on a large
scale to select likely RA responders to combined anakinra-MTX. Trial
registration. Clinical Trials; NCT00213538 (http://www.clinicaltrials.gov).
PMID: 21059672 [PubMed - as supplied by publisher]
16. Eur J Neurosci. 2010 Nov 9. doi: 10.1111/j.1460-9568.2010.07474.x. [Epub ahead of
print]
Gastric electrical stimulation increases ghrelin production and inhibits
catecholaminergic brainstem neurons in rats.
Gallas S, Sinno MH, Boukhettala N, Coëffier M, Dourmap N, Gourcerol G, Ducrotté
P, Déchelotte P, Leroi AM, Fetissov SO.
Digestive System & Nutrition Laboratory (ADEN EA4311), Institute of Medical
Research and Innovation, Rouen University & Hospital, IFR23, Rouen 76183, France
Physiology Laboratory, Faculty of Medicine of Monastir, Monastir, Tunisia
Experimental Neuropsychopharmacology Laboratory, Institute of Medical Research
and Innovation, Rouen University & Hospital, Rouen, France.
Gastric electrical stimulation (GES) is a new therapeutic option for functional
dyspepsia and gastroparesis. In addition to ameliorating nausea and vomiting, GES
results in improved appetite which is not always associated with accelerated
gastric emptying. To explore the central and peripheral factors underlying
GES-associated improvement of appetite we developed a GES model in anaesthetized
Wistar rats. During laparotomy, two electrodes were implanted into the stomach
and high-frequency low-energy GES (14 Hz, 5 mA) was applied. The effects of 1 h
GES were compared with sham stimulation. After GES, c-Fos expression was
increased in the mucosal and submucosal layers of the stimulated area (174%). In
the stomach, GES increased ghrelin mRNA (178%) and doubled the number of
ghrelin-positive cells, resulting in elevated plasma levels of ghrelin (2.3 ± 0.2
vs. 1.6 ± 0.2 ng/mL). In the arcuate nucleus of the hypothalamus, GES increased
c-Fos (277%) and agouti-related protein (AgRP) mRNA expression (135%). GES
reduced the number of c-Fos-positive cells throughout the nucleus of the solitary
tract (between 93 and 75% from rostral to caudal levels) including
catecholaminergic neurons (81% at caudal level). Gastric emptying, plasma glucose
and heart rate variability were not affected by GES. This study shows that GES
may improve appetite via stimulation of main orexigenic pathways, including
ghrelin production in the stomach and AgRP in the hypothalamus, as well as by
reducing the activity of catecholaminergic brainstem neurons.
PMID: 21059113 [PubMed - as supplied by publisher]
17. Radiother Oncol. 2010 Nov 4. [Epub ahead of print]
Simultaneous positron emission tomography (PET) assessment of metabolism with
(18)F-fluoro-2-deoxy-d-glucose (FDG), proliferation with (18)F-fluoro-thymidine
(FLT), and hypoxia with (18)fluoro-misonidazole (F-miso) before and during
radiotherapy in patients with non-small-cell lung cancer (NSCLC): A pilot study.
Vera P, Bohn P, Edet-Sanson A, Salles A, Hapdey S, Gardin I, Ménard JF,
Modzelewski R, Thiberville L, Dubray B.
Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen
University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108].
OBJECTIVES: To investigate the changes in tumour proliferation (using FLT),
metabolism (using FDG), and hypoxia (using F-miso) during curative (chemo-)
radiotherapy (RT) in patients with non-small-cell lung cancer (NSCLC). PATIENTS
AND METHODS: Thirty PET scans were performed in five patients (4 males, 1 female)
that had histological proof of NSCLC and were candidates for curative-intent RT.
Three PET-CT (Biograph S16, Siemens) scans were performed before (t(0)) and
during (around dose 46Gy, t(46)) RT with minimal intervals of 48h between each
PET-CT scan. The tracers used were (18)fluoro-2deoxyglucose (FDG) for metabolism,
(18)fluorothymidine (FLT) for proliferation, and (18)F-misonidasole (F-miso) for
hypoxia. The 3 image sets obtained at each time point were co-registered (rigid:
n=9, elastic: n=1, Leonardo, TrueD, Siemens) using FDG PET-CT as reference. VOIs
were delineated (40% SUV(max) values were used as a threshold) for tumours and
lymph nodes on FDG PET-CT, and they were automatically pasted on FLT and F-miso
PET-CT images. ANOVA and correlation analyses were used for comparison of
SUV(max) values. RESULTS: Four tumours and twelve nodes were identified on
initial FDG PET-CT images. FLT SUV(max) values were significantly lower
(p<0.0006) at t(46) in both tumours and nodes. The decrease in FDG SUV(max)
values had a trend towards significance (p=0.048). F-Miso SUV(max) values were
significantly higher in tumours than in nodes (p=0.02) and did not change during
radiotherapy (p=0.39). A significant correlation was observed between FLT and FDG
uptake (r=0.56, p<10(-4)) when all data were pooled together, and they remained
similar when the before and during RT data were analysed separately. FDG and
F-miso uptakes were significantly correlated (r=0.59, p=0.0004) when all data
were analysed together. The best fit was obtained after adjusting for lesion type
(tumour vs. node). This correlation was observed for the SUV(max) measured during
RT (r=0.70, p=0.008) but not for the pre-RT data (r=0.19, p=0.35). The weak
correlation between FLT and F-miso uptakes only became significant (r=0.66,
p=0.002) when the analysis was restricted to the data acquired during RT.
CONCLUSION: Three different PET acquisitions can be performed
quasi-simultaneously (4-7days) before and during radiotherapy in patients with
NSCLC. Our results at 46Gy suggest that a fast decrease in the proliferation of
both tumours and nodes exists during radiotherapy with differences in metabolism
(borderline significant decrease) and hypoxia (stable).
