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Baudelet M, Van den Steen L, Duprez F, Goeleven A, Nuyts S, Nevens D, Vandenbruaene C, Massonet H, Vergauwen A, Vauterin T, Verstraete H, Wouters K, Vanderveken O, De Bodt M, Van Nuffelen G. Prophylactic Swallowing Therapy During Head-and-Neck Cancer Radiotherapy: Effect of Service-Delivery Mode and Overall Adherence Level on Swallowing Function and Muscle Strength-the PRESTO Trial. Dysphagia 2024; 39:267-281. [PMID: 37550571 PMCID: PMC10957706 DOI: 10.1007/s00455-023-10609-7] [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] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Abstract
Prophylactic swallowing exercises (PSE) during head-and-neck cancer (HNC) (chemo)radiotherapy (CRT) have a positive effect on swallowing function and muscle strength. Adherence rates to PSE are, however, moderate to low, undermining these effects. PRESTO already showed that the service-delivery mode (SDM), the way the exercises are offered, can influence adherence. The aim of this study was to investigate the effect of SDM on swallowing function and muscle strength during and post-CRT. In addition, the effect of overall adherence (OA), independent of SDM, was also investigated. A total of 148 HNC patients, treated with CRT, were randomly assigned to one of the three SDM's (paper-supported, app-supported, or therapist-supported PSE) and performed a 4-week PSE program. OA was calculated based on the percentage of completed exercises. Patients were divided into OA levels: the OA75+ and OA75- group performed respectively ≥ 75 and < 75% of the exercises. Swallowing function based on Mann Assessment of Swallowing Ability-Cancer (MASA-C), tongue and suprahyoid muscle strength during and up to 3 months after CRT were compared between the SDM's and OA levels. Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction was used. No significant differences were found between the three SDMs. Significant time effects were found: MASA-C scores decreased and muscle strength increased significantly during CRT. By the end of CRT, the OA75+ showed significantly better swallowing function compared to OA75-. Muscle strength gain was significantly higher in the OA75+ group. SDM had no impact on swallowing function and muscle strength; however, significant effects were shown for OA level. Performing a high level of exercise repetitions is essential to benefit from PSE.Trial registration ISRCTN, ISRCTN98243550. Registered December 21, 2018-retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search.
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Affiliation(s)
- Margot Baudelet
- Department of Radiation Oncology, University Hospital Ghent, 9000, Ghent, Belgium.
- Department of ENT, University Hospital Ghent, 9000 Ghent, Belgium.
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, University Hospital Ghent, 9000, Ghent, Belgium
- Faculty of Medicine and Health Sciences Ghent, University of Ghent, Ghent, Belgium
| | - Ann Goeleven
- Department of Head and Neck Surgery, Swallowing Clinic, University Hospital Leuven, Louvain, Belgium
- Faculty of Medicine, Department of Neurosciences, Research Group Experimental Oto-rhino-laryngology, KU Leuven, Louvain, Belgium
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, 3000 Leuven, Belgium
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Daan Nevens
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium
- Iridium Network, Antwerp, Belgium
| | | | - Hanne Massonet
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Head and Neck Surgery, Swallowing Clinic, University Hospital Leuven, Louvain, Belgium
- Faculty of Medicine, Department of Neurosciences, Research Group Experimental Oto-rhino-laryngology, KU Leuven, Louvain, Belgium
| | - Alice Vergauwen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
| | | | - Hilde Verstraete
- Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium
- Iridium Network, Antwerp, Belgium
| | - Kristien Wouters
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Ghent, University of Ghent, Ghent, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- University Hospital Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Ghent, University of Ghent, Ghent, Belgium
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Gaillard M, Van den Broeck S, Op de Beeck B, Wouters K, Stijns J, Van de Putte D, Gys B, Houben B, Van Dessel E, Bislenghi G, Komen N. Protocol of the LATFIA trial (Laser Assisted Treatment of Fistula in Ano): a multicentre, prospective, randomized controlled trial comparing fistula-tract laser closure (FiLaC™) with rectal advancement flap for high trans-sphincteric fistulas. Colorectal Dis 2024. [PMID: 38499516 DOI: 10.1111/codi.16951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 03/20/2024]
Abstract
