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Alesina PF, Kniazeva P, Pinto G, Pontin A, Walz MK. Long-term outcome of retroperitoneoscopic partial versus total adrenalectomy in patients with Cushing's syndrome. World J Surg 2024; 48:121-129. [PMID: 38651548 DOI: 10.1002/wjs.12023] [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: 10/23/2023] [Accepted: 10/31/2023] [Indexed: 04/25/2024]
Abstract
BACKGROUND We analyze the long-term outcome of surgery for Cushing's syndrome (CS) and the influence of the extent of surgical resection on the duration of postoperative cortisone substitution. METHODS One-hundred forty-one patients (129 female, 12 males; mean age: 45.7 ± 12.8 years) operated between January 2000 to June 2020 were included in the analysis. Patients suffered from manifest (124) or subclinical (17) CS due to benign unilateral adrenal neoplasia. All tumors were removed by the posterior retroperitoneoscopic approach. 105 patients had total (TA) and 36 partial (PA) adrenalectomies. All patients were discharged with ongoing corticosteroid supplementation therapy. RESULTS Follow-up data could be obtained for 83 patients. Twenty-four (1 male, 23 females; mean age 42.3 years) underwent PA and 59 TA (6 males, 53 females; mean age 44.6 years). Mean follow-up time was 107 ± 68 months (range: 6-243 months). The median duration of postoperative corticosteroid therapy was 9.5 months after PA and 11 months after TA (p = 0.1). Significantly, more patients after total adrenalectomy required corticosteroid therapy for more than 24 months (25% vs. 4%; p = 0.03). Recurrent ipsilateral disease occurred in one case after partial adrenalectomy and was treated by completion adrenalectomy. A case of contralateral recurrence associated with subclinical Cushing's syndrome was observed after total adrenalectomy. CONCLUSIONS The risk of local recurrence after partial adrenalectomy in CS is low. Cortical-sparing surgery may shorten corticosteroid supplementation therapy after surgery.
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Affiliation(s)
- P F Alesina
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Essen, Germany
| | - P Kniazeva
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Essen, Germany
| | - G Pinto
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Essen, Germany
| | - A Pontin
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Essen, Germany
| | - M K Walz
- Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Essen, Germany
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Galderisi A, Kariyawasam D, Stoupa A, Quoc AN, Pinto G, Viaud M, Brabant S, Beltrand J, Polak M, Samara-Boustani D. Glucose pattern in children with classical congenital adrenal hyperplasia: evidence from continuous glucose monitoring. Eur J Endocrinol 2023; 189:K19-K24. [PMID: 37952170 DOI: 10.1093/ejendo/lvad147] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/01/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND While the risk for hypoglycemia during acute illness is well described in children with classical congenital adrenal hyperplasia (CAH), there is little evidence for the prevalence of asymptomatic hypoglycemia and the daily glucose patterns in CAH. Herein, we explored the daytime glucose profile of children with classical CAH. METHODS We conducted an observational study in 11 children (6 female; age 3.1 years [1.4, 5.1]; body mass index 17.3 kg/m2 [15.6, 17.9]) with a genetic diagnosis of classical CAH receiving hydrocortisone and fludrocortisone replacement therapy. Participants underwent 2 14-day continuous glucose monitoring (CGM) sessions and an inpatient 24 h series cortisol and adrenocorticotropic hormone (ACTH) measures. Data were analyzed for 3 daytime lags (7 Am-4 Pm, 4 Pm-10pm, 10 Pm-7 Am) corresponding to the hydrocortisone dosing period with cortisol and ACTH measured before the hydrocortisone dose. RESULTS Eleven participants completed at least 1 CGM session, and 7 out of 11 underwent both the CGM session and the cortisol/ACTH serial measures. In the whole cohort, the percentage of time of sensor glucose values <70 mg/dL was higher during the 10 Pm-7 Am and the 7 Am-4 Pm time slots than in the late afternoon period (17% [7, 54] and 15% [6.8, 24] vs 2% [1.1, 16.7] during the periods 7 Am-4 Pm and 4 Pm-10 Pm, respectively [P = .006 and P = .003]). Nighttime hypoglycemia was mostly spent below the 65 mg/dL (10.9% [4.1, 34]). The glycemic pattern paralleled the nadir of daily cortisol at 7 Am (10.3±4.4 μg/dL). A greater percentage of time in hypoglycemia was associated with lower cortisol concentration at 7 Am and 10 Pm (P < .001 and P = .005). CONCLUSIONS Continuous glucose monitoring demonstrated a disrupted daily glucose pattern in children with CAH, paralleled by a lower cortisol concentration. CLINICALTRIALS.GOV REGISTRATION NCT04322435.
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Affiliation(s)
- Alfonso Galderisi
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
- Department of Pediatrics, Pediatric Endocrinology, Yale University, New Haven, CT, United States
| | - Dulanjalee Kariyawasam
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
- Cochin Institute, INSERM U1016, Paris, France
- IMAGINE Institute Affiliate, INSERM U1163, Paris, France
| | - Athanasia Stoupa
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
- Cochin Institute, INSERM U1016, Paris, France
- IMAGINE Institute Affiliate, INSERM U1163, Paris, France
| | - Adrien Nguyen Quoc
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
| | - Graziella Pinto
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
| | - Magali Viaud
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
| | - Severine Brabant
- Department of Functional Explorations, Necker-Enfants Malades University Hospital, AP-HP Centre, Paris, France
| | - Jacques Beltrand
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
- Cochin Institute, INSERM U1016, Paris, France
- IMAGINE Institute Affiliate, INSERM U1163, Paris, France
| | - Michel Polak
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
- Faculty of Medicine, Université Paris Cité, Paris, France
- Cochin Institute, INSERM U1016, Paris, France
- IMAGINE Institute Affiliate, INSERM U1163, Paris, France
| | - Dinane Samara-Boustani
- Department of Paediatric Endocrinology, Diabetology, and Gynaecology, Necker-Enfants Malades University Hospital, Centre de Référence des Maladies endocriniennes Rares de la Croissance et du Développement (filière FIRENDO), AP-HP Centre, Paris, France
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Mericq V, Iñiguez G, Pinto G, Gonzalez-Briceño LG, Samara-Boustani D, Thalassinos C, Flechtner I, Stoupa A, Beltrand J, Besançon A, Brabant S, Ghazal K, Leban M, Touraine P, Cavada G, Polak M, Kariyawasam D. Identifying patient-related predictors of permanent growth hormone deficiency. Front Endocrinol (Lausanne) 2023; 14:1270845. [PMID: 37881494 PMCID: PMC10597646 DOI: 10.3389/fendo.2023.1270845] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023] Open
Abstract
Objective Isolated childhood growth hormone deficiency (GHD) can persist into adulthood, and re-testing at the transition period is needed to determine whether continued growth hormone therapy is indicated. Here, our objective was to identify predictors of permanent GHD. Design Retrospective single-centre study of patients with childhood-onset GHD who were re-tested after adult height attainment. Methods Auxological, clinical, laboratory, and MRI data throughout follow-up were collected. Results We included 101 patients. At GH treatment initiation, age was 8.1 ± 0.4 years, height -2.25 ± 0.8, and BMI -0.27 ± 0.1 SDS. The 29 (28.7%) patients with persistent GHD had lower height SDS (-2.57 ± 0.1 vs. -2.11 ± 0.1, p<0.001) and mean GH peaks (8.4 ± 1.0 vs.13.2 ± 0.5 mIU/L, p<0.001) at GHD diagnosis; at adult height, they had lower IGF1 (232 ± 19.9 vs. 331 ± 9.1 ng/mL, p<0.001) and higher BMI SDS (-0.15 ± 0.27 vs. -0.73 ± 0.13, p<0.005). By multivariate analysis, the best predictive model included height and BMI SDS, both GH peaks, and MRI findings at diagnosis. Patients with height at diagnosis <-3 SDS had a 7.7 (95% IC 1.4-43.1, p=0.02) fold higher risk of persistent GHD after adjustment on BMI SDS. An abnormal pituitary region by MRI was the strongest single predictor (7.2 times, 95% CI 2.7-19.8) and after multivariate analysis adjustment for GH peaks and height SDS at diagnosis, the risk increased to 10.6 (1.8 - 61.3) times. Conclusions Height <-3 SDS at GHD diagnosis and pituitary MRI abnormalities should lead to a high index of suspicion for persistent GHD.
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Affiliation(s)
- Veronica Mericq
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - German Iñiguez
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
| | - Graziella Pinto
- Paediatric Endocrinology, Diabetology, and Gynaecology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laura G. Gonzalez-Briceño
- Paediatric Endocrinology, Diabetology, and Gynaecology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Dinane Samara-Boustani
- Paediatric Endocrinology, Diabetology, and Gynaecology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Caroline Thalassinos
- Paediatric Endocrinology, Diabetology, and Gynaecology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Flechtner
- Paediatric Endocrinology, Diabetology, and Gynaecology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Athanasia Stoupa
- Paediatric Endocrinology, Diabetology, and Gynaecology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut Imagine, Paris, France
| | - Jacques Beltrand
- Paediatric Endocrinology, Diabetology, and Gynaecology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Paris Cité, Paris, France
| | - Alix Besançon
- Paediatric Endocrinology, Diabetology, and Gynaecology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Séverine Brabant
- Functional Exploration Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Khaldoun Ghazal
- Functional Exploration Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Monique Leban
- Functional Exploration Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Touraine
- Endocrinology Department, La Pitié-Salpêtrière University Hospital, Paris, France
| | - Gabriel Cavada
- Public Health Department, Faculty of medicine, University of Chile, Santiago, Chile
| | - Michel Polak
- Paediatric Endocrinology, Diabetology, and Gynaecology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut Imagine, Paris, France
- Université Paris Cité, Paris, France
| | - Dulanjalee Kariyawasam
- Paediatric Endocrinology, Diabetology, and Gynaecology Department, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Institut Imagine, Paris, France
- Université Paris Cité, Paris, France
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Rosimont M, Kariyawasam D, Samara-Boustani D, Giani E, Beltrand J, Bolle S, Fresneau B, Puget S, Sainte-Rose C, Alapetite C, Pinto G, Touraine P, Piketty ML, Brabant S, Abbou S, Aerts I, Beccaria K, Bourgeois M, Roujeau T, Blauwblomme T, Rocco FD, Thalassinos C, Rigaud C, James S, Busiah K, Simon A, Bourdeaut F, Lemelle L, Guerrini-Rousseau L, Orbach D, Doz F, Dufour C, Grill J, Polak M, Briceño LG. Assessment of Puberty and Hypothalamic-Pituitary-Gonadal Axis Function After Childhood Brain Tumor Treatment. J Clin Endocrinol Metab 2023; 108:e823-e831. [PMID: 36810692 DOI: 10.1210/clinem/dgad097] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
CONTEXT Endocrine complications are common in pediatric brain tumor patients. OBJECTIVE To describe hypothalamic-pituitary-gonadal axis (HPGA) function in patients treated in childhood for a primary brain tumor more than 5 years earlier, in order to identify risk factors for HPGA impairment. METHODS We retrospectively included 204 patients diagnosed with a primary brain tumor before 18 years of age and monitored at the pediatric endocrinology unit of the Necker Enfants-Malades University Hospital (Paris, France) between January 2010 and December 2015. Patients with pituitary adenoma or untreated glioma were excluded. RESULTS Among patients with suprasellar glioma not treated by radiotherapy, the prevalence of advanced puberty was 65% overall and 70% when the diagnosis occurred before 5 years of age. Medulloblastoma chemotherapy caused gonadal toxicity in 70% of all patients and in 87.5% of those younger than 5 years at diagnosis. In the group with craniopharyngioma, 70% of patients had hypogonadotropic hypogonadism, which was consistently accompanied by growth hormone deficiency. CONCLUSION Tumor type, location, and treatment were the risk main factors for HPGA impairment. Awareness that onset can be delayed is essential to guide information of parents and patients, patient monitoring, and timely hormone replacement therapy.
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Affiliation(s)
- Manon Rosimont
- Endocrino-diabéto-pédiatrie, Centre hospitalier chrétien du Montlégia, 4000 Liège, Belgium
| | - Dulanjalee Kariyawasam
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
| | - Dinane Samara-Boustani
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
| | - Elisa Giani
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
| | - Jacques Beltrand
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
- Université Paris Cité, 75006 Paris, France
| | - Stephanie Bolle
- Département de radiothérapie-oncologie, Institut Gustave Roussy, 94805 Villejuif, France
| | - Brice Fresneau
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, 94805 Villejuif, France
| | - Stephanie Puget
- Service de Neurochirurgie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75015 Paris, France
| | - Christian Sainte-Rose
- Service de Neurochirurgie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75015 Paris, France
| | - Claire Alapetite
- Radiation Oncology Department and Proton Centre, Institut Curie, 75005 Paris, France
| | - Graziella Pinto
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
| | - Philippe Touraine
- Université Paris Cité, 75006 Paris, France
- Service Endocrinologie et Médecine de la Reproduction, Hôpital Universitaire La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, 75005 Paris, France
| | - Marie-Liesse Piketty
- Explorations Fonctionnelles, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75013 Paris, France
| | - Séverine Brabant
- Explorations Fonctionnelles, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75013 Paris, France
| | - Samuel Abbou
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, 94805 Villejuif, France
| | - Isabelle Aerts
- SIREDO Oncology Centre (Care, Innovation and research for children and AYA with cancer), Institut Curie, 75015 Paris, France
| | - Kevin Beccaria
- Service de Neurochirurgie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75015 Paris, France
| | - Marie Bourgeois
- Service de Neurochirurgie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75015 Paris, France
| | - Thomas Roujeau
- Unité de Neurochirurgie pédiatrique, Hôpital Gui de Chauliac, 34295 Montpellier, France
| | - Thomas Blauwblomme
- Service de Neurochirurgie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75015 Paris, France
| | | | - Caroline Thalassinos
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
| | - Charlotte Rigaud
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, 94805 Villejuif, France
| | - Syril James
- Service de Neurochirurgie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), 75015 Paris, France
| | - Kanetee Busiah
- Pediatric Endocrinology, Diabetology and Obesity, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland
| | - Albane Simon
- Endocrinologie Pédiatrique, Centre Hospitalier de Versailles, 78157 Le Chesnay, France
| | - Franck Bourdeaut
- SIREDO Oncology Centre (Care, Innovation and research for children and AYA with cancer), Institut Curie, 75015 Paris, France
| | - Lauriane Lemelle
- SIREDO Oncology Centre (Care, Innovation and research for children and AYA with cancer), Institut Curie, 75015 Paris, France
| | - Léa Guerrini-Rousseau
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, 94805 Villejuif, France
| | - Daniel Orbach
- SIREDO Oncology Centre (Care, Innovation and research for children and AYA with cancer), Institut Curie, 75015 Paris, France
- PSL Research University, 75006 Paris, France
| | - François Doz
- Université Paris Cité, 75006 Paris, France
- SIREDO Oncology Centre (Care, Innovation and research for children and AYA with cancer), Institut Curie, 75015 Paris, France
| | - Christelle Dufour
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, 94805 Villejuif, France
| | - Jacques Grill
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut Gustave Roussy, 94805 Villejuif, France
| | - Michel Polak
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
- Université Paris Cité, 75006 Paris, France
| | - Laura González Briceño
- Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Institut IMAGINE (affiliate), 75015 Paris, France
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5
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Nguyen Quoc A, Beccaria K, González Briceño L, Pinto G, Samara-Boustani D, Stoupa A, Beltrand J, Besançon A, Thalassinos C, Puget S, Blauwblomme T, Alapetite C, Bolle S, Doz F, Grill J, Dufour C, Bourdeaut F, Abbou S, Guerrini-Rousseau L, Leruste A, Brabant S, Cavadias I, Viaud M, Boddaert N, Polak M, Kariyawasam D. GH and Childhood-onset Craniopharyngioma: When to Initiate GH Replacement Therapy? J Clin Endocrinol Metab 2023; 108:1929-1936. [PMID: 36794424 DOI: 10.1210/clinem/dgad079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/31/2022] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
CONTEXT Craniopharyngioma is a benign brain tumor with frequent local recurrence or progression after treatment. GH replacement therapy (GHRT) is prescribed in children with GH deficiency resulting from childhood-onset craniopharyngioma. OBJECTIVE To evaluate whether a shorter delay of GHRT initiation after childhood-onset craniopharyngioma completion therapy increased the risk of a new event (progression or recurrence). METHODS Retrospective, observational, monocenter study. We compared a cohort of 71 childhood-onset patients with craniopharyngiomas treated with recombinant human GH (rhGH). Twenty-seven patients were treated with rhGH at least 12 months after craniopharyngioma treatment (>12-month group) and 44 patients before 12 months (<12-month group), among which 29 patients were treated between 6 and 12 months (6-12 month group). The main outcome was the risk of tumor new event (progression of residual tumor or tumor recurrence after complete resection) after primary treatment in the >12-month group and in the <12 month or in the 6- to 12-month group patients. RESULTS In the >12-month group, the 2- and 5-year event-free survivals were respectively 81.5% (95% CI, 61.1-91.9) and 69.4% (95% CI, 47.9-83.4) compared with 72.2% (95% CI, 56.3-83.1) and 69.8% (95% CI, 53.8-81.2) in the <12-month group. The 2- and 5-year event-free survivals were the same in the 6- to 12-month group (72.4%; 95% CI, 52.4-85.1). By log-rank test, the event-free survival was not different between groups (P = .98 and P = .91).The median time for event was not statistically different.In univariate and multivariate analysis, the risk of craniopharyngioma new event was not associated with the GHRT time delay after craniopharyngioma treatment. CONCLUSIONS No association was found between GHRT time delay after childhood-onset craniopharyngioma treatment and an increased risk of recurrence or tumor progression, suggesting GH replacement therapy can be initiated 6 months after last treatment for craniopharyngiomas.