PMID: 21056487 [PubMed - as supplied by publisher]
18. Prog Urol. 2010 Nov;20(12):1089-94. Epub 2010 Sep 28.
[Therapeutic education and alternative medicine].
[Article in French]
Sibert L, Rigaud J, Delavierre D, Labat JJ.
Service d'urologie, EA 4308, hôpital Charles-Nicolle, CHU de Rouen, université de
Rouen, 1, rue de Germont, 76000 Rouen, France. louis.sibert@chu-rouen.fr
OBJECTIVE: To review the most common Complementary and Alternative Medical (CAM)
therapies described for chronic pelvic pain care and to analyze their results as
reported in the literature. MATERIAL AND METHODS: Review of articles and
consensus conferences published on this subject in the Medline (PubMed) database,
selected according to their scientific relevance. RESULTS: Lifestyle
interventions have a positive impact on patients' self-management of their
chronic pain. Positive outcomes are associated with well-balanced diet, dietary
changes and certain dietary supplementations for bladder pain syndrome and
chronic pelvic pain syndrome. Limited data exist supporting the use of
acupuncture for chronic pelvic pain, endometriosis, bladder pain syndrome and
urethral pain syndrome. There is no evidence for homeopathy and mesotherapy.
CONCLUSIONS: Published data on many CAM therapies suggest their potential as
complementary treatment options of chronic pelvic pain. As conventional
treatments, CAM therapies warrant further studies to assist in their validation
as permanent treatment options for this patient population.
PMID: 21056389 [PubMed - in process]
19. Prog Urol. 2010 Nov;20(12):1060-5. Epub 2010 Sep 29.
[Therapeutic management of chronic intrascrotal pain].
[Article in French]
Sibert L, Rigaud J, Delavierre D, Labat JJ.
Service d'urologie, EA 4308, hôpital Charles-Nicolle, CHU de Rouen, université de
Rouen, 1, rue de Germont, 76000 Rouen, France. louis.sibert@chu-rouen.fr
OBJECTIVE: To resume available therapeutic options for intra scrotal chronic
pain, including surgical procedures, and to analyze their efficiency through a
review of published data. MATERIAL AND METHODS: Review of articles published on
this topic in the Medline (PubMed) database, selected according to their
scientific relevance. RESULTS: Initial treatment of epididydimal and testicular
pain should always be conservative. Mean success rates of the different
therapeutic options varies from 27% to 90%. Surgery on the scrotal content should
be considered only if: (1) Pain can be explained by a local intra scrotal cause;
(2) Medical and conservative treatments have failed; (3) Nerve block has been
tried and is efficient in relieving pain; (4) Patients are informed of the risk
of failure. Conservative surgical procedure (epididymectomy, vasovasostomy) have
a success rate of 50-70%. Microsurgical spermatic cord denervation yields better
results, while preserving testis and epididymis integrity. Failure is still
possible (15%). Orchidectomy should be avoided if possible. CONCLUSIONS: Levels
of evidence concerning indications and efficiency of these surgical procedures
are low. Patients suffering from recurring or implacable chronic testicular and
epididymal pain require a multidisciplinary care.
PMID: 21056385 [PubMed - in process]
20. Prog Urol. 2010 Nov;20(12):1010-8.
[Endometriosis and chronic pelvic pain].
[Article in French]
Roman H, Bourdel N, Rigaud J, Delavierre D, Labat JJ, Sibert L.
Clinique gynécologique et obstétricale, CHU de Rouen, 76000 Rouen, France.
OBJECTIVES: To analyse pathophysiology and clinical symptoms of chronic pelvic
pain and their therapeutic care. MATERIAL AND METHODS: Review of articles and
consensus conferences published on this subject in the Medline(®) (PubMed(®))
database. RESULTS: Pain importance and endometriosis lesion size are somewhat
linked. In the case of chronic pains, endometriosis lesions are not always the
only cause of the pain. Imaging consists mostly of MRI and transvaginal
ultrasonography. Treatment must be offered to patients with painful
endometriosis. Hormonal treatment meant to cause amenorrhea is recommended to
improve dysmenorrhea, dyspareunia and chronic pains. Endometriosis should be
confirmed by pathological or surgical findings, before prolonged treatment is
undergone. Prolonged postoperative amenorrhea significantly decreases pain and
lesion relapse. Surgical treatment is effective on painful symptoms and is
recommended in the event of painful endometriosis. Undergoing surgery is
recommended only if individual benefit exceeds risk. CONCLUSIONS: Surgical
treatment should aim at improving symptoms rather than systematically removing
every endometriosis lesion. Diagnosis of endometriosis lesion at an early stage
is currently a major part of public health policy.
PMID: 21056379 [PubMed - in process]
21. Prog Urol. 2010 Nov;20(12):1003-9. Epub 2010 Sep 29.
[Adhesions and chronic pelvic pain].
[Article in French]
Roman H, Bourdel N, Canis M, Rigaud J, Delavierre D, Labat JJ, Sibert L.
Clinique gynécologique et obstétricale, CHU de Rouen, 76000 Rouen, France.
OBJECTIVES: To analyse pathophysiology of adhesions and their link with chronic
pelvic pain, as well as therapeutic and prevention options as reported in the
literature. MATERIAL AND METHODS: Review of articles and consensus conferences
published on this topic in the Medline (Pubmed) database, selected according to
their scientific relevance. RESULTS: Postoperative adhesions are responsible for
a specific morbidity combining chronic pain, small bowel obstruction,
infertility, and morbidity increase in the event of subsequent surgery. Chronic
pains in previously operated on patients can be linked to postoperative
adhesions. Ultrasonography and dynamic MRI can recognize intra abdominal
adhesions, but cannot definitely link them to the painful symptoms. The
prevention of adhesions is done firstly by respecting surgical rules concerning
laparoscopic and open surgical approaches, and secondly by the use of
anti-adhesion products. Pharmacological adhesion prevention systems decrease the
frequency and extent of adhesions. Their efficiency has been proved by studies
with substantial evidence levels. Patients suffering from potentially
adhesion-induced chronic abdominal and pelvic pains can benefit from a
laparoscopic adhesiolysis, which improved pain symptoms in more than 50% of
patients, but exposes to the risk of complications, such as bowel injury.