AIM Anal fistula is one of the most common anal diseases, affecting between 1 and 3 per 10 000 people per year. Symptoms have a potentially severe effect on a patient's quality of life. Surgery is the mainstay of treatment, aiming to cure the fistula and preserve anal sphincter function. Rectal advancement flap (RAF) is currently the gold standard treatment but has recurrence rates varying between 20% and 50% and might lead to disturbance of continence. The aim of the trial described in this work is to discover if the minimally invasive fistula tract laser closure (FiLaC™) technique could achieve higher healing rates and a better functional outcome than RAF. METHOD We will perform a randomized prospective multicentre noninferiority study of the treatment of high trans-sphincteric perianal fistulas, comparing FiLaC™ with RAF in terms of fistula healing, recurrence rate, functional outcome and quality of life. Primary and secondary fistula healing will be evaluated at 26 and 52 weeks' follow-up. Quality of life will be evaluated using the SF-36 questionnaire, the Faecal Incontinence Quality of Life Scale questionnaire and the Vaizey score at 3, 6, 12 and 26 weeks postoperatively. CONCLUSION High trans-sphincteric fistulas have a potentially severe effect on a patient's quality of life. Classical treatment with RAF is a time-consuming invasive procedure. The LATFIA trial aims to compare FiLaC™ with the gold standard treatment with RAF. In case of noninferiority, FiLaC™ treatment could be standardized as a first line treatment for high trans-sphincteric fistulas. Better conservation of the patient's anal sphincter function could possibly be obtained. Likewise, we will report on the postoperative quality of life when applying these two techniques.
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Affiliation(s)
- Marie Gaillard
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
- Antwerp ReSURG, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Sylvie Van den Broeck
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
- Antwerp ReSURG, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Bart Op de Beeck
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Clinical Trial Center, Antwerp University Hospital, Edegem, Belgium
| | - Jasper Stijns
- Department of Abdominal Surgery, University Hospital Brussels, Jette, Belgium
| | - Dirk Van de Putte
- Department of Abdominal Surgery, University Hospital Ghent, Ghent, Belgium
| | - Ben Gys
- Department of Abdominal Surgery, Hospital St. Dimpna, Geel, Belgium
| | - Bert Houben
- Department of Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
| | - Els Van Dessel
- Department of Abdominal Surgery, GasthuisZusters Hospital, Antwerp, Belgium
| | - Gabriele Bislenghi
- Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - Niels Komen
- Department of Abdominal Surgery, Antwerp University Hospital, Edegem, Belgium
- Antwerp ReSURG, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Boudry L, Mateizel I, Wouters K, Papaleo E, Mackens S, De Vos M, Racca A, Adriaenssens T, Tournaye H, Blockeel C. Does dual oocyte retrieval with continuous FSH administration increase the number of mature oocytes in low responders? An open-label randomized controlled trial. Hum Reprod 2024; 39:538-547. [PMID: 38199789 DOI: 10.1093/humrep/dead276] [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] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/21/2023] [Indexed: 01/12/2024] Open
Abstract
STUDY QUESTION Is there an increase in the total number of metaphase II (MII) oocytes between a conventional ovarian stimulation (OS) and a double uninterrupted stimulation? SUMMARY ANSWER There is no increase in the total number of MII oocytes when comparing one conventional OS to a continuous stimulation with double oocyte aspiration. WHAT IS KNOWN ALREADY Based on the concept of multiple follicular waves, the combination of two stimulations in the same ovarian cycle has gained interest in patients with a low ovarian reserve. This so-called dual stimulation approach is usually characterized by a discontinuation of FSH administration for ∼5 days and appears to have a favourable impact on the number of retrieved oocytes without affecting the embryo quality or ploidy status. The outcomes of dual uninterrupted OS have not yet been studied. STUDY DESIGN, SIZE, DURATION This was an open-label randomized controlled trial (RCT) with superiority design, performed in a single tertiary centre. Subjects were randomized with a 1:1 allocation into two groups between October 2019 and September 2021. All patients underwent a conventional stimulation with recombinant FSH. When two or more follicles of 17 mm were present, the final inclusion criterion was assessed; randomization occurred only in the presence of ≤9 follicles of ≥11 mm. In Group A, ovulation was triggered with hCG, and oocyte