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Affiliation(s)
- Adrien Nguyen Quoc
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
- Faculty of medicine, Université Paris Cité, 75006 Paris, France
| | - Kévin Beccaria
- Faculty of medicine, Université Paris Cité, 75006 Paris, France
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
| | - Laura González Briceño
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
| | - Graziella Pinto
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
| | - Dinane Samara-Boustani
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
| | - Athanasia Stoupa
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
- Cochin Institute, INSERM U1016, 75014 Paris, France
- IMAGINE Institute Affiliate, INSERM U1163, 75015 Paris, France
| | - Jacques Beltrand
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
- Faculty of medicine, Université Paris Cité, 75006 Paris, France
- Cochin Institute, INSERM U1016, 75014 Paris, France
- IMAGINE Institute Affiliate, INSERM U1163, 75015 Paris, France
| | - Alix Besançon
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
| | - Caroline Thalassinos
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
| | - Stéphanie Puget
- Faculty of medicine, Université Paris Cité, 75006 Paris, France
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
| | - Thomas Blauwblomme
- Faculty of medicine, Université Paris Cité, 75006 Paris, France
- Department of Pediatric Neurosurgery, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
| | - Claire Alapetite
- Radiation Oncology Department, Curie Institute, 75005 Paris, France
- Radiation Department, Proton Center, 94800 Orsay, France
| | - Stéphanie Bolle
- Department of Radiation Oncology, Gustave Roussy institute, 94800 Villejuif, France
- ICPO (Institut Curie - Centre de Protonthérapie d'Orsay), 94800 Orsay, France
| | - François Doz
- Faculty of medicine, Université Paris Cité, 75006 Paris, France
- SIREDO Center (Care, Innovation, Research in, Children, Adolescent and Young Adults Oncology), Curie Institute, 75005 Paris, France
| | - Jacques Grill
- Child and Adolescent Cancer Department, Gustave Roussy institute, 94800 Villejuif, France
| | - Christelle Dufour
- Child and Adolescent Cancer Department, Gustave Roussy institute, 94800 Villejuif, France
| | - Franck Bourdeaut
- SIREDO Center (Care, Innovation, Research in, Children, Adolescent and Young Adults Oncology), Curie Institute, 75005 Paris, France
| | - Samuel Abbou
- Child and Adolescent Cancer Department, Gustave Roussy institute, 94800 Villejuif, France
| | - Léa Guerrini-Rousseau
- Child and Adolescent Cancer Department, Gustave Roussy institute, 94800 Villejuif, France
| | - Amaury Leruste
- SIREDO Center (Care, Innovation, Research in, Children, Adolescent and Young Adults Oncology), Curie Institute, 75005 Paris, France
| | - Séverine Brabant
- Department of Functional Explorations, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
| | - Iphigénie Cavadias
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
| | - Magali Viaud
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
| | - Nathalie Boddaert
- Faculty of medicine, Université Paris Cité, 75006 Paris, France
- Department of Paediatric Radiology, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
| | - Michel Polak
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
- Faculty of medicine, Université Paris Cité, 75006 Paris, France
- Cochin Institute, INSERM U1016, 75014 Paris, France
- IMAGINE Institute Affiliate, INSERM U1163, 75015 Paris, France
| | - Dulanjalee Kariyawasam
- Paediatric Endocrinology, Diabetology, Gynaecology Department, Necker-Enfants Malades University Hospital, AP-HP Centre, 75015 Paris, France
- Faculty of medicine, Université Paris Cité, 75006 Paris, France
- Cochin Institute, INSERM U1016, 75014 Paris, France
- IMAGINE Institute Affiliate, INSERM U1163, 75015 Paris, France
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6
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Riller Q, Fourgeaud J, Bruneau J, De Ravin SS, Smith G, Fusaro M, Meriem S, Magerus A, Luka M, Abdessalem G, Lhermitte L, Jamet A, Six E, Magnani A, Castelle M, Lévy R, Lecuit MM, Fournier B, Winter S, Semeraro M, Pinto G, Abid H, Mahlaoui N, Cheikh N, Florkin B, Frange P, Jeziorski E, Suarez F, Sarrot-Reynauld F, Nouar D, Debray D, Lacaille F, Picard C, Pérot P, Regnault B, Da Rocha N, de Cevins C, Delage L, Pérot BP, Vinit A, Carbone F, Brunaud C, Marchais M, Stolzenberg MC, Asnafi V, Molina T, Rieux-Laucat F, Notarangelo LD, Pittaluga S, Jais JP, Moshous D, Blanche S, Malech H, Eloit M, Cavazzana M, Fischer A, Ménager MM, Neven B. Late-onset enteric virus infection associated with hepatitis (EVAH) in transplanted SCID patients. J Allergy Clin Immunol 2023; 151:1634-1645. [PMID: 36638922 PMCID: PMC10336473 DOI: 10.1016/j.jaci.2022.12.822] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/14/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Allogenic hematopoietic stem cell transplantation (HSCT) and gene therapy (GT) are potentially curative treatments for severe combined immunodeficiency (SCID). Late-onset posttreatment manifestations (such as persistent hepatitis) are not uncommon. OBJECTIVE We sought to characterize the prevalence and pathophysiology of persistent hepatitis in transplanted SCID patients (SCIDH+) and to evaluate risk factors and treatments. METHODS We used various techniques (including pathology assessments, metagenomics, single-cell transcriptomics, and cytometry by time of flight) to perform an in-depth study of different tissues from patients in the SCIDH+ group and corresponding asymptomatic similarly transplanted SCID patients without hepatitis (SCIDH-). RESULTS Eleven patients developed persistent hepatitis (median of 6 years after HSCT or GT). This condition was associated with the chronic detection of enteric viruses (human Aichi virus, norovirus, and sapovirus) in liver and/or stools, which were not found in stools from the SCIDH- group (n = 12). Multiomics analysis identified an expansion of effector memory CD8+ T cells with high type I and II interferon signatures. Hepatitis was associated with absence of myeloablation during conditioning, split chimerism, and defective B-cell function, representing 25% of the 44 patients with SCID having these characteristics. Partially myeloablative retransplantation or GT of patients with this condition (which we have named as "enteric virus infection associated with hepatitis") led to the reconstitution of T- and B-cell immunity and remission of hepatitis in 5 patients, concomitantly with viral clearance. CONCLUSIONS Enteric virus infection associated with hepatitis is related to chronic enteric viral infection and immune dysregulation and is an important risk for transplanted SCID patients with defective B-cell function.
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Affiliation(s)
- Quentin Riller
- University of Paris Cité, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Jacques Fourgeaud
- University of Paris Cité, Paris, France; Microbiology Department, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Pathogen Discovery Laboratory, Institut Pasteur, Université de Paris, Paris, France; Prise en Charge des Anomalies Congénitales et leur Traitement, Unit 7328, Imagine Institute, University of Paris Cité, Paris, France
| | - Julie Bruneau
- University of Paris Cité, Paris, France; Pathology Department, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Imagine Institute, INSERM UMR 1163, Laboratory of Molecular Mechanisms of Hematologic Disorders and Therapeutic Implications, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Suk See De Ravin
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Grace Smith
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Md
| | - Mathieu Fusaro
- Study Center for Primary Immunodeficiencies, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samy Meriem
- Laboratory of Biostatistics, University of Paris Cité, Paris, France
| | - Aude Magerus
- University of Paris Cité, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Marine Luka
- Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Ghaith Abdessalem
- Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Ludovic Lhermitte
- University of Paris Cité, Paris, France; Laboratory of Onco-Haematology, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; the Institut Necker-Enfants Malades (INEM), INSERM UMR 1151, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Jamet
- University of Paris Cité, Paris, France; Microbiology Department, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; the Institut Necker-Enfants Malades (INEM), INSERM UMR 1151, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuelle Six
- University of Paris Cité, Paris, France; Laboratory of Human Lympho-Hematopoiesis, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Alessandra Magnani
- Department of Biotherapy, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Martin Castelle
- Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Lévy
- University of Paris Cité, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Laboratory of Human Genetics of Infectious Diseases, Necker Branch, INSERM, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Mathilde M Lecuit
- Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Fournier
- University of Paris Cité, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sarah Winter
- University of Paris Cité, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Michaela Semeraro
- University of Paris Cité, Paris, France; Clinical Investigation Center, Clinical Research Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Graziella Pinto
- Pediatric Endocrinology, Gynecology, Diabetology, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hanène Abid
- University of Paris Cité, Paris, France; Microbiology Department, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nizar Mahlaoui
- Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nathalie Cheikh
- Pediatric Hematology Oncology Unit, University Hospital of Besançon, Besançon, France
| | - Benoit Florkin
- Immuno-Hémato-Rhumatologie Pédiatrique, Service de Pédiatrie, CHR Citadelle, Liege, Belgium
| | - Pierre Frange
- University of Paris Cité, Paris, France; Microbiology Department, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Jeziorski
- Department of Pediatrics, Infectious Diseases, and Immunology, University of Montpellier, CHU Montpellier, Montpellier, France
| | - Felipe Suarez
- University of Paris Cité, Paris, France; Imagine Institute, INSERM UMR 1163, Laboratory of Molecular Mechanisms of Hematologic Disorders and Therapeutic Implications, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Hematology Department, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Dalila Nouar
- Service d'Immunologie Clinique et d'Allergologie, Centre Hospitalier Régional Universitaire, Tours, France
| | - Dominique Debray
- Pediatric Liver Unit, National Reference Center for Rare Diseases, Biliary Atresia and Genetic Cholestasis, Inflammatory Biliary Diseases and Autoimmune Hepatitis, ERN Rare Liver, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Florence Lacaille
- Gastroenterology-Hepatology-Nutrition Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Capucine Picard
- Study Center for Primary Immunodeficiencies, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Laboratory of Lymphocyte Activation and Susceptibility to EBV Infection, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Philippe Pérot
- Pathogen Discovery Laboratory, Institut Pasteur, Université de Paris, Paris, France; OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Institut Pasteur, Paris, France
| | - Béatrice Regnault
- Pathogen Discovery Laboratory, Institut Pasteur, Université de Paris, Paris, France; OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Institut Pasteur, Paris, France
| | - Nicolas Da Rocha
- Pathogen Discovery Laboratory, Institut Pasteur, Université de Paris, Paris, France; OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Institut Pasteur, Paris, France
| | - Camille de Cevins
- University of Paris Cité, Paris, France; Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, Imagine Institute, INSERM UMR 1163, Paris, France; Artificial Intelligence & Deep Analytics (AIDA) Group, Data & Data Science (DDS), Sanofi R&D, Chilly-Mazarin, France
| | - Laure Delage
- University of Paris Cité, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Brieuc P Pérot
- University of Paris Cité, Paris, France; Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Angélique Vinit
- Sorbonne Université, UMS037, PASS, Plateforme de Cytométrie de la Pitié-Salpêtrière CyPS, Paris, France
| | - Francesco Carbone
- University of Paris Cité, Paris, France; Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, Paris, France; Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Camille Brunaud
- University of Paris Cité, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Manon Marchais
- University of Paris Cité, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Marie-Claude Stolzenberg
- University of Paris Cité, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Vahid Asnafi
- University of Paris Cité, Paris, France; Laboratory of Onco-Haematology, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; the Institut Necker-Enfants Malades (INEM), INSERM UMR 1151, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thierry Molina
- University of Paris Cité, Paris, France; Pathology Department, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frédéric Rieux-Laucat
- University of Paris Cité, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Luigi D Notarangelo
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | | | - Jean Philippe Jais
- University of Paris Cité, Paris, France; Laboratory of Biostatistics, University of Paris Cité, Paris, France
| | - Despina Moshous
- University of Paris Cité, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Laboratory of Genome Dynamics in the Immune System, Equipe Labellisée Ligue contre le Cancer, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Stephane Blanche
- University of Paris Cité, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Harry Malech
- Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Marc Eloit
- Pathogen Discovery Laboratory, Institut Pasteur, Université de Paris, Paris, France; OIE Collaborating Center for the Detection and Identification in Humans of Emerging Animal Pathogens, Institut Pasteur, Paris, France; Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, France
| | - Marina Cavazzana
- University of Paris Cité, Paris, France; Laboratory of Onco-Haematology, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Laboratory of Human Lympho-Hematopoiesis, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Alain Fischer
- Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Collège de France, Paris, France
| | - Mickaël M Ménager
- University of Paris Cité, Paris, France; Labtech Single-Cell@Imagine, Imagine Institute, INSERM UMR 1163, Paris, France; Laboratory of Inflammatory Responses and Transcriptomic Networks in Diseases, Atip-Avenir Team, Imagine Institute, INSERM UMR 1163, Paris, France
| | - Bénédicte Neven
- University of Paris Cité, Paris, France; Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Paris, France; Pediatric Hematology-Immunology and Rheumatology Unit, Necker-Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Rocha B, Cillero-Pastor B, Illiano A, Calamia V, Fernández Puente P, Lourido L, Paz González R, Quaranta P, Celis R, Cuervo A, Pinto G, Amoresano A, Cañete JDD, Heeren RMA, Ruiz-Romero C, Blanco FJ. POS0464 DIFFERENTIAL MOLECULAR PROFILES IN THE SYNOVIAL TISSUE AND SYNOVIAL FLUID OF PATIENTS WITH RHEUMATOID ARTHRITIS AND PSORIATIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe differential diagnosis of Rheumatoid Arthritis (RA) and Psoriatic arthritis (PsA) is often difficult due to the similarity of symptoms and the unavailability of reliable clinical biomarkers. Molecular alterations have been suggested to contribute to the pathophysiological processes in the knee joint, and it is known that chronic inflammation induces significant changes in the synovial tissue (ST) and synovial fluid (SF) lipidome and proteome.ObjectivesWe aimed to evaluate whether specific characteristics in the molecular profiles from ST and SF could support the differential diagnosis of these diseases.MethodsST frozen samples of patients affected by RA (n=6), PsA (n=12) and control donors (n=10) were compared using Matrix-Assisted Laser Desorption Ionization Mass Spectrometry Imaging (MALDI-MSI) for spatially resolved lipid analysis. To this end, tissue sections were measured on a RapifleX MALDI-TOF/TOF instrument. Next, a targeted approach based on multiple reaction monitoring (MRM-MS) was performed to further validate the lipidomic alterations reported by MALDI-MSI between RA and PsA tissues. In this case, lipids extracted from SF (control donors (n=4), RA (n=21) and PsA (n=27)) were analyzed in a QTRAP 4000 mass spectrometer for the targeted analysis of 84 lipid species. Finally, a quantitative proteomic analysis was carried out on FFPE ST from RA (n=13), PsA (n=13) and controls (n=8) by nLC-MS/MS analysis using a TimsTOF Pro system (Bruker). Statistical analyses were performed using GraphPad Prism, Metaboanalyst and Perseus software.ResultsLipid profiles in ST from PsA and RA were unequivocally distinguished by MALDI-MSI followed by PCA-DA, and were also different comparing with control tissues. Interestingly, several lipid species, including sphingomyelins, phosphatidylcholines (PC) and phosphatidylethanolamines (PE), presented the greatest separation power to classify RA and PsA tissue samples. ANOVA analysis found 35 lipid species significantly different among the study groups, most of them significantly increased in RA and PsA compared to controls. Particularly, 11 lipids showed higher levels in PsA tissues compared with RA, including several PC and PE. The spatial distribution of these PE species was associated with areas of the sublining layer with increased vascularity and inflammatory cell infiltrates, according to MALDI-MSI images. On the other hand, RA and PsA patients were also correctly classified based on the SF levels of all quantified lipid species according to PCA and clustering analysis. Finally, the proteomic analysis quantified around 2,500 distinct proteins in the ST, including several related with lipid metabolism. Near 300 proteins showed altered abundance in the pathological tissues compared to healthy controls (FDR 0.01%, Figure 1A), being the small subset increased in controls mainly extracellular matrix proteins. The comparison between RA and PsA ST led to the identification of a panel of 36 proteins discriminating the two tissues with high statistical significance (p-value <0.01). In this comparison, all proteins except two appeared increased in RA (Figure 1B). A discriminant analysis shows the usefulness of this protein panel to differentiate the two diseases (Figure 1C).Figure 1.Results from the proteomic analysis carried out on synovial tissues. A) Heatmap showing the differential protein profiles between synovial tissues (PsA and RA) and healthy controls (CTL), at FDR 0.01. B) Characteristic protein panel discriminating PsA and RA tissues (p-value < 0.01). C) Discriminant analysis performed using this protein panel.ConclusionOur study shows distinct molecular profiles between RA and PsA synovial tissue and synovial fluid, and reports potential clinically useful lipid and protein markers for the differential diagnosis of these diseases.Disclosure of InterestsNone declared.