CONCLUSION: The decision to perform adhesiolysis should be taken for each patient
individually, while taking in consideration the benefit-to-risk ratio. Adhesion
relapse after adhesiolysis is a frequent phenomenon, but can be reduced by the
use of anti-adhesion products.
PMID: 21056378 [PubMed - in process]
22. Prog Urol. 2010 Nov;20(12):967-72. Epub 2010 Sep 29.
[Pelvic sexual pain].
[Article in French]
Sibert L, Safsaf A, Rigaud J, Delavierre D, Labat JJ.
Service d'urologie, EA 4308, hôpital Charles-Nicolle, CHU de Rouen, université de
Rouen, 1, rue de Germont, 76000 Rouen, France. louis.sibert@chu-rouen.fr
OBJECTIVE: To colligate the clinical and ethiopathogenical elements to take into
account in the assessment of sexual activity-related chronic pelvic and perineal
pain, in the male as well as in the female subject. SUBJECTS AND METHODS: Review
of articles and consensus conferences published on this subject in the Medline
(Pubmed) database, selected according to their scientific relevance. RESULTS: In
the female subject, only dyspareunia has benefitted from a consensual definition.
Deep dyspareunia must start investigations in search of pelvic organs disorders,
endometriosis, painful bladder syndrome adhesions. Superficial dyspareunia can be
a part of provoked vestibulodynia. Vaginismus can be linked to a local disorder,
but can also be caused by an excess of nociception. In the male subject, painful
ejaculation must start investigation in search of a local urological disorder. It
can also be of iatrogenous origin, or be included in a chronic pelvic pain
syndrome. Although less documented, other pelvic and perineal pain syndrome,
coitus-related or not, exist in the male subject. CONCLUSION: Assessment of these
sexual dysfunctions is primarily based on history taking and clinical
examination. In the absence of systematically researched organic disorder, these
pains can be part of functional disorders, in which case a global assessment must
be undergone, by taking into account all aspects of the pain, including emotional
aspects.
PMID: 21056373 [PubMed - in process]
23. Prog Urol. 2010 Nov;20(12):962-6. Epub 2010 Sep 29.
[Epididymal and testicular chronic pain].
[Article in French]
Sibert L, Safsaf A, Rigaud J, Delavierre D, Labat JJ.
Service d'urologie, EA 4308, hôpital Charles-Nicolle, CHU de Rouen, université de
Rouen, 1, rue de Germont, 76000 Rouen, France. louis.sibert@chu-rouen.fr
OBJECTIVE: To list clinical and ethiopathogenical elements relevant to the
analysis of an epididymal and testicular pain. MATERIAL AND METHODS: Review of
published articles on the subject in the Medline(®) (PubMed(®)) database,
selected according to their scientific relevance. RESULTS: Assessment of a
chronic epididymal and testicular pain is mostly clinical and should: (1)
eliminate local urological disorder; (2) suggest a neurological problem, based on
signs and semiology; (3) suggest injury of nervous truncus according to medical
history and scars; (4) detect referred pains, primarily back and thoracolumbar
pains. The causal link between epididymal cysts, surgical aftereffect, local
infection and chronic epididymal and testicular pain is not established with
certainty. Spermatic cord nerve block, as a diagnostic test, should be done
before undergoing any invasive procedure. CONCLUSION: The fundamental notion is
being able to distinguish epididymal and testicular pain and scrotal pain,
because the testis has an abdominal origin, and therefore a sympathetic instead
of sacral innervation. An absence evident somatic or iatrogenous cause should
suggest hypersensibility to pain. Assessment of an epididymal and testicular pain
requires a global clinical examination, which should take into account every
aspect of the pain, including its functional and emotional components.
PMID: 21056372 [PubMed - in process]
24. Prog Urol. 2010 Nov;20(12):917-21. Epub 2010 Sep 29.
[Impact of chronic pelvic pain on sexual functions and fertility].
[Article in French]
Sibert L, Safsaf A, Rigaud J, Delavierre D, Labat JJ.
Service d'urologie, EA 4308, hôpital Charles-Nicolle, CHU de Rouen, université de
Rouen, 1, rue de Germont, 76000 Rouen, France. louis.sibert@chu-rouen.fr
OBJECTIVE: To summarize current knowledge on prevalence, characteristics and
ethiopathogenical hypothesis concerning sexuality and fertility dysfunctions in
patients with chronic pelvic pain. MATERIAL AND METHODS: Review of articles
published on this subject in the Medline (PubMed) database, selected according to
their scientific relevance. RESULTS: In the male subject, most frequent sexual
dysfunctions are erectile dysfunction and ejaculation disturbance (premature
ejaculation, painful ejaculation). Chronic epididymal and testicular pain has a
negative impact on the quality of sexual intercourse and satisfaction of both
partners. Association between lower urinary tract symptoms--frequent in the event
of chronic pelvic pain syndrome--and sexual dysfunction has been proved. Change
in spermatic parameters exists in the event of chronic pelvic pain syndrome, but
their impact on male fertility has not yet been established. In the female
subject, sexual dysfunction is less studied. However, effect of chronic pelvic
and perineal pain on female patient sexuality cannot be ignored, as they can
affect all components of the sexual cycle. There is no data published on the link
between infertility and chronic pelvic and perineal pain in the female subject.