retrieval (OR) was performed 34-36 h later, followed by a fresh single or double embryo transfer (SET or DET) on Day 3/5. In Group B, ovulation was triggered with GnRH agonist, followed by another OS, without discontinuation of the FSH administration. In the presence of one or more follicles of ≥17 mm, the second stimulation was completed with hCG. A freeze-all strategy (Day 3/5) was applied for both retrievals, followed by transfer of one or two embryos in an artificially prepared frozen-thawed cycle. In the absence of one or more follicles of ≥17 mm after 13 additional days of stimulation, the second cycle was cancelled. All ORs were executed by a senior fertility specialist who was blinded for the first treatment, and all follicles >10 mm were aspirated, according to routine clinical practice. The primary outcome was the total number of MII oocytes. Patients were followed up until all embryos were transferred, or until live birth was achieved. Other secondary outcomes included the number of cumulus-oocyte complexes (COCs), the number of good quality embryos (Day 3/5), the ongoing pregnancy rate, and gonadotropin consumption. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients between 25 and 40 years old, with an anti-Müllerian hormone level of ≤1.5 ng/ml, antral follicle count of ≤6, or ≤5 oocytes after a previous stimulation, were included. At the start, 70 patients were eligible for participation in the trial, of whom 48 patients fulfilled the final inclusion criterium and were randomized. After drop-out of two patients, 23 patients were randomized to a single round of OS (Group A), and 23 patients were randomized to two uninterrupted rounds of OS (Group B). MAIN RESULTS AND THE ROLE OF CHANCE Baseline characteristics were similar between both groups. The cumulative number of COCs and MII oocytes after completion of the second OR was similar in Group A and Group B [5.3 ± 2.7 versus 5.3 ± 3.0 (P = 0.95); 4.1 ± 2.4 versus 4.3 ± 2.7 (P = 0.77)]. Likewise, a comparable number of excellent and good quality embryos was available on Day 3 (3.0 ± 2.0 versus 2.7 ± 2.0; P = 0.63). In Group B, the cancellation rate due to insufficient response to the second round of stimulation was 39.1% (9/23). When focusing on the first stimulation in both groups, there were no significant differences regarding basal FSH, gonadotropin consumption, and the number of preovulatory follicles. After the first OR, the mean number of COC and MII oocytes was significantly higher in Group A (who had hCG triggering), compared to Group B (who had GnRH agonist triggering) [5.3 ± 2.7 versus 3.3 ± 2.2; difference 95% CI (0.54 to 3.45), P = 0.004 and 4.1 ± 2.4 versus 3.0 ± 2.2; difference 95% CI (-0.15 to 2.6), P = 0.05, respectively]. Likewise, the number of excellent and good quality embryos on Day 3 was significantly higher (3.0 ± 2.0 versus 1.9 ± 1.7; P = 0.02) in Group A. LIMITATIONS, REASONS FOR CAUTION This study was powered to demonstrate superiority for the number of MII oocytes after dual stimulation. Investigating the impact of dual stimulation on pregnancy rates would have required a larger sample size. Furthermore, the heterogeneity in embryo vitrification and transfer policies precluded a correct comparison of embryologic outcomes between both groups. WIDER IMPLICATIONS OF THE FINDINGS This is the first RCT investigating the role of continuous stimulation with double aspiration in low responders. Our results show no statistically significant differences in the cumulative number of MII oocytes between one conventional stimulation with fresh ET and two consecutive stimulations with a freeze-only approach. Furthermore, the observed suboptimal oocyte yield after agonist ovulation triggering in low responders in the dual uninterrupted OS group is a reason for concern and further scrutiny, given that previous RCTs have shown similar outcomes in normal and high responders after hCG and GnRH agonist triggers. STUDY FUNDING/COMPETING INTEREST(S) This work was supported in part by a research grant from Organon. H.T. received honoraria for lectures and presentations from Abbott, Cooper Surgical, Gedeon-Richter, Cook, Goodlife, and Ferring. L.B. received fees for lectures from Merck & Organon and support for attending ESHRE 2023. M.D.V. reports fees for lectures from Ferring, Merck, Organon, IBSA, Gedeon Richter, and Cooper Surgical and support for attending ASRM 2023. S.M. received honoraria for lectures and presentations from Abbott, Cooper Surgical, Gedeon-Richter, IBSA, and Merck. C.B. was on the Advisory board and received consulting fees from Theramex and received honoraria for lectures and presentations from Abbott, Ferring, Gedeon-Richter, IBSA, and Merck. TRIAL REGISTRATION NUMBER NCT03846544. TRIAL REGISTRATION DATE 19 February 2019. DATE OF FIRST PATIENT’S ENROLMENT 28 October 2019.