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Ryzhkova N, Kryshen A, Niklasson M, Pinto G, Aleinikov A, Kutyavin I, Bergeron Y, Ali AA, Drobyshev I. Climate drove the fire cycle and humans influenced fire occurrence in the East European boreal forest. ECOL MONOGR 2022. [DOI: 10.1002/ecm.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- N. Ryzhkova
- Forest Research Institute of the Karelian Research Centre of the Russian Academy of Sciences, 11 Pushkinskaya St. Petrozavodsk Republic of Karelia Russia
- Institut de recherche sur les forêts, Université du Québec en Abitibi‐Témiscamingue, 445 Boulevard de l'université, Rouyn‐Noranda, Canada J9X 5E4 and Centre d’études de la forêt Université du Québec à Montréal, CP 8888 Montréal Canada
| | - A. Kryshen
- Forest Research Institute of the Karelian Research Centre of the Russian Academy of Sciences, 11 Pushkinskaya St. Petrozavodsk Republic of Karelia Russia
| | - M. Niklasson
- Swedish University of Agricultural Sciences, Southern Swedish Forest Research Centre PO Box 49, SE‐230 53 Alnarp Sweden
- Foundation Nordens Ark, Åby säteri, SE‐456 93 Hunnebostrand Sweden
| | - G. Pinto
- Swedish University of Agricultural Sciences, Southern Swedish Forest Research Centre PO Box 49, SE‐230 53 Alnarp Sweden
- German Centre for Integrative Biodiversity Research (iDiv) Halle‐Jena‐Leipzig, Puschstrasse 4 Leipzig Germany
| | - A. Aleinikov
- Center for Forest Ecology and Productivity of RAS, Profsoyuznaya st. 84/32 bldg. 14 Moscow Russia
| | - I. Kutyavin
- Institute of Biology of Komi Science Centre of the Ural Branch of the Russian Academy of Sciences, 28 Kommunisticheskaya st. Syktyvkar Russia
| | - Y. Bergeron
- Institut de recherche sur les forêts, Université du Québec en Abitibi‐Témiscamingue, 445 Boulevard de l'université, Rouyn‐Noranda, Canada J9X 5E4 and Centre d’études de la forêt Université du Québec à Montréal, CP 8888 Montréal Canada
- Centre d’études de la forêt Université du Québec à Montréal, CP 8888 Montréal Canada
| | - Adam A. Ali
- Département Biologie Écologie, Institut des Sciences de l’Évolution de Montpellier (ISEM) Université de Montpellier, campus Triolet, cc065, 34095 Montpellier cedex France
| | - I. Drobyshev
- Forest Research Institute of the Karelian Research Centre of the Russian Academy of Sciences, 11 Pushkinskaya St. Petrozavodsk Republic of Karelia Russia
- Institut de recherche sur les forêts, Université du Québec en Abitibi‐Témiscamingue, 445 Boulevard de l'université, Rouyn‐Noranda, Canada J9X 5E4 and Centre d’études de la forêt Université du Québec à Montréal, CP 8888 Montréal Canada
- Swedish University of Agricultural Sciences, Southern Swedish Forest Research Centre PO Box 49, SE‐230 53 Alnarp Sweden
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González Briceño LG, Kariyawasam D, Samara-Boustani D, Giani E, Beltrand J, Bolle S, Fresneau B, Puget S, Sainte-Rose C, Alapetite C, Pinto G, Piketty ML, Brabant S, Abbou S, Aerts I, Beccaria K, Bourgeois M, Roujeau T, Blauwblomme T, Di Rocco F, Thalassinos C, Pauwels C, Rigaud C, James S, Busiah K, Simon A, Bourdeaut F, Lemelle L, Guerrini-Rousseau L, Orbach D, Touraine P, Doz F, Dufour C, Grill J, Polak M. High Prevalence of Early Endocrine Disorders After Childhood Brain Tumors in a Large Cohort. J Clin Endocrinol Metab 2022; 107:e2156-e2166. [PMID: 34918112 DOI: 10.1210/clinem/dgab893] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Endocrine complications are common in pediatric brain tumor patients. OBJECTIVE We aimed to describe the endocrine follow-up of patients with primary brain tumors. METHODS This is a noninterventional observational study based on data collection from medical records of 221 patients followed at a Pediatric Endocrinology Department. RESULTS Median age at diagnosis was 6.7 years (range, 0-15.9), median follow-up 6.7 years (0.3-26.6), 48.9% female. Main tumor types were medulloblastoma (37.6%), craniopharyngioma (29.0%), and glioma (20.4%). By anatomic location, 48% were suprasellar (SS) and 52% non-suprasellar (NSS). Growth hormone deficiency (GHD) prevalence was similar in both groups (SS: 83.0%, NSS: 76.5%; P = 0.338), appearing at median 1.8 years (-0.8 to 12.4) after diagnosis; postradiotherapy GHD appeared median 1.6 years after radiotherapy (0.2-10.7). Hypothyroidism was more prevalent in SS (76.4%), than NSS (33.9%) (P < 0.001), as well as ACTH deficiency (SS: 69.8%, NSS: 6.1%; P < 0.001). Early puberty was similar in SS (16%) and NSS (12.2%). Hypogonadotropic hypogonadism was predominant in SS (63.1%) vs NSS (1.3%), P < 0.001, and postchemotherapy gonadal toxicity in NSS (29.6%) vs SS (2.8%), P < 0.001. Adult height was lower for NSS compared to target height (-1.0 SD, P < 0.0001) and to SS patients (P < 0.0001). Thyroid nodules were found in 13/45 patients (28.8%), including 4 cancers (4.8-11.5 years after radiotherapy). Last follow-up visit BMI was higher in both groups (P = 0.0001), and obesity incidence was higher for SS (46.2%) than NSS (17.4%). CONCLUSION We found a high incidence of early-onset endocrine disorders. An endocrine consultation and nutritional evaluation should be mandatory for all patients with a brain tumor, especially when the tumor is suprasellar or after hypothalamus/pituitary irradiation.
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Affiliation(s)
- Laura Gabriela González Briceño
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
- ESPE Fellowship - European Society for Paediatric Endocrinology
| | - Dulanjalee Kariyawasam
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
| | - Dinane Samara-Boustani
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
| | - Elisa Giani
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
| | - Jacques Beltrand
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
- Université de Paris, 75006 Paris, France
| | - Stéphanie Bolle
- Institut Gustave Roussy, Département de radiothérapie-oncologie, 94805 Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, 94805 Villejuif, France
| | - Stéphanie Puget
- Université de Paris, 75006 Paris, France
- Hôpital Universitaire Necker-Enfants Malades - APHP, Service Neurochirurgie, 75015 Paris, France
| | - Christian Sainte-Rose
- Hôpital Universitaire Necker-Enfants Malades - APHP, Service Neurochirurgie, 75015 Paris, France
| | - Claire Alapetite
- Institut Curie, Radiation Oncology Department and Proton Center, 75005 Paris, France
| | - Graziella Pinto
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
| | - Marie-Liesse Piketty
- Hôpital Necker-Enfants Malades, Explorations Fonctionnelles, 75015 Paris, France
| | - Séverine Brabant
- Hôpital Necker-Enfants Malades, Explorations Fonctionnelles, 75015 Paris, France
| | - Samuel Abbou
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, 94805 Villejuif, France
| | - Isabelle Aerts
- Institut Curie, SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), 75005 Paris, France
| | - Kevin Beccaria
- Hôpital Universitaire Necker-Enfants Malades - APHP, Service Neurochirurgie, 75015 Paris, France
| | - Marie Bourgeois
- Hôpital Universitaire Necker-Enfants Malades - APHP, Service Neurochirurgie, 75015 Paris, France
| | - Thomas Roujeau
- Hôpital Montpellier, Hôpital Gui de Chauliac, Unité de Neurochirurgie pédiatrique, 34295 Montpellier, France
| | - Thomas Blauwblomme
- Hôpital Universitaire Necker-Enfants Malades - APHP, Service Neurochirurgie, 75015 Paris, France
| | | | - Caroline Thalassinos
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
| | - Christian Pauwels
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
| | - Charlotte Rigaud
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, 94805 Villejuif, France
| | - Syril James
- Hôpital Universitaire Necker-Enfants Malades - APHP, Service Neurochirurgie, 75015 Paris, France
| | - Kanetee Busiah
- Lausanne University Hospital, Pediatric Endocrinology, Diabetology and Obesity Unit, Lausanne University, 1011 Lausanne, Switzerland
| | - Albane Simon
- Hôpital André Mignot - Centre Hospitalier de Versailles, Endocrinologie Pédiatrique, 78157 Le Chesnay, France
| | - Franck Bourdeaut
- Institut Curie, SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), 75005 Paris, France
| | - Lauriane Lemelle
- Institut Curie, SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), 75005 Paris, France
| | - Léa Guerrini-Rousseau
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, 94805 Villejuif, France
- Team "Genomics and Oncogenesis of Pediatric Brain Tumors", INSERM U981, Gustave Roussy, University Paris Saclay, 94805 Villejuif, France
| | - Daniel Orbach
- Institut Curie, SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), 75005 Paris, France
- PSL Research University, 75006 Paris, France
| | - Philippe Touraine
- Hôpital Universitaire La Pitié-Salpêtrière - APHP, Service Endocrinologie et médecine de la reproduction, Sorbonne Université Médecine, 75013 Paris, France
| | - François Doz
- Université de Paris, 75006 Paris, France
- Institut Curie, SIREDO Oncology Center (Care, Innovation and research for children and AYA with cancer), 75005 Paris, France
| | - Christelle Dufour
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, 94805 Villejuif, France
- Team "Genomics and Oncogenesis of Pediatric Brain Tumors", INSERM U981, Gustave Roussy, University Paris Saclay, 94805 Villejuif, France
| | - Jacques Grill
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric and Adolescent Oncology, 94805 Villejuif, France
- Team "Genomics and Oncogenesis of Pediatric Brain Tumors", INSERM U981, Gustave Roussy, University Paris Saclay, 94805 Villejuif, France
| | - Michel Polak
- Hôpital Universitaire Necker-Enfants Malades - Assistance Publique Hôpitaux de Paris (APHP), Service d'Endocrinologie, gynécologie et diabétologie pédiatrique, Institut IMAGINE (affiliate), 75015 Paris, France
- Université de Paris, 75006 Paris, France
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Clerc A, Coupaye M, Mosbah H, Pinto G, Laurier V, Mourre F, Merrien C, Diene G, Poitou C, Tauber M. Diabetes Mellitus in Prader-Willi Syndrome: Natural History during the Transition from Childhood to Adulthood in a Cohort of 39 Patients. J Clin Med 2021; 10:jcm10225310. [PMID: 34830599 PMCID: PMC8625265 DOI: 10.3390/jcm10225310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 02/05/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) affects 20% of patients with Prader-Willi syndrome (PWS), with many cases diagnosed during the transition period. Our aim was to describe the natural history of T2DM in patients with PWS before the age of 25 years and to develop screening and preventive strategies. Thirty-nine patients followed in the French PWS Reference Center were included (median age 25.6 years [23.7; 31.7]). Twenty-one had been treated with growth hormone (GH), fifteen had not, and three had an unknown status. The median age at T2DM diagnosis was 16.8 years (11–24) and the median BMI was 39 kg/m2 [34.6; 45], with 34/35 patients living with obesity. The patients displayed frequent psychiatric (48.3% hospitalization,) and metabolic (56.4% hypertriglyceridemia,) comorbidities and a parental history of T2DM (35.7%) or overweight (53.6%) compared to the PWS general population. There was no difference in BMI and metabolic complications between the GH-treated and non-GH-treated groups at T2DM diagnosis. Patients with PWS who develop early T2DM have severe obesity, a high frequency of psychiatric and metabolic disorders, and a family history of T2DM and overweight. These results underline the need for early identification of patients at risk, prevention of obesity, and repeated blood glucose monitoring during the transition period.
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Affiliation(s)
- Alice Clerc
- Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Service d’Endocrinologie, Obésités, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, 31059 Toulouse, France; (A.C.); (G.D.)
| | - Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, 75013 Paris, France; (M.C.); (H.M.); (C.P.)
| | - Héléna Mosbah
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, 75013 Paris, France; (M.C.); (H.M.); (C.P.)
| | - Graziella Pinto
- Assistance Publique-Hôpitaux de Paris, Service d’Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker-Enfants Malades, 75743 Paris, France;
| | - Virginie Laurier
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Hôpital Marin d’Hendaye, 64701 Hendaye, France; (V.L.); (F.M.); (C.M.)
| | - Fabien Mourre
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Hôpital Marin d’Hendaye, 64701 Hendaye, France; (V.L.); (F.M.); (C.M.)
| | - Christine Merrien
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Hôpital Marin d’Hendaye, 64701 Hendaye, France; (V.L.); (F.M.); (C.M.)
| | - Gwenaëlle Diene
- Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Service d’Endocrinologie, Obésités, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, 31059 Toulouse, France; (A.C.); (G.D.)
- Inserm UMR 1295—CERPOP (Centre d’Epidémiologie et de Recherche en Santé des POPulations), Équipe SPHERE (Santé Périnatale, Pédiatrique et des Adolescents: Approche Épidémiologique et Évaluative), Université Toulouse III Paul Sabatier, 31062 Toulouse, France
| | - Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, 75013 Paris, France; (M.C.); (H.M.); (C.P.)
- UMRS 1269, Faculté de Médecine Sorbonne Université, INSERM, Nutrition et Obésité: Approches Systémiques «NutriOmics», 75006 Paris, France
| | - Maithé Tauber
- Centre de Référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et Autres Formes Rares d’Obésité avec Troubles du Comportement Alimentaire), Service d’Endocrinologie, Obésités, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, 31059 Toulouse, France; (A.C.); (G.D.)
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291—CNRS UMR5051—Université Toulouse III, 31062 Toulouse, France
- Correspondence:
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11
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Pinto G, Villaschi A, Sanz-Sanchez J, Fazzari F, Regazzoli D, Mangieri A, Pini D, Bragato RM, Colombo A, Reimers B, Condorelli G, Stefanini GG, Chiarito M, Cannata F. Transcatheter aortic valve replacement in severe aortic stenosis and cardiac amyloidosis: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) and cardiac amyloidosis (CA) are typical degenerative diseases of the elderly. According to recent studies, up to 16% of patients referred to transcatheter aortic valve replacement (TAVR) have a concomitant diagnosis of CA. Until recently, TAVR in patients with CA and AS has been considered futile, following the results of small observational studies. However, few studies recently suggested a beneficial impact of TAVR in patients with AS and CA as compared with medical therapy alone.
Purpose
To clarify the efficacy and safety profile of TAVR in CA-AS patients.
Methods
We performed a systematic review and meta-analysis of studies evaluating the risk of mortality after TAVR in CA-AS patients as compared with medical therapy. Moreover, we performed a systematic review and descriptive meta-analysis of studies reporting outcomes and complication rates of TAVR in CA-AS patients as compared with patients with AS alone.
Results
We identified 4 observational studies reporting data on mortality in CA-AS patients treated with either TAVR or medical therapy. Mortality was significantly lower in patients undergoing TAVR (OR 0.23, 95% CI 0.07–0.73, I2=0%, NNT=2.6) as compared with medical therapy. A sensitivity analysis with hazard ratio as effect estimate showed consistent results. Then, we identified 4 observational studies reporting data on mortality, re-hospitalizations and periprocedural complications of TAVR in CA-AS patients as compared with patients with AS alone. We found higher rates of mortality, cardiovascular hospitalization and need for permanent pacemaker implantation in CA-AS patients as compared to lone AS patients undergoing TAVR. Conversely, no differences were found in terms of stroke, acute kidney injury and vascular complications.
Conclusions
Our analysis rejects the idea of futility of TAVR in CA-AS patients showing a clear survival benefit of CA-AS patients undergoing TAVR as compared with medical therapy. Moreover, these patients may undergo TAVR with an acceptable procedural risk, that is substantially comparable to lone AS patients, except for a higher incidence of permanent pacemaker implantation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Pinto
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - A Villaschi
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - J Sanz-Sanchez
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | - F Fazzari
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - D Regazzoli
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - A Mangieri
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - D Pini
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - R M Bragato
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - A Colombo
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - B Reimers
- IRCCS Humanitas Research Hospital, Rozzano - Milano, Italy
| | - G Condorelli
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - G G Stefanini
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - M Chiarito
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
| | - F Cannata
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele - Milan, Italy
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Coupaye M, Laurier V, Benvegnu G, Poitou C, Faucher P, Mosbah H, Diene G, Pinto G, Briceño LG, Merrien C, Toyos AC, Montastier E, Tauber M, Mourre F. Paradoxical low severity of COVID-19 in Prader-Willi syndrome: data from a French survey on 647 patients. Orphanet J Rare Dis 2021; 16:325. [PMID: 34289876 PMCID: PMC8294211 DOI: 10.1186/s13023-021-01949-4] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/11/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients with Prader-Willi syndrome (PWS) often have comorbidities, especially obesity, that may constitute a risk factor for severe forms of COVID-19. We aimed to assess prevalence and medical course of SARS-CoV-2 infection in children and adults with PWS. From November 2020 to January 2021, we performed a detailed medical survey on 342 adults and 305 children with PWS followed in the French reference center. RESULTS We obtained responses from 288 adults (84%) and 239 children (78%). From March 2020 to January 2021, 38 adults (13.2%) and 13 children (5.4%) with PWS had SARS-CoV-2 infection. Mean age of adults was 34.1 ± 11.9 years and mean body mass index was 40.6 ± 12.7 kg/m2; 82% had obesity and 37% had diabetes. Only 3 children (23%) had obesity and none had diabetes. Similar to the general population, the most frequent symptoms of COVID-19 were asthenia, fever, cough, headache and shortness of breath. All patients had a favorable outcome. CONCLUSION PWS itself is not a risk factor for severe COVID-19 in children and adults. On the contrary, evolution of SARS-CoV-2 infection in adults with PWS seems more favorable than expected, given their comorbidities.