CONCLUSIONS: Allowing to the frequency of sexual dysfunction and its impact on
quality of life, sexual function assessment must be a part of every consultation
for chronic pelvic and perineal pain.
PMID: 21056366 [PubMed - in process]
25. Prog Urol. 2010 Nov;20(12):892-6. Epub 2010 Sep 29.
[Integration of chronic pelvic pain to the accreditation and professional
practice assessment procedures].
[Article in French]
Sibert L, Rigaud J, Delavierre D, Labat JJ.
Service d'urologie, EA 4308, hôpital Charles-Nicolle, CHU de Rouen, université de
Rouen, 1, rue de Germont, 76000 Rouen, France. louis.sibert@chu-rouen.fr
OBJECTIVE: To list available actions in order to optimize urological care of
patients suffering from chronic pelvic and perineal pain, based on guidelines for
accreditation and professional practice assessment. MATERIAL AND METHODS:
Legislative texts concerning accreditation and PPA, as well as professional
recommendations concerning chronic pains have been consulted. RESULTS:
Professional practice assessment of chronic pelvic and perineal pain is hampered
by the lack of specific professional guidelines. Urological management of chronic
pelvic and perineal pain can only be optimized if initial and continued training
is strengthened. Furthermore, current professional structures implemented for
professional practice assessment and accreditation processes (staff,
multi-disciplinary meetings, morbidity-mortality reviews) should be applied in a
more systematic way to pelvic chronic pain by urologists. CONCLUSION: The need
for improvement in the management of chronic pelvic pain is felt in the
urological field, and should lead to developing means of evaluating professional
practices, a goal to which the French Urology Association has committed itself.
PMID: 21056362 [PubMed - in process]
26. Prog Urol. 2010 Nov;20(12):872-85. Epub 2010 Sep 29.
[Chronic pelvic pain: epidemiology and economic impact].
[Article in French]
Sibert L, Rigaud J, Delavierre D, Labat JJ.
Service d'urologie, EA 4308, hôpital Charles-Nicolle, CHU de Rouen, université de
Rouen, 1, rue de Germont, 76000 Rouen, France. louis.sibert@chu-rouen.fr
OBJECTIVE: To combine epidemiological and health economics data concerning
urological chronic pelvic pain syndromes. MATERIAL: Review of articles concerning
this topic in the Medline (PubMed) database, chosen according to their scientific
relevance. RESULTS: Prevalences are about 10,000/100,000 for chronic pelvic pain
syndrome/chronic prostatis, 239 to 306/100,000 for bladder pain
syndrome/interstitial cystitis, 15,000 to 20,000/100,000 for post-vasectomy
testis and epididymis pain, 14,000/100,000 concerning deep female dyspareunia,
1000 to 9000/100,000 for male ejaculation or orgasma-related pain, 15,000 to
21,000/100,000 for female chronic pelvic pain, of which one third is related to
endometriosis. Little has been published about the frequency of other chronic
pelvic and perineal pain syndromes. The financial impact is comparable to other
more frequent chronic diseases, with costs definitely above what the prevalences
would have led to believe. CONCLUSION: The frequency of pelvic disease
association, their predisposing factors, common environments and comordities
suggest a possible common origin. This epidemiological data highlights the
benefit of a multidisciplinary approach of chronic pelvic and perineal pain. This
could lead to a better understanding of involved mechanisms, and ultimately
treatment options.
PMID: 21056360 [PubMed - in process]
27. Prog Urol. 2010 Nov;20(12):836-42. Epub 2010 Sep 28.
[Chronic pelvic pain in urology: a nationwide questionnaire survey among French
urologists].
[Article in French]
Sibert L, Rigaud J, Delavierre D, Labat JJ.
Service d'urologie, EA 4308, hôpital Charles-Nicolle, CHU de Rouen, université de
Rouen, 1, rue de Germont, 76000 Rouen, France. louis.sibert@chu-rouen.fr
OBJECTIVE: To know the opinion of French urologists concerning the importance of
pelvic and perineal pain syndromes in their clinical activity, their management,
self-admitted knowledge and training needs concerning this situation. MATERIAL
AND METHODS: Eight hundred and seventy-eight urologists exercising in France, all
French Urology Association (AFU) members, have been asked to fill in an online
questionnaire concerning their daily management of chronic pelvic and perineal
pain syndromes. RESULTS: Three hundred and fifty-two urologists answered
(response rate 40%). For about 20%, chronic pelvic and perineal pain syndromes
took up more than 5% of consult activity. More than half took care of between 20
and 100 new cases of chronic pelvic and perineal pain every year. More than two
thirds deemed their knowledge concerning chronic pelvic and perineal pain fair to
insufficient. Three quarters of urologists would like to benefit from an opinion
from another specialist for more than one out of four patients. More than 56%
deemed that the organization of their daily consult activity was inadequate for
the management of this type of patient. Most of them deemed useful to develop
additional specific training programs. CONCLUSION: This survey shows that pelvic
and perineal pain syndromes are frequent in daily urological consult activity,
despite the fact that urologists feel they lack in training and organization to
manage properly these diseases.
PMID: 21056356 [PubMed - in process]
28. Ann Pathol. 2010 Nov;30(5 Suppl 1):88-9.
[In Process Citation].
[Article in French]
Sabourin JC.
Service de pathologie, hôpital Charles-Nicolle, CHU de Rouen, 1 rue de Germont,
Rouen cedex, France. jean-christophe.sabourin@chu-rouen.fr
PMID: 21055556 [PubMed - in process]
29. Semin Arthritis Rheum. 2010 Nov 1. [Epub ahead of print]
Infectious Complications in Polymyositis and Dermatomyositis: A Series of 279
Patients.
Marie I, Ménard JF, Hachulla E, Chérin P, Benveniste O, Tiev K, Hatron PY.
Department of Internal Medicine, CHU Rouen, Rouen, France.
OBJECTIVES:: To assess the prevalence and characteristics of severe pyogenic,
nonpyogenic, and opportunistic infections in polymyositis and dermatomyositis
(PM/DM) patients and to evaluate the predictive values for infections on clinical
presentation and biochemical findings of PM/DM to detect patients at risk for
such infections. METHODS:: The medical records of 279 consecutive PM/DM patients
in 3 medical centers were reviewed. RESULTS:: One hundred four severe infections
occurred in our patients (37.3%), ie, pyogenic (n = 71) and
nonpyogenic/opportunistic infections (n = 33). Pyogenic infections were mainly
due to aspiration pneumonia (n = 46) and calcinosis cutis infection. Thirty-three
PM/DM patients developed nonpyogenic/opportunistic infections that were due to
the following: Candida albicans, Pneumocystis jiroveci, Aspergillus fumigatus,
Geotrichum capitatum, Mycobacterium (avium-intracellulare complex, xenopi,
marinum, peregrinum, tuberculosis), Helicobacter heilmanii, cytomegalovirus,
herpes simplex and zoster virus, hepatitis B and C, JC virus, Leishmania major,
Strongyloides stercoralis. Esophageal dysfunction, ventilatory insufficiency,
malignancy, and lymphopenia were significantly more frequent in the group of
PM/DM patients with infections. CONCLUSION:: Our study underscores the high
frequency of infections in PM/DM, resulting in an increased mortality rate. Our
results suggest that prophylaxis against pyogenic infections should be routinely
recommended for patients with PM/DM, including regular physical examination of
lungs to depict aspiration pneumonia as well as risk factors of aspiration
pneumonia. Finally, because a great variety of micro-organisms may be responsible
for opportunistic infections, it seems difficult to initiate primary prophylaxis
in PM/DM patients exhibiting risk factors for opportunistic infections.
PMID: 21047670 [PubMed - as supplied by publisher]
30. J Fr Ophtalmol. 2010 Nov;33(9):630-636. Epub 2010 Oct 29.
[Subconjunctival bevacizumab for corneal neovascularization.]
[Article in French]
Gueudry J, Richez F, Tougeron-Brousseau B, Genevois O, Muraine M.
Service d'ophtalmologie, hôpital Charles-Nicolle, 1, rue de Germont, 76031 Rouen
cedex, France.
PURPOSE: To assess efficacy and safety of subconjunctival bevacizumab in corneal
neovascularization treatment. METHODS: The study was a prospective case series
that included patients treated with subconjunctival bevacizumab injections for
corneal neovascularization over a period of four months. A dose of 2.5mg (0.1mL)
of bevacizumab (25mg/mL) was injected into the subconjunctival area 1-2mm behind
the limbus near the corneal neovascularization. The main outcome measures were
visual acuity, corneal neovascularization, as well as local and general side
effects. RESULTS: Thirteen eyes of 12 patients were included. The mean patient
age was 44.2 years (range, 18-87 years). Patients received from two to four
bevacizumab injections. The mean corneal neovascularization area decreased from
41.1 to 33.7 % at day 45 (p=0.0003) and to 33.9 % at day 120 (p=0.0013). Median
visual acuity changed from 1.32 to 1.28 LogMAR on day 45 and to 1.25 LogMAR on
day 120. Subconjunctival bevacizumab was well tolerated without general side
effects. There was no significant change in intraocular pressure. An epithelial
defect was described in three patients after initiation of bevacizumab therapy.
CONCLUSIONS: Subconjunctival bevacizumab injections were effective and safe in
reducing corneal neovascularization within the first four months. Meanwhile,
improving vision may provide additional strategies.
PMID: 21035899 [PubMed - as supplied by publisher]
31. Pediatr Allergy Immunol. 2010 Nov;21(7):1015-20. doi:
10.1111/j.1399-3038.2010.01076.x.
Exhaled nitric oxide fractions are well correlated with clinical control in
recurrent infantile wheeze treated with inhaled corticosteroids.
Ghdifan S, Verin E, Couderc L, Lubrano M, Michelet I, Marguet C.
Division of Pediatric Pulmonology, Allergy, and Cystic Fibrosis Division of
Respiratory Physiology, Charles Nicolle University Hospital, INSERM CIC 204,
Rouen University, Rouen, France.
Fractional exhaled nitric oxide (FeNO) is a non-invasive marker of bronchial
inflammation in asthma. However, the interest of FeNO measurement remained
limited in infantile wheeze. The aim of this prospective study was to evaluate
the feasibility and reproducibility of FeNO off-line measurement in very young
children with recurrent wheeze and to assess whether clinical control of
infantile wheeze correlates with FeNO levels. Two exhalation samples were
collected in mylar balloon during quite tidal breathing. FeNO measurements were
performed off-line by a NO analyzer. The participating patients were aged ≤36
months, wheezes had started before the age of 24 months, and they were receiving
maintenance treatment with inhaled corticosteroids for at least 3 months
duration. The studied population comprised of 40 uncontrolled infants with
persistent wheezy respiratory symptoms, median age 14.5 months, and 40 with
optimal controlled infantile wheeze, median age 14 months. The reproducibility
was excellent (r = 0.95; p < 0.0001). There was a significant difference in FeNO
levels between the groups of persistent wheeze and well-controlled infants: 19.8
(2.5-99.3) ppb vs. 7.7 (0.6-29.5) ppb, p < 0.0001. At a FeNO level >15 ppb, the
predictive values for uncontrolled disease were as follows: positive predictive
value = 65%, negative predictive value = 90%. FeN0 levels were not increased by
atopy or passive tobacco. Off-line assessment of FeNO is feasible, reproducible,
and well accepted in wheezy very young children. Optimal clinical control of
infantile wheeze appeared to be associated with the control of bronchial
inflammation when evaluated by FeNO measurements.