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Affiliation(s)
- Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
| | - Virginie Laurier
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Hôpital Marin d'Hendaye, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), Hendaye, France
| | - Grégoire Benvegnu
- Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Service d'Endocrinologie, Obésités, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), Toulouse, France
- Centre de compétences Maladies Rares à Expression Psychiatrique, Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
- INSERM, Nutrition et Obésité: Approches Systémiques «NutriOmics», Sorbonne Université, Paris, France
| | - Pauline Faucher
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Héléna Mosbah
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Service de Nutrition, Hôpital Pitié-Salpêtrière, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), 47-83 boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Gwenaelle Diene
- Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Service d'Endocrinologie, Obésités, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), Toulouse, France
- Inserm UMR 1295 - CERPOP (Centre d'Epidémiologie et de Recherche en santé des POPulations), équipe SPHERE (Santé périnatale, pédiatrique et des adolescents: approche épidémiologique et évaluative), Université Toulouse III Paul Sabatier, Toulouse, France
| | - Graziella Pinto
- Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie, Gynécologie et Diabétologie pédiatrique, Hôpital Necker-Enfants Malades, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), Paris, France
| | - Laura González Briceño
- Assistance Publique-Hôpitaux de Paris, Service d'Endocrinologie, Gynécologie et Diabétologie pédiatrique, Hôpital Necker-Enfants Malades, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), Paris, France
| | - Christine Merrien
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Hôpital Marin d'Hendaye, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), Hendaye, France
| | - Ana Camarena Toyos
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Hôpital Marin d'Hendaye, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), Hendaye, France
| | - Emilie Montastier
- Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Service d'Endocrinologie, Maladies métaboliques et Nutrition, Centre Hospitalier Universitaire de Toulouse, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), Toulouse, France
| | - Maithé Tauber
- Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Service d'Endocrinologie, Obésités, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), Toulouse, France
- Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity) INSERM UMR1291, CNRS UMR5051, Université Toulouse III, Toulouse, France
| | - Fabien Mourre
- Assistance Publique-Hôpitaux de Paris, Centre de référence Maladies Rares (PRADORT, Syndrome de Prader-Willi et autres formes rares d'obésité avec troubles du comportement alimentaire), Hôpital Marin d'Hendaye, ENDO-ERN (European Reference Network on Rare Endocrine Conditions), Hendaye, France
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John J, Henry M, Ringoir A, Pinto G, Kesner K, Lazarus J, Sinha S. Change in renal function post-nephrectomy for renal cell carcinoma in patients with and without hypertension and/or diabetes. S AFR J SURG 2021. [DOI: 10.17159/2078-5151/2020/v58n2a3091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Le Roux E, Menesguen F, Tejedor I, Popelier M, Halbron M, Faucher P, Malivoir S, Pinto G, Léger J, Hatem S, Polak M, Poitou C, Touraine P. Transition of young adults with endocrine and metabolic diseases: the 'TRANSEND' cohort. Endocr Connect 2021; 10:21-28. [PMID: 33263561 PMCID: PMC7923139 DOI: 10.1530/ec-20-0520] [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: 10/23/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The transition from paediatric to adult medicine involves risks of poor patient outcomes and of significant losses of patients to follow up. The research aimed to analyse the implementation in an initial cohort of patients of a new programme of transition to adult care based on a case management approach. DESIGN A longitudinal study of the case management approach to transition, initiated in a university hospital in France in September 2016. METHODS Patients with the endocrine or metabolic disease diagnosed during childhood and transferred to adult care were included. The transition programme includes three steps based on case management: liaising with paediatric services, personalising care pathways, and liaising with structures outside the hospital (general practitioners, agencies in the educational and social sector). RESULTS The cohort included 500 patients, with malignant brain tumour (n = 56 (11%)), obesity (n = 55 (11%)), type 1 diabetes (n = 54 (11%)), or other disease (n = 335 (67%)). Their median age at transfer was 19, and the sex ratio was 0.5. At median 21 months of follow-up, 439 (88%) had a regular follow-up in or outside the hospital, 47 (9%) had irregular follow-up (absence at the last appointment or no appointment scheduled within the time recommended), 4 had stopped care on doctor's advice, 4 had died, 3 had moved, and 3 had refused care. The programme involved 9615 case management actions; 7% of patients required more than 50 actions. Patients requiring most support were usually those affected by a rare genetic form of obesity. CONCLUSIONS Case managers successfully addressed the complex needs of patients. Over time, the cohort will provide unprecedented long-term outcome results for patients with various conditions who experienced this form of transition.
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Affiliation(s)
- Enora Le Roux
- Université de Paris, ECEVE UMR 1123, Inserm, Paris, France
- AP-HP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d’Épidémiologie Clinique, Inserm, Paris, France
| | - Florence Menesguen
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Isabelle Tejedor
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Marc Popelier
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Diabétologie, Paris, France
| | - Marine Halbron
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Diabétologie, Paris, France
| | - Pauline Faucher
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Nutrition, Centre du Syndrome de Prader-Willi et Autres Obésités Rares, Paris, France
| | - Sabine Malivoir
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Graziella Pinto
- AP-HP.Université de Paris Centre, Hôpital Universitaire Necker Enfants Malades, Département d’Endocrinologie, Diabétologie et Gynécologie Pédiatrique, Paris, France; Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Juliane Léger
- AP-HP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Service d’Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du Développement, Paris, France
| | | | - Michel Polak
- AP-HP.Université de Paris Centre, Hôpital Universitaire Necker Enfants Malades, Département d’Endocrinologie, Diabétologie et Gynécologie Pédiatrique, Paris, France; Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Christine Poitou
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Nutrition, Centre du Syndrome de Prader-Willi et Autres Obésités Rares, Paris, France
| | - Philippe Touraine
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
- Correspondence should be addressed to P Touraine:
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15
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Bellon N, Hadj-Rabia S, Stoupa A, Clerc A, Pinto G, Bodemer C. Les atteintes endocriniennes du syndrome de Netherton. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Garcia S, Tavares A, Peixoto P, Costa F, Saraiva D, Varzim P, Monteiro A, Fontes M, Pinto G. PO-1073: Dosimetric Predictors of Survival in Esophageal Cancers Treated with Preoperative Chemoradiation. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01090-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Mehta S, Avila J, Niklitschek S, Fernandez F, Villagran C, Vera F, Rocuant R, Cardenas G, Frauenfelder A, Vieira D, Vijayan Y, Pinto G, Vallenilla I, Prieto L, Cardenas J. Enhancing AI-guided STEMI detection algorithms by incorporating higher quality fiduciary EKG elements. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
As EKG interpretation paradigms to a physician-free milieu, accumulating massive quantities of distilled pre-processed data becomes a must for machine learning techniques. In our pursuit of reducing ischemic times in STEMI management, we have improved our Artificial Intelligence (AI)-guided diagnostic tool by following a three-step approach: 1) Increase accuracy by adding larger clusters of data. 2) Increase the breadth of EKG classifications to provide more precise feedback and further refine the inputs which ultimately reflects in better and more accurate outputs. 3) Improving the algorithms' ability to discern between cardiovascular entities reflected in the EKG records.
Purpose
To bolster our algorithm's accuracy and reliability for electrocardiographic STEMI recognition.
Methods
Dataset: A total of 7,286 12-lead EKG records of 10-seconds length with a sampling frequency of 500 Hz obtained from Latin America Telemedicine Infarct Network from April 2014 to December 2019. This included the following balanced classes: angiographically confirmed STEMI, branch blocks, non-specific ST-T abnormalities, normal, and abnormal (200+ CPT codes, excluding the ones included in other classes). Labels of each record were manually checked by cardiologists to ensure precision (Ground truth). Pre-processing: First and last 250 samples were discarded to avoid a standardization pulse. Order 5 digital low pass filters with a 35 Hz cut-off was applied. For each record, the mean was subtracted to each individual lead. Classification: Determined classes were “STEMI” and “Not-STEMI” (A combination of randomly sampled normal, branch blocks, non-specific ST-T abnormalities and abnormal records – 25% of each subclass). Training & Testing: A 1-D Convolutional Neural Network was trained and tested with a dataset proportion of 90/10, respectively. The last dense layer outputs a probability for each record of being STEMI or Not-STEMI. Additional testing was performed with a subset of the original complete dataset of unconfirmed STEMI. Performance indicators (accuracy, sensitivity, and specificity) were calculated for each model and results were compared with our previous findings from past experiments.
Results
Complete STEMI data: Accuracy: 95.9% Sensitivity: 95.7% Specificity: 96.5%; Confirmed STEMI: Accuracy: 98.1% Sensitivity: 98.1% Specificity: 98.1%; Prior Data obtained in our previous experiments are shown below for comparison.
Conclusion(s)
After the addition of clustered pre-processed data, all performance indicators for STEMI detection increased considerably between both Confirmed STEMI datasets. On the other hand, the Complete STEMI dataset kept a strong and steady set of performance metrics when compared with past results. These findings not only validate the consistency and reliability of our algorithm but also connotes the importance of creating a pristine dataset for this and any other AI-derived medical tools.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - J Avila
- Cardionomous AI, Santiago, Chile
| | | | | | | | - F Vera
- Cardionomous AI, Santiago, Chile
| | | | | | | | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - Y Vijayan
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - I Vallenilla
- Lumen Foundation, Miami, United States of America
| | - L Prieto
- Lumen Foundation, Miami, United States of America
| | - J Cardenas
- Lumen Foundation, Miami, United States of America
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Mehta S, Niklitschek S, Fernandez F, Villagran C, Vera F, Frauenfelder A, Vieira D, Ceschim M, Quintero S, Pinto G, Vallenilla I, Perez Del Nogal G, Cardenas J, Prieto L, Luna M. Waddling beyond door to balloon times and impinging true ischemic times with artificial intelligence-guided single lead EKG for STEMI detection. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The present process of STEMI detection is cumbersome as it utilizes outdated equipment and requires a trained technician and an expert cardiologist. We have developed a patient-administered, Artificial Intelligence (AI) guided, Single Lead EKG for early STEMI detection.
Purpose
To answer the question “Is early STEMI detection possible with a Single Lead EKG?”
Methods
We experimented with an AI-guided algorithm for a single-lead EKG for STEMI detection with the following step-wise developments: 1) An AI algorithm that predictably interprets STEMI using a 12-lead EKG; 2) An AI algorithm for STEMI detection using a single-lead EKG; 3) A methodology for identifying the best single lead to detect STEMI; 4) Advanced AI algorithms for STEMI localization with a single-lead EKG. The AI methodology was as follows: Sample: The mammoth Latin American Telemedicine Infarct Network telemedicine database that provides an umbrella of AMI management to 100 million patients in Brazil, Colombia, Mexico, Chile, and Argentina was queried for cardiologist annotated EKG. A total of 8,511 EKG and 90,592 classified heartbeats were selected for the experiments. Preprocessing: segmentation of each ECG into individual heartbeats. Training & Testing: 90% and 10%, respectively, of the total dataset. Classification: 1-D Convolutional Neural Network; classes were construed for each heartbeat. Performance indicators were calculated per lead.
Results
The algorithm was able to provide an accuracy of 91.9%. Lead V2 yielded the best results among individual leads for STEMI detection.
Conclusions
Early experiments provide a framework for augmenting STEMI detection with the use of AI-guided, single lead techniques. Such approaches seem rational as we target the reduction of true STEMI ischemic times.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | | | | | | | - F Vera
- Cardionomous AI, Santiago, Chile
| | | | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - M Ceschim
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - I Vallenilla
- Lumen Foundation, Miami, United States of America
| | | | - J Cardenas
- Lumen Foundation, Miami, United States of America
| | - L Prieto
- Lumen Foundation, Miami, United States of America
| | - M Luna
- Lumen Foundation, Miami, United States of America
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19
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Mehta S, Gibson M, Niklitschek S, Fernandez F, Villagran C, Escobar E, Vera F, Frauenfelder A, Vieira D, Vijayan Y, Quintero S, Vallenilla I, Pinto G, Cardenas J, Merchant S. Maximum artificial intelligence and complete reconstruct of population-based AMI care. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
After creating a behemoth hub and spoke AMI network that encompasses more than 100 million patients in 5 countries, we have begun to incorporate Artificial Intelligence (AI) algorithms into our telemedicine strategy with the goal of creating comprehensive, very early AMI diagnosis and physician-free triage. In doing so, we have replaced door-to-balloon times (d2b) with symptom-to-balloon times (s2b) as an immutable objective.
Purpose
To incorporate AI attributes for very early AMI detection, triage, and management.
Methods
We expanded our effective telemedicine strategy (100 million population; 877,178 telemedicine encounters; 55% overall mortality reduction; $291 million cost savings) with a logistic reset to impact s2b. To do this, we incorporated our Single Lead 1.0 (lead I) and Single Lead 2.0 (lead V2) technology for self-administered AMI detection with our physician-free STEMI diagnosis and triage AI algorithms. Single Lead algorithms and physician-free protocols were generated by utilizing Machine Learning from our mammoth annotated EKG repository.
Results
In addition to three logistic markers of efficiency Time-to-Telemedicine Diagnosis (TTD), Door-In-Door-Out (DIDO) and Transfer Times (TT); we are monitoring s2b. A gradual release of the algorithms and single lead is occurring at the telemedicine spokes. Detailed results will be available at the time of presentation.
Conclusions
Impacting s2b, the Achilles Heel of Primary PCI, may be achieved with the use of patient-administered AMI detection tools. Incorporation of these technologies into AI algorithms will add to telemedicine efficiencies for population-based AMI care.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - M Gibson
- Harvard Medical School, Boston, United States of America
| | | | | | | | | | - F Vera
- Cardionomous AI, Santiago, Chile
| | | | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - Y Vijayan
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
| | - I Vallenilla
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - J Cardenas
- Lumen Foundation, Miami, United States of America
| | - S Merchant
- Lumen Foundation, Miami, United States of America
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20
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Mehta S, Avila J, Villagran C, Fernandez F, Niklitschek S, Vera F, Rocuant R, Cardenas G, Escobar E, Frauenfelder A, Vieira D, Vijayan Y, Pinto G, Ceschim M, Luna M. Moving in sync – concordance betweena artificial intelligence and cardiologist on detecting normal electrocardiograms. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Merging modern technologies with classic diagnostic tests often results in a sense of insecurity within the medical community, particularly so with potentially life-saving studies such as the electrocardiogram (EKG). In order to provide a greater sense of trust between Artificial Intelligence (AI) and cardiologists, we provide an AI-driven algorithm capable of accurately and reliably characterize an EKG as normal within a highly complex, cardiologist-reviewed EKG database and report the degree of concordance between this machine vs physician scenario.
Purpose
To provide a dependable and accurate AI algorithm that conducts EKG interpretation in a cardiologist-tier manner.
Methods
The International Telemedical System (ITMS) developed and tested an EKG assessing AI algorithm and incorporated it into the workflow of their Telemedicine Integrated Platform, a digital EKG reading program where cardiologists continuously report their findings remotely in real-time. During the month of April 2,019; 35 ITMS cardiologists reported a grand total of 61,441 EKG records, later submitting them to the AI algorithm implemented through the “One Click Report” process. Through this simple 2-step approach, the algorithm provides a suggestion of “Normal” or “Abnormal” to the cardiologist based on the patterns of the fiducial points included in said EKG reports. Confirmation of these suggestions by the cardiologists ensued.
Results
Overall, cardiologists confirmed 23,213 out of 25,013 AI outputs for “Normal” EKGs, demonstrating a concordance of 92.8% for Normal diagnosis.