PMID: 20977500 [PubMed - in process]
32. J Exp Med. 2010 Nov 22;207(12):2561-8. Epub 2010 Oct 25.
Extracellular NAD+ shapes the Foxp3+ regulatory T cell compartment through the
ART2-P2X7 pathway.
Hubert S, Rissiek B, Klages K, Huehn J, Sparwasser T, Haag F, Koch-Nolte F, Boyer
O, Seman M, Adriouch S.
Institut National de la Santé et de la Recherche Medicale, U905, 2 University of
Rouen, and 3 Department of Immunology, University Hospital of Rouen, 76183 Rouen,
France.
CD4(+)CD25(+)FoxP3(+) regulatory T cells (T reg cells) play a major role in the
control of immune responses but the factors controlling their homeostasis and
function remain poorly characterized. Nicotinamide adenine dinucleotide (NAD(+))
released during cell damage or inflammation results in ART2.2-mediated
ADP-ribosylation of the cytolytic P2X7 receptor on T cells. We show that T reg
cells express the ART2.2 enzyme and high levels of P2X7 and that T reg cells can
be depleted by intravenous injection of NAD(+). Moreover, lower T reg cell
numbers are found in mice deficient for the NAD-hydrolase CD38 than in wild-type,
P2X7-deficient, or ART2-deficient mice, indicating a role for extracellular
NAD(+) in T reg cell homeostasis. Even routine cell preparation leads to release
of NAD(+) in sufficient quantities to profoundly affect T reg cell viability,
phenotype, and function. We demonstrate that T reg cells can be protected from
the deleterious effects of NAD(+) by an inhibitory ART2.2-specific single domain
antibody. Furthermore, selective depletion of T reg cells by systemic
administration of NAD(+) can be used to promote an antitumor response in several
mouse tumor models. Collectively, our data demonstrate that NAD(+) influences
survival, phenotype, and function of T reg cells and provide proof of principle
that acting on the ART2-P2X7 pathway represents a new strategy to manipulate T
reg cells in vivo.
PMID: 20975043 [PubMed - in process]
33. Eur J Surg Oncol. 2010 Nov;36(11):1080-4. Epub 2010 Sep 9.
Transposed right colon segment for vaginal reconstruction after pelvic
exenteration.
Bridoux V, Kianifard B, Michot F, Resch B, Sibert L, Tuech JJ.
Department of Digestive Surgery, Rouen University Hospital, France.
Vaginal reconstruction following pelvic exenteration surgery for malignant
disease is an important step in the physical and psychological rehabilitation of
such patients. Planning of such procedures must include a strategy for
reconstruction of the vagina and the oncological surgical team must be aware of
the surgical techniques available in order to optimally plan and execute such
procedures. We described a procedure which involves supralevator exenteration of
the pelvis along with primary colorectal anastomosis. A transposed right colon
segment is used to reconstruct the vagina and an omental flap is interpositioned
between the reconstructed vagina and the colorectal anastomosis. The procedure is
described in the text and in a didactic video.
PMID: 20828978 [PubMed - indexed for MEDLINE]
34. Gastroenterol Clin Biol. 2010 Nov;34(11):606-11. Epub 2010 Sep 6.
Outcome of patients with obscure gastrointestinal bleeding after negative capsule
endoscopy: Results of a one-year follow-up study.
Lorenceau-Savale C, Ben-Soussan E, Ramirez S, Antonietti M, Lerebours E, Ducrotté
P.
Service d'hépatogastroentérologie et nutrition, centre hospitalier universitaire
de Rouen, 76031 Rouen cedex, France; Service d'hépatogastroentérologie, hôpital
européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France.
BACKGROUND: Capsule endoscopy (CE) is an effective method for investigating the
small bowel, especially in cases of obscure gastrointestinal bleeding (OGIB),
although the long-term outcome of patients with a negative CE is generally not
known. PATIENTS AND METHODS: For 49 patients with OGIB and a negative CE, their
referring physicians filled out a follow-up questionnaire to assess bleeding
recurrence and any repeat investigations after negative video capsule endoscopy
(VCE). RESULTS: A minimum follow-up duration of one year (median: 15.9 months)
was available for 35 patients with an overall rebleeding rate of 23% (n=8). Of
these eight patients, four women presented with recurrence prior to new
investigations. In the four remaining patients, repeat endoscopy work-ups after
negative CE were performed and revealed previously missed lesions with bleeding
potential, mainly in the stomach. Overall, 13 patients, with or without
rebleeding, had repeat endoscopy work-ups after a negative CE, leading to a
definitive diagnosis in nine patients, with lesions located in the stomach and
colon in eight of them. CONCLUSION: Patients with OGIB and a negative CE had a
low rate of rebleeding. This study highlights the importance of the initial
endoscopy work-up, and suggests that CE be proposed after a minimum of two
gastroscopies and one complete colonoscopy.
PMID: 20822872 [PubMed - in process]
35. Scand J Work Environ Health. 2010 Nov;36(6):484-7. Epub 2010 Aug 25.
Searching for high-quality articles about intervention studies in occupational
health--what is really missed when using only the Medline database?
Rollin L, Darmoni S, Caillard JF, Gehanno JF.
Service de Médecine du Travail, Rouen University Hospital, 1 rue de Germont,
Rouen, France. laetitia.rollin@chu-rouen.fr
OBJECTIVE: Most occupational health physicians access electronic databases to
obtain reliable medical information. Although it has been demonstrated that the
use of Medline alone does not ensure comprehensiveness, many experts rely solely
on this database. Our study aimed to discover to what extent the physician who
limits his/her search to Medline misses studies of high quality. METHODS: We
constructed a "gold standard" database of high-quality intervention studies
gathering all the references included in the systematic reviews of the Cochrane
Library and indexed under the topic "occupational health field". We then searched
all these references, one by one, in Medline. RESULTS: Overall, 88.8% [95%
confidence interval (95% CI) 86.1-91.5] of the high quality studies included in
our gold standard database were indexed in Medline. References included in
reviews on psychiatric or psychological topics were significantly less often
indexed in Medline [81.7% (95% CI 75.9-88.5)] than references included in reviews
on other topics [92.2% (95% CI 89.5-95.0)] (P=0.001). CONCLUSION: The recall
ratio of Medline for high-quality intervention studies is close to 90%. For
occupational health practitioners who aim to find reliable answers to their daily
practice questions, searching Medline only is more cost-effective than previously
thought.
PMID: 20740265 [PubMed - in process]
36. Clin Exp Immunol. 2010 Nov;162(2):298-305. doi: 10.1111/j.1365-2249.2010.04220.x.
Epub 2010 Aug 20.
Beneficial effects of cathepsin inhibition to prevent chemotherapy-induced
intestinal mucositis.
Alamir I, Boukhettala N, Aziz M, Breuillé D, Déchelotte P, Coëffier M.
Institute for Biomedical Research and European Institute for Peptide Research,
Rouen University, France.
One of the main secondary toxic side effects of anti-mitotic agents used to treat
cancer patients is intestinal mucositis. Previous data showed that cathepsin D
activity, contributing to the proteolytic lysosomal pathway, is up-regulated
during intestinal mucositis in rats. At the same time, cathepsin inhibition
limits intestinal damage in animal models of inflammatory bowel diseases. The aim
of this study was to evaluate the effects of cathepsin inhibition on
methotrexate-induced mucositis in rats. Male Sprague-Dawley rats received saline
solution subcutaneously as the control group or 2·5 mg/kg of methotrexate for 3
days (D0-D2). From D0 to D3 methotrexate-treated rats also received
intraperitoneal injections of pepstatin A, a specific inhibitor of cathepsin D or
E64, an inhibitor of cathepsins B, H and L, or vehicle. Rats were euthanized at
D4 and jejunal samples were collected. Body weight and food intake were partially
preserved in rats receiving E64 compared with rats receiving vehicle or pepstatin
A. Cathepsin D activity, used as a marker of lysosomal pathway, was reduced both
in E64 and pepstatin-treated rats. However, villus atrophy and intestinal damage
observed in methotrexate-treated rats were restored in rats receiving E64 but not
in rats receiving pepstatin A. The intramucosal concentration of proinflammatory
cytokines, interleukin-1β and cytokine-induced neutrophil chemoattractant
(CINC)-2, was markedly increased in methotrexate-treated rats receiving vehicle
or pepstatin A but not after E64 treatment. In conclusion, a large broad
inhibition of cathepsins could represent a new potential target to limit the
severity of chemotherapy-induced mucositis as opposed to the inhibition of
cathepsin D alone.
PMID: 20731673 [PubMed - in process]
37. Interact Cardiovasc Thorac Surg. 2010 Nov;11(5):667-9. Epub 2010 Aug 17.
Isolated ventricular septal rupture secondary to blunt trauma.
Hamdan-Challe M, Godin M, Bouchart F, Doguet F.
Department of Cardiology, Rouen University Hospital and University of Rouen,
France.
A ventricular septal rupture (VSR) is a rare complication of blunt chest trauma.
We describe the case of a 25-year-old man who developed a VSR as a result of a
high-speed road accident. The rupture was closed by left ventricular remodeling
and replacement of the diseased myocardium with a Dacron patch. The patch sutures
were reinforced with glue. Redo surgery was necessary at nine months due to patch
detachment and embolization of the glue in the right lower lobe. The patient is
asymptomatic, at 13-month follow-up.
PMID: 20716555 [PubMed - in process]
38. Interact Cardiovasc Thorac Surg. 2010 Nov;11(5):708-10. Epub 2010 Aug 13.
Place of extracorporeal membrane oxygenation in acute aortic dissection.
Doguet F, Vierne C, Leguillou V, Bessou JP.
Department of Thoracic and Cardiovascular Surgery, Rouen University Hospital, 1
rue de Germont, 76000 Rouen, France. fabien.doguet@chu-rouen.fr
Comment in:
Interact Cardiovasc Thorac Surg. 2010 Nov;11(5):710.
Coronary artery dissection (CAD) is a rare but serious complication of type A
aortic dissection (AD) which may be discovered preoperatively in the presence of
clinical or ECG signs of ischemia, or intraoperatively after dissection of the
coronary ostium. Treatment of CAD consists of surgical repair with glue and, if
necessary, coronary artery bypass graft. No case of AD with CAD complicated by
major arrhythmias treated by assisted circulation has been reported in the
literature. We report the first case of AD with implementation of extracorporeal
membranous oxygenation following cardiotomy with a favorable outcome.
PMID: 20709696 [PubMed - in process]
39. Presse Med. 2010 Nov;39(11):e247-57. Epub 2010 Jul 7.
[Influence of age on characteristics of cutaneous vasculitis: a series of 132
patients].
[Article in French]
Marie I, Mikolajcz S, Benichou J, Grassi V, Levesque H.