Conclusion
Through this methodology, we provide an AI technology that can be reliably applied and trusted in EKG digital platforms to identify and suitably label a normal EKG. Further testing will accrue into a multi label algorithm compatible with abnormal cardiovascular entities, potentially precluding the role of the cardiologist for triaging, particularly in the prehospital setting. We anticipate that this approach will become a promising methodology in modern cardiology practice.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - J Avila
- Cardionomous AI, Santiago, Chile
| | | | | | | | - F Vera
- Cardionomous AI, Santiago, Chile
| | | | | | - E Escobar
- Lumen Foundation, Miami, United States of America
| | | | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - Y Vijayan
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - M Ceschim
- Lumen Foundation, Miami, United States of America
| | - M Luna
- Lumen Foundation, Miami, United States of America
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21
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Mehta S, Niklitschek S, Fernandez F, Villagran C, Avila J, Cardenas G, Rocuant R, Vera F, Frauenfelder A, Vieira D, Quintero S, Pinto G, Vijayan Y, Merchant S, Bou Daher D. Innovative techniques to construct powerful artificial intelligence algorithms for st-elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
With the sudden advent of Artificial Intelligence (AI), incorporation of these technologies into key aspects of our working environment has become an ever so delicate task, especially so when dealing with time-sensitive and potentially lethal scenarios such as ST-Elevation Myocardial Infarction (STEMI) management. By further expanding into our successful experiences with AI-guided algorithms for STEMI detection, we implemented an innovative ensemble method into our methodology as we seek to improve the algorithm's predictive capabilities.
Purpose
Through the ensemble method, we combined two ML techniques to boost our previous experiments' accuracy and reliability.
Methods
Database: EKG records obtained from Latin America Telemedicine Infarct Network (Mexico, Colombia, Argentina, and Brazil) from April 2014 to December 2019. Dataset: Two separate datasets were used to train and test two sets of AI algorithms. The first comprised of 11,567 records and the second 7,286 records, each composed of 12-lead EKG records of 10-second length with sampling frequency of 500 Hz, including the following balanced classes: unconfirmed & angiographically confirmed STEMI (first model); angiographically confirmed STEMI only (second model); and, for both models, we included branch blocks, non-specific ST-T abnormalities, normal, and abnormal (200+ CPT codes, excluding the ones included in other classes). Label per record was manually checked by cardiologists to ensure precision (Ground truth). Pre-processing: First and last 250 samples were discarded to avoid a standardization pulse. An order 5 digital low pass filter with a 35 Hz cut-off was applied. For each record, the mean was subtracted to each individual lead. Classification: The determined classes were STEMI and Not-STEMI (A combination of randomly sampled normal, branch blocks, non-specific ST-T abnormalities and abnormal records – 25% of each subclass). Training & Testing: The last dense layer outputs a probability for each record of being STEMI or Not-STEMI. These probabilities were calculated for each model (Model 1 trained with Complete STEMI dataset and Model 2 trained with confirmed STEMI only dataset) and aggregated using the mean aggregation to generate the final label for each record. A 1-D Convolutional Neural Network was trained and tested with a dataset proportion of 90%/10%; respectively. Results are reported for both testing datasets (Complete and confirmed STEMI only records).
Results
Complete STEMI Dataset: Accuracy: 96.5% Sensitivity: 96.2% Specificity: 96.9% – Confirmed STEMI only Dataset: Accuracy: 98.5% Sensitivity: 98.3% Specificity: 98.6%'
Conclusion(s)
While Model 1 and Model 2 achieved similar performances with promising results on their own, applying a combination of both through the ensemble model exhibits a clear improvement in performance when applied to both datasets. This provides a blueprint for advanced automated STEMI detection through wearable devices.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | | | | | | | - J Avila
- Cardionomous AI, Santiago, Chile
| | | | | | - F Vera
- Cardionomous AI, Santiago, Chile
| | | | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - Y Vijayan
- Lumen Foundation, Miami, United States of America
| | - S Merchant
- Lumen Foundation, Miami, United States of America
| | - D Bou Daher
- Lumen Foundation, Miami, United States of America
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22
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Mehta S, Avila J, Villagran C, Fernandez F, Niklitschek S, Vera F, Rocuant R, Cardenas G, Frauenfelder A, Vieira D, Quintero S, Pinto G, Vallenilla I, Luna M, Bou Daher D. Artificial intelligence methodology: multi-label classification of abnormal EKG records. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Our previous experience with Artificial Intelligence (AI)-conducted EKG characterization displayed outstanding results in fast and reliable identification of Normal EKGs within the International Telemedical System (ITMS)'s massive record repository. By expanding the array of recognizable cardiovascular entities, we upgraded our methodology to accurately discriminate an anomaly amongst a highly complex database of EKG records.
Purpose
To present a feasible AI-guided filter that can accurately discriminate and classify Normal and Abnormal EKG records within a multilabeled cardiologist-annotated EKG database.
Methods
ITMS developed and tested the “One Click”' process, a “Normal/Abnormal” EKG assessing AI algorithm, by incorporating it into their digital EKG reading platform where cardiologists continuously report their findings remotely in real time. To ameliorate the diagnostic range of the algorithm, a separate dataset of 121,641 12-lead EKG records was consolidated from the ITMS database from October 2011 to January 2019. Only de-identified data was used. Preprocessing: The first 2s of each short lead and 9s of the long lead were considered. Limb leads I, II and III; and precordial leads V1, V2, V3, and V5 were used. The mean was removed from each lead. AI models/Classification: Two models were created and tested independently based on the method of EKG acquisition (69,852 records transtelephonic [TTP]; 52,259 mobile transmission [MOB]). Each record is categorized into six disjoint classes based on the most common types of cardiac disorders (Low/null co-occurrence pathologies in these datasets were grouped into analogous groups). Training/Testing: Distribution of both sets per transmission type was performed through a greedy algorithm, which identified multiple diagnoses per EKG record and labeled it separately to the corresponding group, ensuring sufficient samples per class. Detailed class distribution is shown below. An inception convolutional neural network was implemented; “Normal” or “Abnormal” labels were assigned to each EKG record independently and were compared to cardiologists' reports; performance indicators were calculated for each model and group.
Results
MOB model accrued an average accuracy of 86.7%; sensitivity of 90.5%; and specificity of 83.9%. TTP model yielded an average accuracy of 77.2%; sensitivity of 91.1%; and specificity of 69.4% (Lower values were attributed to the “Ventricular Complexes” group, which challenged the algorithm by having a smaller ratio of abnormal exams). Detailed results of each training set are shown below.
Conclusion
Providing an effective and reliable multilabel-capable EKG triaging tool remains a challenging but attainable goal. Continuous systematic enhancement of our AI-driven methodology has led us to satisfactory, yet imperfect results which compel us to further study and improve our efforts to provide a trustworthy cardiologist-friendly triage device.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - J Avila
- Cardionomous AI, Santiago, Chile
| | | | | | | | - F Vera
- Cardionomous AI, Santiago, Chile
| | | | | | | | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - I Vallenilla
- Lumen Foundation, Miami, United States of America
| | - M Luna
- Lumen Foundation, Miami, United States of America
| | - D Bou Daher
- Lumen Foundation, Miami, United States of America
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John J, Henry M, Ringoir A, Pinto G, Kesner K, Lazarus J, Sinha S. Change in renal function post-nephrectomy for renal cell carcinoma in patients with and without hypertension and/or diabetes. S AFR J SURG 2020; 58:101-104. [PMID: 32644314] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND The standard of care for surgically resectable disease renal cell carcinoma (RCC) is a nephrectomy. Post-nephrectomy, these patients are at risk for the development of new onset chronic kidney disease or the progression of pre-existing chronic kidney disease. We aimed to report the changes in renal function in patients who had a nephrectomy for RCC. METHODS This retrospective, descriptive, cross-sectional study identified 137 patients who had a nephrectomy for RCC from 1 January 2009 to 31 December 2017. The pre-nephrectomy and post-nephrectomy estimated glomerular filtration rate (eGFR) and the histological subtype of RCC on histopathological analysis of the resected specimen were recorded from the National Health Laboratory Services online results platform. All analyses were conducted using SPSS (Version 25) and the significance level was set at p < 0.05. RESULTS After a mean follow-up period of 26.5 ± 22 months (median = 19 months), the patients' eGFR dropped by a mean of 4.82 ± 8.67 ml/min/1.73 m2 (95% CI 3.23-6.41) post-nephrectomy. The mean eGFR fall in patients' who had hypertension and/or diabetes (n = 63) was significantly larger compared to patients who had neither of these comorbidities (n = 54; p < .001; mean = 7.30 ± 8.40 ml/min/1.73 m2 (95% CI 5.19-9.42) and 1.93 ± 8.14 ml/min/1.73 m2 (95% CI 0.30-4.15) respectively. CONCLUSIONS The decline in renal function in patients with hypertension and/or diabetes mellitus is more pronounced than in patients with neither of these comorbidities. In these high-risk patients, measures must be taken to prevent the development and limit the progression of chronic kidney disease.
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Affiliation(s)
- J John
- Department of Urology, Walter Sisulu University and Frere Hospital, South Africa and Division of Urology, Department of Surgery, University of Cape Town and Groote Schuur Hospital, South Africa
| | - M Henry
- Centre for Higher Education Development, University of Cape Town, South Africa
| | - A Ringoir
- Division of Urology, Department of Surgery, University of Cape Town and Groote Schuur Hospital, South Africa
| | - G Pinto
- Division of Urology, Department of Surgery, University of Cape Town and Groote Schuur Hospital, South Africa
| | - K Kesner
- Department of Urology, Walter Sisulu University and Frere Hospital, South Africa
| | - J Lazarus
- Division of Urology, Department of Surgery, University of Cape Town and Groote Schuur Hospital, South Africa
| | - S Sinha
- Division of Urology, Department of Surgery, University of Cape Town and Groote Schuur Hospital, South Africa
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Welfringer-Morin A, Pinto G, Baujat G, Vial Y, Hadj-Rabia S, Bodemer C, Boccara O. Hypophosphatemic rickets: A rare complication of congenital melanocytic nevus syndrome. Pediatr Dermatol 2020; 37:541-544. [PMID: 32157705 DOI: 10.1111/pde.14139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report the case of a child who presented with a giant melanocytic nevus with numerous satellite nevi at birth and developed hypophosphatemic rickets due to excessive secretion of the FGF23 hormone. A NRAS c.182A>G (Q61R) mutation was identified in the lesional skin. The functional outcome was favorable with medical treatment.
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Affiliation(s)
- Anne Welfringer-Morin
- Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), APHP, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
| | - Graziella Pinto
- Department of Endocrinology and Diabetology, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Geneviève Baujat
- Department of Genetics, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Université de Paris, Paris, France
| | - Yoann Vial
- Department of Genetics, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Robert Debré, Paris, France.,INSERM UMR S1131, Institut Universitaire d'Hématologie, Université de Paris, Paris, France
| | - Smail Hadj-Rabia
- Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), APHP, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
| | - Christine Bodemer
- Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), APHP, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
| | - Olivia Boccara
- Dermatology and Reference Center for Genodermatoses and Rare Skin Diseases (MAGEC), APHP, Institut Imagine, Hôpital Universitaire Necker-Enfants Malades, Université de Paris, Paris, France
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25
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Stoupa A, Al Hage Chehade G, Chaabane R, Kariyawasam D, Szinnai G, Hanein S, Bole-Feysot C, Fourrage C, Nitschke P, Thalassinos C, Pinto G, Mnif M, Baron S, De Kerdanet M, Reynaud R, Barat P, Hachicha M, Belguith N, Polak M, Carré A. High Diagnostic Yield of Targeted Next-Generation Sequencing in a Cohort of Patients With Congenital Hypothyroidism Due to Dyshormonogenesis. Front Endocrinol (Lausanne) 2020; 11:545339. [PMID: 33692749 PMCID: PMC7937947 DOI: 10.3389/fendo.2020.545339] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To elucidate the molecular cause in a well-characterized cohort of patients with Congenital Hypothyroidism (CH) and Dyshormonogenesis (DH) by using targeted next-generation sequencing (TNGS). STUDY DESIGN We studied 19 well-characterized patients diagnosed with CH and DH by targeted NGS including genes involved in thyroid hormone production. The pathogenicity of novel mutations was assessed based on in silico prediction tool results, functional studies when possible, variant location in important protein domains, and a review of the recent literature. RESULTS TNGS with variant prioritization and detailed assessment identified likely disease-causing mutations in 10 patients (53%). Monogenic defects most often involved TG, followed by DUOXA2, DUOX2, and NIS and were usually homozygous or compound heterozygous. Our review shows the importance of the detailed phenotypic description of patients and accurate analysis of variants to provide a molecular diagnosis. CONCLUSIONS In a clinically well-characterized cohort, TNGS had a diagnostic yield of 53%, in accordance with previous studies using a similar strategy. TG mutations were the most common genetic defect. TNGS identified gene mutations causing DH, thereby providing a rapid and cost-effective genetic diagnosis in patients with CH due to DH.
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Affiliation(s)
- Athanasia Stoupa
- INSERM U1016, Cochin Institute, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- IMAGINE Institute affiliate, Paris, France
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Ghada Al Hage Chehade
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Rim Chaabane
- Laboratory of Human Molecular Genetics, Medicine School, University of Sfax, Sfax, Tunisia
| | - Dulanjalee Kariyawasam
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Gabor Szinnai
- Pediatric Immunology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Pediatric Endocrinology, University Children’s Hospital Basel, University of Basel, Basel, Switzerland
| | - Sylvain Hanein
- INSERM U1163, IMAGINE Institute, Translational Genetics, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Christine Bole-Feysot
- Genomics Platform, INSERM UMR 1163, Paris Descartes Sorbonne Paris Cite University, Imagine Institute, Paris, France
| | - Cécile Fourrage
- Bioinformatics Platform, Paris Descartes University, IMAGINE Institute, Paris, France
| | - Patrick Nitschke
- Bioinformatics Platform, Paris Descartes University, IMAGINE Institute, Paris, France
| | - Caroline Thalassinos
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Graziella Pinto
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
| | - Mouna Mnif
- Endocrinology Department, CHU Hedi Chaker, Sfax, Tunisia
| | - Sabine Baron
- Pediatrics Department, CHU Nantes, Nantes, France
| | | | | | - Pascal Barat
- CHU de Bordeaux, Pediatric Endocrinology, Bordeaux, France
| | | | - Neila Belguith
- Laboratory of Human Molecular Genetics, Medicine School, University of Sfax, Sfax, Tunisia
- Medical Genetics Department, CHU Hedi Chaker, Sfax, Tunisia
| | - Michel Polak
- INSERM U1016, Cochin Institute, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- IMAGINE Institute affiliate, Paris, France
- Pediatric Endocrinology, Gynecology and Diabetology Unit, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France
- Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, Necker-Enfants Malades University Hospital, Paris, France
- Centre Régional de Dépistage Néonatal (CRDN) Ile de France, Paris, France
- *Correspondence: Michel Polak, ; Aurore Carré,
| | - Aurore Carré
- INSERM U1016, Cochin Institute, Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- IMAGINE Institute affiliate, Paris, France
- *Correspondence: Michel Polak, ; Aurore Carré,
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Khirani S, Amaddeo A, Baujat G, Michot C, Couloigner V, Pinto G, Arnaud E, Picard A, Cormier-Daire V, Fauroux B. Sleep-disordered breathing in children with pycnodysostosis. Am J Med Genet A 2019; 182:122-129. [PMID: 31680459 DOI: 10.1002/ajmg.a.61393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/11/2019] [Accepted: 10/09/2019] [Indexed: 11/08/2022]
Abstract
Upper airway obstruction is a common feature in pycnodysostosis and may cause obstructive sleep apnea (OSA). The aim of our study was to analyze sleep-disordered breathing and respiratory management in children with pycnodysostosis. A retrospective review of the clinical charts and sleep studies of 10 consecutive children (three girls and seven boys) with pycnodysostosis seen over a time period of 10 years was performed. Six patients had severe OSA and/or nocturnal hypoventilation and were started on continuous positive airway pressure (CPAP) as a first treatment at a median age of 3.4 ± 2.6 years, because of the lack of indication of any surgical treatment. Three patients could be weaned after several years from CPAP after spontaneous improvement (two patients) or multiple upper airway surgeries (one patient). Three patients had upper airway surgery prior to their first sleep study with two patients still needing CPAP during their follow-up. Only one patient never developed OSA. Patients with pycnodysostosis are at a high risk of severe OSA, underlying the importance of a systematic screening for sleep-disordered breathing. Multidisciplinary care is mandatory because of the multilevel airway obstruction. CPAP is very effective and well accepted for treating OSA.