CHU de Rouen, Département de médecine interne, 76031 Rouen cedex, France.
isabelle.marie@chu-rouen.fr
OBJECTIVES: Age onset of cutaneous vasculitis may influence clinical
manifestations and outcome of this condition. However, to date, no authors have
analyzed characteristics of cutaneous vasculitis, especially causes, in elderly
patients (≥ 65 years). METHODS: The aims of this retrospective study were to
compare clinical and biochemical characteristics as well as causes of cutaneous
vasculitis between elderly patients (n=58) and younger subjects (n=74). RESULTS:
Median time onset between first clinical symptoms and diagnosis of cutaneous
vasculitis was similar between elderly and younger (15 vs 10 days; P=0.39).
Clinical characteristics did not differ between the 2 groups. The following
biochemical parameters were more frequently found in elderly patients: higher
median levels of erythrocyte sedimentation rate (44 vs 28 mm/h; P=0.006), urea (8
vs 5 mmol/L; P<0.0001), creatininemia (92 vs 74 μmol/L; P=0.004), and lower
values of serum protein (P=0.023). The more common causes of cutaneous vasculitis
in elderly patients were as follows: infections (n=24), drugs (n=12), systemic
vasculitides (n=8) and cancer (n=8); only cancer-associated cutaneous vasculitis
was more frequently observed in elderly patients (P=0.02). CONCLUSION: Our study
suggests that age onset of cutaneous vasculitis may influence causes of cutaneous
vasculitis, as cancer were more common in elderly patients. Moreover, infectious
manifestations were different in elderly patients (urinary and pulmonary
infections) compared to younger patients (otorhinolaryngeal infections). In
essence, our data underline that the search for cancer should be performed in
elderly patients exhibiting cutaneous vasculitis.
PMID: 20615657 [PubMed - in process]
40. Transpl Int. 2010 Nov;23(11):1135-43. doi: 10.1111/j.1432-2277.2010.01122.x.
Comparative effects of sirolimus and cyclosporin on conduit arteries endothelial
function in kidney recipients.
Joannides R, Etienne I, Iacob M, De Ligny BH, Barbier S, Bellien J, Lebranchu Y,
Thuillez C, Godin M.
Department of Pharmacology, Rouen University Hospital & INSERM U644, Institute
for Biomedical Research, University of Rouen, Rouen, France.
robinson.joannides@chu-rouen.fr
This study attempted to establish whether a calcineurin inhibitor (CNI)-free
immunosuppressant regimen based on sirolimus (SRL) is associated with a
preservation of conduit arteries endothelial function in kidney recipients or
not. Twenty-nine kidney recipients were randomized to receive since
transplantation SRL (n=15) or cyclosporin A (CsA, n=14) associated with
mycophenolate mofetil (MMF) and steroids (6months) in a parallel prospective
study. Systolic, diastolic blood pressures, glomerular filtration rate (GFR) and
radial artery flow-mediated dilatation (FMD) induced by postischaemic hyperaemia
were assessed in a blind manner at one (M1) and 7months (M7) after
transplantation. Endothelium-independent dilatation was assessed by glyceryl
trinitrate spray. There was no difference between the groups for all vascular
parameters at M1. At M7, systolic blood pressure was lower (SRL: 119±3 vs. CsA:
138±4mmHg, P<0.05) and FMD was higher in SRL compared with CsA (SRL: 13.1±0.9 vs.
CsA: 9.9±0.9%, P<0.05) without any difference for hyperaemia,
endothelium-independent dilatation and GFR (SRL: 66.7±1.05 vs. CsA:
67.5±1.22ml/min). Our results demonstrate that a CNI-free regimen based on SRL
and MMF prevents conduit artery endothelial dysfunction compared with CsA and MMF
in kidney recipients suggesting a beneficial arterial wall effect that may also
contribute to the decrease in systolic blood pressure.
PMID: 20536790 [PubMed - in process]
41. J Androl. 2010 Nov-Dec;31(6):617-30. Epub 2010 Mar 4.
Rapid screening of cryopreservation protocols for murine prepubertal testicular
tissue by histology and PCNA immunostaining.
Milazzo JP, Travers A, Bironneau A, Safsaf A, Gruel E, Arnoult C, Macé B, Boyer
O, Rives N.
Reproductive Biology Laboratory-CECOS, Institute for Biomedical Research, Rouen
University Hospital, 1 rue de Germont, Rouen Cedex, France.
Numerous parameters have to be tested to identify optimal conditions for
prepubertal testicular tissue banking. Our study evaluated 19 different
cryopreservation conditions for immature testicular tissue using a rapid
screening method. Immature mice testes were cryopreserved using either
1,2-propanediol (PROH) or dimethyl sulfoxide (DMSO) at a concentration of 0.75 or
1.5 M using a controlled slow-cooling rate protocol with (S+) or without seeding
(S+). Equilibration was performed either at room temperature or at 4°C for 15 or
30 minutes. Seminiferous cord cryodamage was determined by scoring morphologic
alterations. Cell proliferation ability was evaluated using a proliferating cell
nuclear antigen (PCNA) antibody. Testes cryopreserved with optimal conditions
were grafted into immunodeficient mice. The highest proportions of PCNA-positive
nuclei and lowest morphologic alterations were observed with 1.5 M DMSO. Tissues
were more altered with 0.75 M DMSO or PROH. Complete germ cell maturation was
observed after allografting of testicular pieces previously frozen with 1.5 M
DMSO, S+, 30 minutes. The 1.5 M DMSO, S+ or S+ protocol preserved prepubertal
mice testicular tissue architecture and germ cell and Sertoli cell proliferation
potential. Allografting of thawed testis fragments into immunodeficient mice
confirmed that the 1.5 M DMSO, S+, 30 minutes protocol maintained testicular
somatic and germ cell functions. Postthaw histologic evaluation and PCNA
immunostaining are useful to rapidly test numerous freeze-thaw parameters. They
may also be efficient tools to control human prepubertal frozen testis quality,
within the context of a clinical application.
PMID: 20203335 [PubMed - in process]