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Affiliation(s)
- Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,ASV Santé, Gennevilliers, France
| | - Alessandro Amaddeo
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France.,EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris Descartes University, Paris, France
| | - Geneviève Baujat
- AP-HP, Hôpital Necker-Enfants malades, Genetics Department, National Reference Centre for Skeletal Dysplasia, INSERM UMR 1163, University Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Caroline Michot
- AP-HP, Hôpital Necker-Enfants malades, Genetics Department, National Reference Centre for Skeletal Dysplasia, INSERM UMR 1163, University Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Vincent Couloigner
- Pediatric Head and Neck Surgery and Otorhinolaryngology Department, AP-HP, Hôpital Necker-Enfants malades, Pediatric Head and Neck Surgery and Otorhinolaryngology, Paris, France
| | - Graziella Pinto
- Pediatric Endocrinology Department, AP-HP, Hôpital Necker-Enfants malades, Pediatric Endocrinology, Paris, France
| | - Eric Arnaud
- Pediatric Neurosurgery Department, AP-HP, Hôpital Necker-Enfants malades, Pediatric Neurosurgery, Centre de référence des malformations craniofaciales-CRMR CRANIOST, Paris, France.,Clinique Marcel Sembat, Ramsay Générale de Santé, Boulogne Billancourt, France
| | - Arnaud Picard
- Pediatric Maxillofacial and Plastic Surgery Department, AP-HP, Hôpital Necker-Enfants malades, Pediatric Maxillofacial and Plastic Surgery, Paris, France
| | - Valérie Cormier-Daire
- AP-HP, Hôpital Necker-Enfants malades, Genetics Department, National Reference Centre for Skeletal Dysplasia, INSERM UMR 1163, University Paris Descartes-Sorbonne Paris Cité, Institut Imagine, Paris, France
| | - Brigitte Fauroux
- ASV Santé, Gennevilliers, France.,EA 7330 VIFASOM (Vigilance Fatigue Sommeil et Santé Publique), Paris Descartes University, Paris, France
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27
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Pacoricona Alfaro DL, Lemoine P, Ehlinger V, Molinas C, Diene G, Valette M, Pinto G, Coupaye M, Poitou-Bernert C, Thuilleaux D, Arnaud C, Tauber M. Causes of death in Prader-Willi syndrome: lessons from 11 years' experience of a national reference center. Orphanet J Rare Dis 2019; 14:238. [PMID: 31684997 PMCID: PMC6829836 DOI: 10.1186/s13023-019-1214-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 04/29/2019] [Accepted: 09/24/2019] [Indexed: 12/12/2022] Open
Abstract
Background In the last 20 years, substantial improvements have been made in the diagnosis, treatment and management of patients with Prader-Willi syndrome (PWS). Few data on causes of death are available since those improvements were made. Our study assessed the causes of death among French patients with PWS over the first 11 years of experience of the nationwide French Reference Center for PWS (FRC-PWS). Methods Our study relied on two sources of mortality information at national level between 2004 and 2014: The French Epidemiological Centre for the Medical Causes of Death (CépiDc) Registry and the FRC-PWS database. Causes of death were classified into seven categories: respiratory, cardiovascular, gastrointestinal, severe infection, sudden death, other causes, and unknown. Descriptive statistics were calculated separately for children (< 18 years-old) and adults (≥18 years-old). Results One hundred and four deaths were identified in France from 2004 to 2014. The median age at death was 30 years, ranging from less than 1 month to 58 years. Seventeen deaths occurred in patients under 18 years, with 70% of them in children under 2 years. Respiratory causes accounted for more than 50% of the deaths in patients with PWS in both children and adults. Both cause and age of death did not significantly differ according to gender or genetic subtype. Conclusions Patients with PWS die prematurely due to a respiratory cause in most cases at all ages. In those adult patients with data on obesity, 98% were reported to be obese.
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Affiliation(s)
| | - Perrine Lemoine
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France
| | | | - Catherine Molinas
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France.,French National Reference Center for Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France.,Centre de Physiopathologie de Toulouse-Purpan, UMR 5282 CNRS, UMR 1043 Inserm, Paul Sabatier University, Toulouse, France
| | - Gwénaëlle Diene
- UMR 1027 Inserm- Paul Sabatier University, Toulouse, France.,Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France.,French National Reference Center for Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France
| | - Marion Valette
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France.,French National Reference Center for Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France
| | - Graziella Pinto
- Pediatric Endocrinology, Diabetology and Gynecology Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Necker Children's University Hospital, Paris, France
| | - Muriel Coupaye
- French National Reference Center for Prader-Willi Syndrome, Nutrition Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France
| | - Christine Poitou-Bernert
- French National Reference Center for Prader-Willi Syndrome, Nutrition Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Paris, France.,Nutriomics team, Sorbonne University, UPMC University Paris 06, Inserm, Paris, France
| | - Denise Thuilleaux
- French National Reference Center for Prader-Willi Syndrome, Prader-Willi Unit, Assistance Publique Hôpitaux de Paris (AP-HP), Marine Hendaye Hospital, Hendaye, France
| | - Catherine Arnaud
- UMR 1027 Inserm- Paul Sabatier University, Toulouse, France.,Unité de Soutien Méthodologique à la Recherche, University Hospital Center of Toulouse, Toulouse, France
| | - Maithé Tauber
- Endocrinology, Obesity, Bone Diseases, Genetics and Gynecology Unit, Children's Hospital, University Hospital Center of Toulouse, Toulouse, France. .,French National Reference Center for Prader-Willi Syndrome, Children's Hospital, University Hospital Center of Toulouse, 330, avenue de Grande-Bretagne - TSA 40031, 31059, Toulouse cedex 9, France. .,Centre de Physiopathologie de Toulouse-Purpan, UMR 5282 CNRS, UMR 1043 Inserm, Paul Sabatier University, Toulouse, France.
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Consoli A, Çabal Berthoumieu S, Raffin M, Thuilleaux D, Poitou C, Coupaye M, Pinto G, Lebbah S, Zahr N, Tauber M, Cohen D, Bonnot O. Effect of topiramate on eating behaviours in Prader-Willi syndrome: TOPRADER double-blind randomised placebo-controlled study. Transl Psychiatry 2019; 9:274. [PMID: 31685813 PMCID: PMC6828670 DOI: 10.1038/s41398-019-0597-0] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 05/24/2019] [Accepted: 06/20/2019] [Indexed: 11/09/2022] Open
Abstract
Prader-Willi Syndrome (PWS) is a rare genetic syndrome leading to severe behavioural disorders and mild cognitive impairment. The objective of this double-blind randomised placebo-controlled trial was to study the efficacy and tolerance of topiramate on behavioural disorders in patients with PWS. Participants (aged 12-45 years) had genetically confirmed PWS and severe irritability/impulsivity, eating disorders and/or obesity, and skin picking. Thirty-two participants received a placebo (PBO), and 30 participants received topiramate (TOP) (50-200 mg/day) for 8 weeks. The primary outcome was the rate of responders using the Clinical Global Impression-Improvement (CGI-I) scale. The secondary outcome measures included the Aberrant Behaviour Checklist, the Dykens Hyperphagia Questionnaire (DHK), the Self-Injurious Behaviour Scale (SIBS) and the body mass index (BMI). We found no significant difference in the primary outcome (the CGI-I): 9 (30%) patients were very much or much improved in the TOP group compared to 7 (22.6%) patients in the PBO group. However, the DHK behaviour and severity scores improved significantly more over time in patients treated with topiramate versus those receiving a placebo, with a significant dose-effect relationship. DHK scores were also significantly associated with genetic subtypes and hospitalisation status. The effects of topiramate on eating behaviours remained significant after adjusting for genetic subtype and hospitalisation. Topiramate had therefore a significant effect on eating disorders, with a dose-effect relationship. Given the burden of eating disorders in PWS, we believe that topiramate may become the first psychotropic option within the global care of obesity in individuals with PWS.
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Affiliation(s)
- Angèle Consoli
- Département de Psychiatrie de l'Enfant et de l'Adolescent, AP-HP, Groupe-Hospitalier Pitié-Salpêtrière, Paris, France. .,GRC-15, Approche dimensionnelle des épisodes psychotiques de l'enfant et de l'adolescent, Faculté de Médecine, UPMC, Sorbonne Universités, Paris, France.
| | - Sophie Çabal Berthoumieu
- 0000 0004 0638 325Xgrid.414018.8Unité d’Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale. Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France
| | - Marie Raffin
- 0000 0001 2150 9058grid.411439.aDépartement de Psychiatrie de l’Enfant et de l’Adolescent, AP-HP, Groupe-Hospitalier Pitié-Salpêtrière, Paris, France ,0000 0001 2308 1657grid.462844.8GRC-15, Approche dimensionnelle des épisodes psychotiques de l’enfant et de l’adolescent, Faculté de Médecine, UPMC, Sorbonne Universités, Paris, France
| | - Denise Thuilleaux
- Assistance-Publique Hôpitaux de Paris (AP-HP), Hopital Marin de Hendaye, French Reference Center for Prader-Willi Syndrome, Hendaye, France
| | - Christine Poitou
- 0000 0001 2150 9058grid.411439.aAssistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, French Reference Center for Prader-Willi Syndrome, Nutrition Department, CRNH Ile de France, F-75013 Paris, France ,Sorbonne Université, INSERM, Nutriomics team, F-75013 Paris, France
| | - Muriel Coupaye
- 0000 0001 2150 9058grid.411439.aAssistance Publique-Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, French Reference Center for Prader-Willi Syndrome, Nutrition Department, CRNH Ile de France, F-75013 Paris, France
| | - Graziella Pinto
- 0000 0004 0593 9113grid.412134.1Assistance-Publique Hôpitaux de Paris (AP-HP), Necker Enfants Malades Hospital University Hospital, Pediatric Endocrinology, Diabetology and Gynecology Department, F-75015 Paris, France
| | - Said Lebbah
- 0000 0001 2150 9058grid.411439.aAssistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Department of Biostatistics, F-75013 Paris, France
| | - Noel Zahr
- 0000 0001 2150 9058grid.411439.aAssistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France
| | - Maïthé Tauber
- 0000 0004 0638 325Xgrid.414018.8Unité d’Endocrinologie, Obésité, Maladies Osseuses, Génétique et Gynécologie Médicale. Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France ,0000 0004 0638 325Xgrid.414018.8Axe Pédiatrique du CIC 9302/INSERM. Hôpital des Enfants, Toulouse, France ,0000 0004 0443 5335grid.462366.3INSERM U1043, Centre de Physiopathologie de Toulouse Purpan, UPS, Toulouse, France
| | - David Cohen
- 0000 0001 2150 9058grid.411439.aDépartement de Psychiatrie de l’Enfant et de l’Adolescent, AP-HP, Groupe-Hospitalier Pitié-Salpêtrière, Paris, France ,0000 0001 2112 9282grid.4444.0Institut des Systèmes Intelligents et de Robotiques, CNRS, UMR 7222, UPMC, Sorbonne Universités, Paris, France
| | - Olivier Bonnot
- 0000 0004 0472 0371grid.277151.7Service Universitaire de Psychiatrie de l’Enfant et de l’Adolescent, CHU de Nantes, Nantes, France
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Schenkmayerova A, Pinto G, Marek M, Toul M, Hernychova L, Liskova V, Emond S, Bednar D, Prokop Z, Chaloupkova R, Hollfelder F, Bornscheuer U. Functional switching based on altered enzyme flexibility via InDel mutagenesis of a reconstructed ancestor. J Biotechnol 2019. [DOI: 10.1016/j.jbiotec.2019.05.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stourac J, Vavra O, Kokkonen P, Filipovic J, Pinto G, Schenkmayerova A, Damborsky J, Bednar D. Caver web: identification of tunnels and channels in proteins and analysis of ligand transport. J Biotechnol 2019. [DOI: 10.1016/j.jbiotec.2019.05.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mehta S, Botelho R, Fernandez F, Villagran C, Frauenfelder A, Matheus C, Vieira D, Torres MA, Ceschim M, Nola F, Pinto G, Mazzini J, Cecilio E, Acosta MI, Lopez C. P6422Physician vs machine: an innovative ST-elevation myocardial infarction pathway through artificial intelligence. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The diagnosis of ST-Elevation Myocardial Infarction (STEMI) has traditionally relied on a cardiologist's interpretation of an Electrocardiogram (EKG). This cumbersome process is costly, inefficient and out of date. Artificial Intelligence (AI) -guided algorithms can provide point-of-care, accurate STEMI diagnosis that will facilitate STEMI management.
Purpose
To demonstrate the feasibility of an automated AI-guided EKG analysis for STEMI diagnosis.
Methods
An observational, retrospective, case-control study. Sample: 8,511 EKG cardiologist-annotated records, including 4,255 STEMI cases. Records excluded patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (90,592 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample were used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVidia GTX 1070 GPU, 8GB RAM.
Results
The model achieved an accuracy of 96.5%, with a sensitivity of 96.3%, and a specificity of 96.8%.
Conclusion(s)
1) AI-guided interpretation of the EKG can reliably diagnose STEMI; 2) AI algorithms can be incorporated into ambulance systems for pre-hospital diagnosis, single page activation, emergency department bypass, facilitating more efficient STEMI pathways.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - C Villagran
- Lumen Foundation, Miami, United States of America
| | | | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - M A Torres
- Lumen Foundation, Miami, United States of America
| | - M Ceschim
- Lumen Foundation, Miami, United States of America
| | - F Nola
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - J Mazzini
- Lumen Foundation, Miami, United States of America
| | - E Cecilio
- Lumen Foundation, Miami, United States of America
| | - M I Acosta
- Lumen Foundation, Miami, United States of America
| | - C Lopez
- Lumen Foundation, Miami, United States of America
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Mehta S, Botelho R, Niklitschek S, Fernandez F, Cade J, Prudente M, Cavalcanti R, Dusilek C, Hamdan N, Hurtado E, Lacativa M, Frauenfelder A, Vieira D, Torres MA, Pinto G. P1524Women are from venus and face barriers for AMI treatment. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Latin American Telemedicine Infarct Network (LATIN), a program for managing population-based AMI care, has utilized an innovative hub-spoke strategy and remote guidance to expand medical access in remote parts of Brazil, Colombia, Mexico, and Argentina. Based on the Global Lumen Organization for Women (GLOW) project, that has previously demonstrated gender inequalities and worse outcomes for women who undergo Primary PCI, our research explored the management of female patients in our network.
Purpose
To demonstrate gender disparities in a telemedicine-guided, population based AMI program.
Methods
Meta-analysis of >750,000 patients within LATIN. Telemedicine was employed as a screening tool to accurately diagnose AMI. According to the duration of chest pain and transfer time, AMI patients were triaged into guidelines-based pathways of thrombolysis, pharmaco-invasive management or Primary PCI. Resource allocation was identical for men and women.
Results
Data from 784,395 screened patients reveals broad gender disparities. The critical results yielded that female patients have a lower prevalence of STEMI diagnosis and treatment regardless of the technique – PCI, pharmaco-invasive or CABG (p<0.01). These findings assume more significance given the fact that more women than men, were screened through the Telemedicine pathway.
Conclusions
LATIN gender data signals the urgency to demand better AMI care for women.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Lumen Foundation, Miami, United States of America
| | | | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - J Cade
- Lumen Foundation, Miami, United States of America
| | - M Prudente
- Lumen Foundation, Miami, United States of America
| | - R Cavalcanti
- Lumen Foundation, Miami, United States of America
| | - C Dusilek
- Lumen Foundation, Miami, United States of America
| | - N Hamdan
- Lumen Foundation, Miami, United States of America
| | - E Hurtado
- Lumen Foundation, Miami, United States of America
| | - M Lacativa
- Lumen Foundation, Miami, United States of America
| | | | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - M A Torres
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
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Mehta S, Botelho R, Fernandez F, Feres F, Abizaid A, Cade J, Perin M, Prudente M, Cavalcanti R, Dusilek C, Frauenfelder A, Matheus C, Pinto G, Mazzini J, Quintero S. P3352Telemedicine transcends national boundaries in quest of creating a behemoth ami program. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Latin America Telemedicine Infarct Network (LATIN) has exploited the remarkable competence of telemedicine for remote guidance. In doing so, LATIN created a mammoth population-based AMI network that employed experts located several hundred miles away to guide the reperfusion strategies for almost 800,000 screened patients. In this pioneering project, telemedicine was initially utilized to guide AMI management within national confines. We speculated whether LATIN telemedicine navigation could outstrip countrywide borders.
Purpose
To maximally harness the vast possibilities of telemedicine for improving AMI care.
Methods
During its pilot phase, LATIN began as a hub and spoke, AMI system in Colombia where 20 spokes (small community health centers and rural clinics) were configured with 3 hubs that could perform Primary PCI. These sites were linked through web-based connectivity. Expert cardiologists, located 50–250 miles away in Bogota, Colombia, used sophisticated telemedicine platforms for urgent EKG diagnosis and teleconsultation of the entire AMI process. Based upon the duration of chest pain and travel time to the hub, these experts guided patients through guideline-based strategies of thrombolysis, pharmaco invasive management or primary PCI. Efficiency of the telemedicine process was measured with the new metric of time to telemedicine diagnosis (TTD). Cloud computing, GPS navigation, and numerous business intelligent tools were gradually incorporated into LATIN telemedicine. As systems became more scalable, the program was expanded to Brazil, where LATIN flourished. Over the last 18 months, LATIN telemedicine capabilities have been pressed across national boundaries. Presently, all 82 LATIN centers in Mexico are guided by experts located in Bogota, Colombia and the 7 Argentina centers channeled through Santiago, Chile.
Results
784,947 patients were screened for AMI at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). Navigation pathways are depicted in the attached figure. TTD remains extremely low in all four countries, and comparable efficiency and tele-accuracy have been achieved. With expanded geographic reach, 8,448 (1.08%) patients were diagnosed with STEMI and 3,911 (46.3%) urgently reperfused, including 3,049 (78%) with Primary PCI. Time to TTD ranged between 2.8 to 5.8 minutes, with a mean of 3.5 min. Tele-accuracy was 98.5%, D2B 51 min, and in-hospital mortality 5.2%. Various other comparative metrics for the 4 countries are being gathered and will be available at the time of presentation.
Conclusions
LATIN demonstrates the robust ability of telemedicine to transcend national boundaries to guide AMI management. This strategy can be adopted in under-developed countries in Asia and Africa to provide an umbrella of AMI care for the millions of disadvantaged patients.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - F Feres
- Lumen Foundation, Miami, United States of America
| | - A Abizaid
- Lumen Foundation, Miami, United States of America
| | - J Cade
- Lumen Foundation, Miami, United States of America
| | - M Perin
- Lumen Foundation, Miami, United States of America
| | - M Prudente
- Lumen Foundation, Miami, United States of America
| | - R Cavalcanti
- Lumen Foundation, Miami, United States of America
| | - C Dusilek
- Lumen Foundation, Miami, United States of America
| | | | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - J Mazzini
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
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Mehta S, Botelho R, Fernandez F, Villagran C, Frauenfelder A, Ceschim M, Matheus C, Vieira D, Torres MA, Pinto G, Quintero S, Jacobucci R, Marin MA, Funatsu C, Vallenilla I. P6417Increasing the accuracy of a machine learning algorithm for STEMI diagnosis by incorporating demographic variables. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Our previous work demonstrated the diagnostic value of Artificial Intelligence (AI) -driven algorithms for ST-Elevation Myocardial Infarction (STEMI). In the present research, we explore the importance of demographic data inclusion, in order to achieve a more accurate diagnosis.
Purpose
To demonstrate that incorporation of demographic variables into the sample records will augment the accuracy of AI-based protocols for STEMI diagnosis.
Methods
An observational, retrospective, case-control study. Demographic data (age and gender) male/female ratio 1.3, ages 98–18 years was added to the sample records. Sample: 8,511 EKG records, previously diagnosed as normal, abnormal (over 200 conditions) or STEMI. Records excluded other patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (90,592 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample was used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with Nvidia GTX 1070GPU, 8GB RAM.
Results
The model yielded an accuracy of 97.1%, a sensitivity of 96.8%, and a specificity of 97.5%.
Conclusions
The ability of AI-guided algorithms to diagnose STEMI is increased by expanding the morphological variables with demographic data. This approach may be applied to improve the EKG diagnosis of other cardiovascular entities and improve clinical management.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - C Villagran
- Lumen Foundation, Miami, United States of America
| | | | - M Ceschim
- Lumen Foundation, Miami, United States of America
| | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - M A Torres
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
| | - R Jacobucci
- Lumen Foundation, Miami, United States of America
| | - M A Marin
- Lumen Foundation, Miami, United States of America
| | - C Funatsu
- Lumen Foundation, Miami, United States of America
| | - I Vallenilla
- Lumen Foundation, Miami, United States of America
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Mehta S, Fernandez F, Villagran C, Ceschim M, Matheus C, Pinto G, Mazzini J, Pisana L, Quintero S, Nola F, Safie R, Aboushi H, Munguia A, Cecilio E, Lopez C. P6418The continued proficiency of artificial intelligence for interpreting EKG: single lead EKG for STEMI culprit lesion localization. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Traditionally, the 12-lead electrocardiogram (EKG) has been used for diagnosing ST-Elevation Myocardial Infarction (STEMI) and for identifying the culprit lesion. We have previously demonstrated the impact of combining a Single Lead approach with Artificial Intelligence (AI) to replace tasks previously dominated by the 12 lead EKG. This research explores the role of the single lead EKG in identifying a culprit lesion.
Purpose
To test the use of a single lead approach to accurately locate the culprit vessel.
Methods
An observational, retrospective, case-control study. Sample: 2,542 exclusively STEMI diagnosis EKG records that included post discharge feedback from healthcare centers, confirming diagnosis and culprit vessel (Left Main Coronary Artery [LMCA]; Left Anterior Descending [LAD]; Right Coronary Artery [RCA]; Left Circumflex Artery [LCX]; Saphenous Vein Graft [SVG]). Records excluded other patient and medical information. The sample was derived from the private International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing:detection of QRS complexes using a wavelet system, segmentation of each EKG into individual heartbeats (27,125 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented; “LCMA”, “LAD”, “CX”, “RCA”, “SVG”, and “No Information” classes were considered for each heartbeat per lead; individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample was used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVidia GTX 1070 GPU, 8GB RAM.
Results
Accuracy: 77.4% Lead III; Sensitivity: LMCA (Lead aVL 25%); LAD (Lead aVF 87.8%); RCA (Leads V1, V3 92.9%); LCX (Lead aVL 21.7%).
Conclusions
Our results yielded the dominance of a specific single lead to each culprit vessels, aVF for LAD and V1 and V3 for RCA. We continue testing with different algorithms to search for reliable results for the LMCA and LCX. Nonetheless, conjugating a Single Lead EKG with an AI-augmented algorithm enables faster and easier management for patients that present with STEMI affecting the LAD and RCA territories.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - C Villagran
- Lumen Foundation, Miami, United States of America
| | - M Ceschim
- Lumen Foundation, Miami, United States of America
| | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - J Mazzini
- Lumen Foundation, Miami, United States of America
| | - L Pisana
- Lumen Foundation, Miami, United States of America
| | - S Quintero
- Lumen Foundation, Miami, United States of America
| | - F Nola
- Lumen Foundation, Miami, United States of America
| | - R Safie
- Lumen Foundation, Miami, United States of America
| | - H Aboushi
- Lumen Foundation, Miami, United States of America
| | - A Munguia
- Lumen Foundation, Miami, United States of America
| | - E Cecilio
- Lumen Foundation, Miami, United States of America
| | - C Lopez
- Lumen Foundation, Miami, United States of America
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Mehta S, Botelho R, Fernandez F, Villagran C, Frauenfelder A, Matheus C, Vieira D, Torres MA, Pinto G, Mazzini J, Pisana L, Jacobucci R, Marin MA, Funatsu C, Vallenilla I. P2426Validating the diagnostic value of a machine learning algorithm for STEMI detection. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
We have previously reported the use of Artificial Intelligence (AI) guided EKG analysis for detection of ST-Elevation Myocardial Infarction (STEMI). To demonstrate the diagnostic value of our algorithm, we compared AI predictions with reports that were confirmed as STEMI.
Purpose
To demonstrate the absolute proficiency of AI for detecting STEMI in a standard12-lead EKG.
Methods
An observational, retrospective, case-control study. Sample: 5,087 EKG records, including 2,543 confirmed STEMI cases obtained via feedback from health centers following appropriate patient management (thrombolysis, primary Percutaneous Coronary Intervention (PCI), pharmacoinvasive therapy or coronary artery bypass surgery). Records excluded patient and medical information. The sample was derived from the International Telemedical Systems (ITMS) database. LUMENGT-AI Algorithm was employed. Preprocessing: detection of QRS complexes by wavelet system, segmentation of each EKG into individual heartbeats (53,667 total beats) with fixed window of 0.4s to the left and 0.9s to the right of main QRS; Classification: A 1-D convolutional neural network was implemented, “STEMI” and “Not-STEMI” classes were considered for each heartbeat, individual probabilities were aggregated to generate the final label for each record. Training & Testing: 90% and 10% of the sample were used, respectively. Experiments: Intel PC i7 8750H processor at 2.21GHz, 16GB RAM, Windows 10 OS with NVIDIA GTX 1070 GPU, 8GB RAM.
Results
The model yielded an accuracy of 97.2%, a sensitivity of 95.8%, and a specificity of 98.5%.
Conclusion(s)
Our AI-based algorithm can reliably diagnose STEMI and will preclude the role of a cardiologist for screening and diagnosis, especially in the pre-hospital setting.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | - C Villagran
- Lumen Foundation, Miami, United States of America
| | | | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - D Vieira
- Lumen Foundation, Miami, United States of America
| | - M A Torres
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - J Mazzini
- Lumen Foundation, Miami, United States of America
| | - L Pisana
- Lumen Foundation, Miami, United States of America
| | - R Jacobucci
- Lumen Foundation, Miami, United States of America
| | - M A Marin
- Lumen Foundation, Miami, United States of America
| | - C Funatsu
- Lumen Foundation, Miami, United States of America
| | - I Vallenilla
- Lumen Foundation, Miami, United States of America
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Mehta S, Botelho R, Fernandez F, Alcocer Gamba M, De Los Rios O, Ricalde A, Acosta H, Villagra L, Perin M, Feres F, Frauenfelder A, Matheus C, Ceschim M, Pinto G, Mazzini J. P575Merging technologies to provide Mexico an innovative nationwide AMI management network. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
“Cόdigo Infarto”, the vast patient-centric, app-based, educational crusade of the Mexican Society of Interventional Cardiology (SOCIME) has been combined with the Latin America Telemedicine Infarct Network (LATIN) to create a comprehensive, national AMI program for Mexico.
Purpose
To demonstrate the benefits of amalgamating educational initiatives of national cardiology societies with a global telemedicine program for improving AMI management.
Methods
“Cόdigo Infarto” App connects patients to a network of several hundred cardiologists and 250 Primary PCI-capable labs. LATIN provides the partnership with its robust telemedicine platform, a hub-spoke strategy that supports patient's access to appropriate medical management. Remotely located experts, in Colombia, provide urgent EKG diagnosis via tele-consultation to the entire LATIN Mexico network. They activate ambulance dispatch and implement guideline-based protocols.
Results
Numerous “Cόdigo Infarto” sites have incorporated LATIN to provide a simple and accelerated management of AMI patients. Currently, the partnership (7 hubs, 78 spokes) has screened 19,886 patients. A total of 359 STEMI cases (1.8%) have been diagnosed; 118 patients (33%) were urgently reperfused, Primary PCI was performed in 74% of the latter cases. D2B time was 41 min. Reasons for the lack of treatment include delayed presentation, lack of ICU beds and insurance denials. Currently, these constraints are being methodically probed. Updated results will be available at time of presentation.
Conclusions
The synergy of the AMI initiative for Mexico provides a template for similar initiatives in developing countries.
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Affiliation(s)
- S Mehta
- Lumen Foundation, Miami, United States of America
| | - R Botelho
- Lumen Foundation, Miami, United States of America
| | - F Fernandez
- Lumen Foundation, Miami, United States of America
| | | | | | - A Ricalde
- Lumen Foundation, Miami, United States of America
| | - H Acosta
- Lumen Foundation, Miami, United States of America
| | - L Villagra
- Lumen Foundation, Miami, United States of America
| | - M Perin
- Lumen Foundation, Miami, United States of America
| | - F Feres
- Lumen Foundation, Miami, United States of America
| | | | - C Matheus
- Lumen Foundation, Miami, United States of America
| | - M Ceschim
- Lumen Foundation, Miami, United States of America
| | - G Pinto
- Lumen Foundation, Miami, United States of America
| | - J Mazzini
- Lumen Foundation, Miami, United States of America
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Currò G, Piscitelli G, Lazzara C, Komaei I, Fortugno A, Pinto G, Guccione F, Cogliandolo A, Dattola A, Latteri S, Navarra G. Laparoscopic sleeve gastrectomy for morbid obesity: role of intraluminal and intraperitoneal postoperative drainage. G Chir 2019; 38:181-184. [PMID: 29182900 DOI: 10.11138/gchir/2017.38.4.181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Bleeding and staple line leak are the most common postoperative complications of LSG. To prevent and/or to promptly identify such complications, conventional peri-operative protocols imply post-operative gastric decompression (NGT) and staple line drain (IAD). Our aim was to evaluate the role of naso-gastric tube (NGT) and intra-abdominal drain (IAD) in preventing and/or facilitating identification and treatment of post-operative complications after sleeve gastrectomy. PATIENTS AND METHODS A retrospective observational study on two consecutive series has been undertaken to evaluate the real utility of routine placement of NGT and IAD at the end of a LSG to prevent (primary end-point), promptly identify (secondary end-point) and manage (tertiary end-point) bleeding and staple line leakage. Collected outcome data of all consecutive cases, which underwent primary LSG at our Department, were analyzed. The first 100 consecutive patients (group A) received the standard perioperative protocol and the other consecutive 100 (group B) received a fast track protocol (no NGT neither IAD). RESULTS The two groups were not different in their outcome. Two bleeding occurred in Group A and were conservatively treated. One abscess developed in group B soon after surgery. It was diagnosed by an abdominal CT performed because patients presented fever, leucocitosis and tachycardia. It was successfully treated by percutaneous ultrasound-guided drainage. One fistula occurred in group B after discharge on 30th post-operative day. Fistula was suspected based on fever and tachycardia in absence of any abdominal discomfort and was confirmed by an abdominal CT. The patient was successfully treated in 40 days by endoscopic positioning of a gastric tube-prosthesis and percutaneous ultrasound-guided drainage of abdominal collection. A third patient in group B experienced bleeding suspected due to hemoglobin drop and confirmed by abdominal CT. He also was conservatively treated. CONCLUSIONS In conclusion, placement of drains does not facilitate detection of leak, abscess, or bleeding after primary LSG.
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González Briceño LG, Viaud M, Beltrand J, Flechtner I, Dassa Y, Samara-Boustani D, Thalassinos C, Pauwels C, Busiah K, Pinto G, Jaquet D, Polak M. Improved General and Height-Specific Quality of Life in Children With Short Stature After 1 Year on Growth Hormone. J Clin Endocrinol Metab 2019; 104:2103-2111. [PMID: 30649493 DOI: 10.1210/jc.2018-02523] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/10/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Short stature in children and adolescents may lead to social and emotional stress, with negative effects on quality of life (QoL). GH treatment may improve QoL through height normalization. Our objective here was to evaluate general and height-specific QoL after 1 year of GH treatment. DESIGN Prospective, single-center, observational cohort study. METHODS Children ≥ 4 years of age starting GH at our center from 2012 to 2015 to treat short stature were studied. Patients with serious diseases, syndromic short stature, or developmental delay were excluded. At treatment initiation and 1 year later, patients and their parents completed the general PedsQL 4.0 and height-specific Quality of Life in Short Stature Youth (QoLiSSY) questionnaires. Correlations between self-report and parent-report scores and between height gain and QoL improvements were assessed based on Pearson correlation coefficients. RESULTS Seventy-four children (42 boys, 32 girls), median age (± SD), 10.2 ± 3.0 years (range, 4.1 to 16.6 years), were included. The self-report PedsQL indicated significant improvements in emotional (P = 0.02) and social (P = 0.03) QoL. As assessed by the QoLiSSY, children reported improvement of social QoL (+0.2 SD; P = 0.04), and parents reported improvement of children's physical (+0.1 SD; P < 0.0001), emotional (+0.3 SD; P < 0.0001), and social (+0.3 SD; P < 0.0001) QoL. Height SD score (SDS) gains showed moderate positive correlations with QoLISSY self-report score gains (R = 0.53, R2 = 0.28; P < 0.001) and QoLISSY parent-report gains (R = 0.60, R2 = 0.41; P < 0.00001). CONCLUSIONS After 1 year of GH treatment, children had significant gains in emotional and social QoL, as assessed by a general self-report questionnaire and height-specific parent-report questionnaire.
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Affiliation(s)
- Laura G González Briceño
- Pediatric Endocrinology, Diabetology and Gynecology Department, Hôpital Universitaire Necker-Enfants Malades [Assistance Publique Hôpitaux de Paris (AP-HP)], Paris, France
- European Society for Paediatric Endocrinology (ESPE) Clinical Fellowship, Paris, France
| | - Magali Viaud
- Pediatric Endocrinology, Diabetology and Gynecology Department, Hôpital Universitaire Necker-Enfants Malades [Assistance Publique Hôpitaux de Paris (AP-HP)], Paris, France
- Centre de référence des maladies endocriniennes rares de la croissance et du développement, Paris, France
| | - Jacques Beltrand
- Pediatric Endocrinology, Diabetology and Gynecology Department, Hôpital Universitaire Necker-Enfants Malades [Assistance Publique Hôpitaux de Paris (AP-HP)], Paris, France
- Centre de référence des maladies endocriniennes rares de la croissance et du développement, Paris, France
- Université Paris Descartes, Paris, France
| | - Isabelle Flechtner
- Pediatric Endocrinology, Diabetology and Gynecology Department, Hôpital Universitaire Necker-Enfants Malades [Assistance Publique Hôpitaux de Paris (AP-HP)], Paris, France
- Centre de référence des maladies endocriniennes rares de la croissance et du développement, Paris, France
| | - Yamina Dassa
- Pediatric Endocrinology, Diabetology and Gynecology Department, Hôpital Universitaire Necker-Enfants Malades [Assistance Publique Hôpitaux de Paris (AP-HP)], Paris, France
- Centre de référence des maladies endocriniennes rares de la croissance et du développement, Paris, France
| | - Dinane Samara-Boustani
- Pediatric Endocrinology, Diabetology and Gynecology Department, Hôpital Universitaire Necker-Enfants Malades [Assistance Publique Hôpitaux de Paris (AP-HP)], Paris, France
- Centre de référence des maladies endocriniennes rares de la croissance et du développement, Paris, France
| | - Caroline Thalassinos
- Pediatric Endocrinology, Diabetology and Gynecology Department, Hôpital Universitaire Necker-Enfants Malades [Assistance Publique Hôpitaux de Paris (AP-HP)], Paris, France
- Centre de référence des maladies endocriniennes rares de la croissance et du développement, Paris, France
| | - Christian Pauwels
- Pediatric Endocrinology, Diabetology and Gynecology Department, Hôpital Universitaire Necker-Enfants Malades [Assistance Publique Hôpitaux de Paris (AP-HP)], Paris, France
- Centre de référence des maladies endocriniennes rares de la croissance et du développement, Paris, France
| | - Kanetee Busiah
- Pediatric Endocrinology, Diabetology and Obesity, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Graziella Pinto
- Pediatric Endocrinology, Diabetology and Gynecology Department, Hôpital Universitaire Necker-Enfants Malades [Assistance Publique Hôpitaux de Paris (AP-HP)], Paris, France
- Centre de référence des maladies endocriniennes rares de la croissance et du développement, Paris, France
| | - Delphine Jaquet
- Pediatric Endocrinology, Diabetology and Gynecology Department, Hôpital Universitaire Necker-Enfants Malades [Assistance Publique Hôpitaux de Paris (AP-HP)], Paris, France
| | - Michel Polak
- Pediatric Endocrinology, Diabetology and Gynecology Department, Hôpital Universitaire Necker-Enfants Malades [Assistance Publique Hôpitaux de Paris (AP-HP)], Paris, France
- Centre de référence des maladies endocriniennes rares de la croissance et du développement, Paris, France
- Université Paris Descartes, Paris, France
- l'Institut des Maladies Génétiques (IMAGINE Institute), Paris, France
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Welfringer-Morin A, Pinto G, Baujat G, Cavé H, de Saint Denis T, Hadj-Rabia S, Bodemer C, Boccara O. Rachitisme hypophosphatémique : complication rare du syndrome du naevus pigmentaire congénital. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gudo ES, Ali S, António VS, Chelene IR, Chongo I, Demanou M, Falk K, Guiliche OC, Heinrich N, Monteiro V, Muianga AF, Oludele J, Mula F, Mutuku F, Amade N, Alho P, Betsem E, Chimbuinhe Z, Cristovam AJ, Galano G, Gessain A, Harris E, Heise M, Inalda F, Jala I, Jaszi E, King C, Kitron U, Kümmerer BM, LaBeaud AD, Lagerqvist N, Malai G, Mazelier M, Mendes S, Mukoko D, Ndenga B, Njouom R, Pinto G, Tivane A, Vu DM, Vulule J. Seroepidemiological Studies of Arboviruses in Africa. Adv Exp Med Biol 2018; 1062:361-371. [PMID: 29845545 DOI: 10.1007/978-981-10-8727-1_25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
The literature on sero-epidemiological studies of flaviviral infections in the African continent is quite scarce. Much of the viral epidemiology studies have been focussing on diseases such as HIV/AIDS because of their sheer magnitude and impact on the lives of people in the various affected countries. Increasingly disease outbreaks caused by arboviruses such as the recent cases of chikungunya virus, dengue virus and yellow fever virus have prompted renewed interest in studying these viruses. International agencies from the US, several EU nations and China are starting to build collaborations to build capacity in many African countries together with established institutions to conduct these studies. The Tofo Advanced Study Week (TASW) was established to bring the best scientists from the world to the tiny seaside town of Praia do Tofo to rub shoulders with African virologists and discuss cutting-edge science and listen to the work of researchers in the field. In 2015 the 1st TASW focussed on Ebola virus. The collections of abstracts from participants at the 2nd TASW which focused on Dengue and Zika virus as well as presentations on other arboviruses are collated in this chapter.
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Affiliation(s)
| | - S Ali
- National Institute of Health, Maputo, Mozambique
| | - V S António
- National Institute of Health, Maputo, Mozambique
| | - I R Chelene
- National Institute of Health, Maputo, Mozambique
| | - I Chongo
- National Institute of Health, Maputo, Mozambique
| | - M Demanou
- Laboratoire des arbovirus et des virus de fièvres hémorragiques, Centre Pasteur du Cameroun (CPC), Yaoundé, Cameroon.
| | - K Falk
- The Public Health Agency of Sweden and Karolinska Institute, Solna, Sweden.
| | - O C Guiliche
- National Institute of Health, Maputo, Mozambique
| | - N Heinrich
- Infectious Diseases & Tropical Medicine, Medical Center of the University of Munich (LMU), Munich, Germany.
| | - V Monteiro
- National Institute of Health, Maputo, Mozambique
| | - A F Muianga
- National Institute of Health, Maputo, Mozambique
| | - J Oludele
- National Institute of Health, Maputo, Mozambique
| | - F Mula
- National Institute of Health, Maputo, Mozambique
| | - F Mutuku
- Technical University of Mombasa, Mombasa, Kenya.
| | - N Amade
- National Institute of Health, Maputo, Mozambique
| | - P Alho
- National Institute of Health, Maputo, Mozambique
| | - E Betsem
- Faculté de médecine et des Sciences Biomédicales, Université de Yaoundé 1, Yaoundé, Cameroon
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
| | | | | | - G Galano
- Pemba Provincial Hospital, Pemba, Mozambique
| | - A Gessain
- Unité d'Epidémiologie et Physiopathologie des Virus Oncogènes, Institut Pasteur, Paris, France
| | - E Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, CA, USA
| | - M Heise
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - F Inalda
- National Institute of Health, Maputo, Mozambique
| | - I Jala
- Laboratoire des arbovirus et des virus de fièvres hémorragiques, Centre Pasteur du Cameroun (CPC), Yaoundé, Cameroon
- Tropical Disease Research Center (TDRC), Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - E Jaszi
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - C King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - U Kitron
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
| | - B M Kümmerer
- Institute of Virology, University of Bonn Medical Centre, Bonn, Germany
| | - A D LaBeaud
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, USA
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, California, USA
| | - N Lagerqvist
- The Public Health Agency of Sweden and Karolinska Institute, Solna, Sweden
| | - G Malai
- Polana Caniço General Hospital Mozambique, Maputo, Mozambique
| | - M Mazelier
- Laboratoire des arbovirus et des virus de fièvres hémorragiques, Centre Pasteur du Cameroun (CPC), Yaoundé, Cameroon
| | - S Mendes
- Nampula Central Hospital, Nampula, Mozambique
| | - D Mukoko
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, California, USA
| | - B Ndenga
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - R Njouom
- Laboratoire des arbovirus et des virus de fièvres hémorragiques, Centre Pasteur du Cameroun (CPC), Yaoundé, Cameroon
| | - G Pinto
- National Institute of Health, Maputo, Mozambique
| | - A Tivane
- National Institute of Health, Maputo, Mozambique
| | - D M Vu
- Department of Pediatrics, Division of Infectious Diseases, Stanford University School of Medicine, California, USA
| | - J Vulule
- Centre for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
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Denis J, Dangouloff-Ros V, Pinto G, Flechtner I, Piketty M, Samara D, Levy R, Grévent D, Millischer AE, Brunelle F, Prevot V, Polak M, Boddaert N. Arterial Spin Labeling and Central Precocious Puberty. Clin Neuroradiol 2018; 30:137-144. [DOI: 10.1007/s00062-018-0738-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/19/2018] [Indexed: 12/23/2022]
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Paepegaey AC, Coupaye M, Pinto G, Dubern B, Oppert JM, Poitou C. Impact de la transition sur les paramètres endocriniens, anthropométriques et métaboliques à l’âge adulte des patients ayant un syndrome de Prader-Willi. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Paepegaey AC, Coupaye M, Jaziri A, Ménesguen F, Dubern B, Polak M, Oppert JM, Tauber M, Pinto G, Poitou C. Impact of transitional care on endocrine and anthropometric parameters in Prader-Willi syndrome. Endocr Connect 2018; 7:663-672. [PMID: 29666169 PMCID: PMC5952243 DOI: 10.1530/ec-18-0089] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 04/01/2018] [Accepted: 04/17/2018] [Indexed: 11/08/2022]
Abstract
CONTEXT The transition of patients with Prader-Willi syndrome (PWS) to adult life for medical care is challenging because of multiple comorbidities, including hormone deficiencies, obesity and cognitive and behavioral disabilities. OBJECTIVE To assess endocrine management, and metabolic and anthropometric parameters of PWS adults who received (n = 31) or not (n = 64) transitional care, defined as specialized pediatric care followed by a structured care pathway to a multidisciplinary adult team. PATIENTS AND STUDY DESIGN Hormonal and metabolic parameters were retrospectively recorded in 95 adults with PWS (mean ± s.d. age 24.7 ± 8.2 years, BMI: 39.8 ± 12.1 kg/m²) referred to our Reference Center and compared according to transition. RESULTS Among the entire cohort, 35.8% received growth hormone (GH) during childhood and 16.8% had a GH stimulation test after completion of growth. In adulthood, 14.7% were treated with GH, 56.8% received sex-hormone therapy, whereas 91.1% were hypogonadic and 37.9% had undergone valid screening of the corticotropic axis. The main reason for suboptimal endocrine management was marked behavioral disorders. Patients receiving transitional care were more likely to have had a GH stimulation test and hormonal substitutions in childhood. They also had a lower BMI, percentage of fat mass, improved metabolic parameters and fewer antidepressant treatments. Transitional care remained significantly associated with these parameters in multivariate analysis when adjusted on GH treatment. CONCLUSION A coordinated care pathway with specialized pediatric care and transition to a multidisciplinary adult team accustomed to managing complex disability including psychiatric troubles are associated with a better health status in adults with PWS.
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Affiliation(s)
- A C Paepegaey
- Nutrition DepartmentAssistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, French Reference Center for Prader-Willi Syndrome, Sorbonne Université, Paris, France
| | - M Coupaye
- Nutrition DepartmentAssistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, French Reference Center for Prader-Willi Syndrome, Sorbonne Université, Paris, France
| | - A Jaziri
- Nutrition DepartmentAssistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, French Reference Center for Prader-Willi Syndrome, Sorbonne Université, Paris, France
| | - F Ménesguen
- Nutrition DepartmentAssistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, French Reference Center for Prader-Willi Syndrome, Sorbonne Université, Paris, France
| | - B Dubern
- Nutrition and Gastroenterology DepartmentAssistance-Publique Hôpitaux de Paris (AP-HP), Armand Trousseau Children's Hospital, Paris, France
| | - M Polak
- Pediatric EndocrinologyDiabetology and Gynecology Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Necker Enfants Malades Hospital University Hospital, Paris, France
| | - J M Oppert
- Nutrition DepartmentAssistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, French Reference Center for Prader-Willi Syndrome, Sorbonne Université, Paris, France
| | - M Tauber
- Pediatric Endocrinology DepartmentChildren's Hospital, French Reference Center for Prader-Willi Syndrome, Toulouse, France
| | - G Pinto
- Pediatric EndocrinologyDiabetology and Gynecology Department, Assistance-Publique Hôpitaux de Paris (AP-HP), Necker Enfants Malades Hospital University Hospital, Paris, France
| | - C Poitou
- Nutrition DepartmentAssistance-Publique Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, French Reference Center for Prader-Willi Syndrome, Sorbonne Université, Paris, France
- INSERMUMRS 1166, Nutriomic Group 6, Paris, France
- Sorbonne UniversitéUMRS1166, Paris, France
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Rodrigues Pinto E, Garcia S, Lago R, Vendeira L, Pinto G. EP-1621: Retrospective study - Outcome of radiotherapy for invasive bladder cancer in older patients. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31930-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Monteiro A, Rodrigues D, Fontes M, Varzim P, Figueira R, Lago R, Garcia S, Reis T, Carvalho A, Pinto G. EP-2382: Impact on treatment plan of daily MV EPI versus MV CBCT imaging for prostate cancer IGRT. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Garcia S, Rodrigues D, Lago R, Chorão P, Osório L, Soares P, Pinto G. EP-1250: Ocular Adnexal lymphoma: a 12-years experience in an institution. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31560-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Dinis LT, Bernardo S, Luzio A, Pinto G, Meijón M, Pintó-Marijuan M, Cotado A, Correia C, Moutinho-Pereira J. Kaolin modulates ABA and IAA dynamics and physiology of grapevine under Mediterranean summer stress. J Plant Physiol 2018; 220:181-192. [PMID: 29195232 DOI: 10.1016/j.jplph.2017.11.007] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 06/07/2023]
Abstract
The foliar exogenous application of kaolin, a radiation-reflecting inert mineral, has proven to be an effective short-term climate change mitigation strategy for Mediterranean vineyards. In this work, we address the hypothesis that kaolin could improve both the hormonal dynamics and physiological responses of grapevines growing in Douro Region, northern Portugal. For this purpose, the leaf water potential, gas exchange and chlorophyll a fluorescence parameters were monitored, as well as the abscisic acid (ABA) and indole-3-acetic acid (IAA) quantification and immunolocalization were assessed. The study revealed a slight decrease in ABA and an increase in IAA in the kaolin treatment, which in turn were associated with the improvement of physiological performance. A month after spraying, kaolin improves the water potential respectively, 30% and 17% in the predawn and midday periods. Besides, plants treated with kaolin showed higher values of stomatal conductance, net CO2 assimilation rate and intrinsic water use efficiency. Kaolin also ameliorates the effective PSII efficiency (67%), as well as the maximum quantum efficiency of photosystem II and the photosynthetic electron transport rate (>73%). These results were consistent with the higher photochemical quenching and the lower non-photochemical quenching observed in treated leaves and with the better performance obtained by the JIP test parameters. Physiological and hormonal analysis confirmed that kaolin effectively enhance grapevine summer stress tolerance.
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Affiliation(s)
- L-T Dinis
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes e Alto Douro, Apt. 1013, 5000-801 Vila Real, Portugal.
| | - S Bernardo
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes e Alto Douro, Apt. 1013, 5000-801 Vila Real, Portugal
| | - A Luzio
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes e Alto Douro, Apt. 1013, 5000-801 Vila Real, Portugal
| | - G Pinto
- Department of Biology & CESAM - Centre for Environmental and Marine Studies, University of Aveiro, Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
| | - M Meijón
- Plant Physiology, Department B.O.S., Faculty of Biology, University of Oviedo, 33006 Oviedo, Asturias, Spain
| | - M Pintó-Marijuan
- Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, University of Barcelona, Avinguda Diagonal 643, 08028 Barcelona, Spain
| | - A Cotado
- Departament de Biologia Evolutiva, Ecologia i Ciències Ambientals, Facultat de Biologia, University of Barcelona, Avinguda Diagonal 643, 08028 Barcelona, Spain
| | - C Correia
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes e Alto Douro, Apt. 1013, 5000-801 Vila Real, Portugal
| | - J Moutinho-Pereira
- Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), University of Trás-os-Montes e Alto Douro, Apt. 1013, 5000-801 Vila Real, Portugal
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Baptista A, Silva F, Porteiro J, Míguez J, Pinto G, Fernandes L. On the Physical Vapour Deposition (PVD): Evolution of Magnetron Sputtering Processes for Industrial Applications. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.promfg.2018.10.125] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Stoupa A, Samara-Boustani D, Flechtner I, Pinto G, Jourdon I, González-Briceño L, Bidet M, Laborde K, Chevenne D, Millischer AE, Lottmann H, Blanc T, Aigrain Y, Polak M, Beltrand J. Efficacy and Safety of Continuous Subcutaneous Infusion of Recombinant Human Gonadotropins for Congenital Micropenis during Early Infancy
. Horm Res Paediatr 2017; 87:103-110. [PMID: 28081535 DOI: 10.1159/000454861] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/28/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early postnatal administration of gonadotropins to infants with congenital hypogonadotropic hypogonadism (CHH) can mimic minipuberty, thereby increasing penile growth. We assessed the effects of gonadotropin infusion on stretched penile length (SPL) and hormone levels in infants with congenital micropenis. METHODS Single-center study including 6 males with micropenis in case of isolated CHH (n = 4), panhypopituitarism (n = 1), and partial androgen insensitivity syndrome (PAIS; n = 1). Patients were evaluated at baseline, monthly and at the end of the study through a clinical examination (SPL, testicular position and size), serum hormone assays (testosterone, luteinizing hormone, follicle-stimulating hormone, inhibin B, anti-Müllerian hormone [AMH]), and ultrasound of penis/testes. RESULTS In CHH, significant increases occurred in serum testosterone (from undetectable level to 3.5 ± 4.06 ng/mL [12.15 ± 14.09 nmol/L]), SPL (from 13.8 ± 4.5 to 42.6 ± 5 mm; p < 0.0001), inhibin B (from 94.8 ± 74.9 to 469.4 ± 282.5 pg/mL, p = 0.04), and AMH (from 49.6 ± 30.6 to 142 ± 76.5 ng/mL, p = 0.03). Micropenis was corrected in all patients, except one. On treatment, in the patient with PAIS, SPL was increased from 13 to 38 mm. CONCLUSIONS Early gonadotropin infusion is a safe, well-tolerated and effective treatment. The effect in PAIS has not been reported previously. Long-term follow-up is needed to assess the impact, if any, on future fertility and reproduction.
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