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Affiliation(s)
- L Boudry
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - I Mateizel
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - K Wouters
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - E Papaleo
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Mackens
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - M De Vos
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - A Racca
- Department of Gynaecology and Reproductive Medicine, Instituto Bernabeu Venezia, Venezia, Italy
| | - T Adriaenssens
- Laboratory of Follicle Biology, Vrije Universiteit Brussel, Brussels, Belgium
| | - H Tournaye
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - C Blockeel
- Brussels IVF, Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Clinck I, Mertens J, Wouters K, Dirinck E, De Block C. Insulin resistance and CGM-derived parameters in people with type 1 diabetes: are they associated? J Clin Endocrinol Metab 2024:dgae015. [PMID: 38198792 DOI: 10.1210/clinem/dgae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/12/2024]
Abstract
BACKGROUND Insulin resistance (IR) is increasingly more prevalent in people with type 1 diabetes (T1D). We investigated whether IR is associated with continuous glucose monitor (CGM)-derived parameters (glucometrics) such as time in range (TIR), time above range (TAR), time below range (TBR) and glycaemic variability (CV). METHODS This is a retrospective analysis of two databases: IR was quantified according to the estimated glucose disposal rate (eGDR) (NCT04664036) and by performing a hyperinsulinaemic-euglycaemic clamp (HEC) (NCT04623320). All glucometrics were calculated over 28 days. RESULTS A total of 287 subjects were included. Mean age was 46 ± 17 years, 55% were male, TIR was 57 ± 14% and eGDR was 7.6 (5.6 - 9.3) mg/kg min. The tertile of people with the lowest eGDR (highest level of IR) had a higher TAR compared to the tertile with the highest eGDR (39 ± 15% versus 33 ± 14, p = 0.043). Using logistic regression, a higher eGDR was associated with a higher chance to fall in a higher TIR- (OR 1.251, p < 0.001), a lower TAR- (OR 1.281, p < 0.001) and a higher TBR-tertile (OR 0.893, p = 0.039), adjusted for age, sex, diabetes duration, smoking status and alcohol intake. In the 48 people undergoing a HEC, no significant association between glucometrics and the HEC-determined glucose disposal rate (M-value) was observed. CONCLUSION In people with T1D, an association between IR, measured by eGDR, and worse CGM profiles was observed.
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Affiliation(s)
- Isabel Clinck
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium
| | - Jonathan Mertens
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Medicine and Paediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium
| | - Kristien Wouters
- Clinical Trial Centre (CTC), CRC Antwerp, Antwerp University Hospital, Edegem, Belgium
| | - Eveline Dirinck
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Medicine and Paediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium
| | - Christophe De Block
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Medicine and Paediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Faculty of Medicine & Health Sciences, Antwerp, Belgium
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Lauwers P, Wouters K, Vanoverloop J, Avalosse H, Hendriks JMH, Nobels F, Dirinck E. The impact of diabetes on mortality rates after lower extremity amputation. Diabet Med 2024; 41:e15152. [PMID: 37227722 DOI: 10.1111/dme.15152] [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: 01/31/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To assess the impact of diabetes, amputation level, sex and age on mortality rates after lower extremity amputation (LEA) in Belgium, and to assess temporal trends in one-year survival rates from 2009 to 2018. METHODS Nationwide data on individuals who underwent minor and major LEA from 2009 to 2018 were collected. Kaplan-Meier survival curves were constructed. A Cox regression model with time-varying coefficients was used to estimate the likelihood of mortality after LEA in individuals with or without diabetes. Matched amputation-free individuals with or without diabetes were used for comparison. Time trends were analysed. RESULTS Amputations 41,304 were performed: 13,247 major and 28,057 minor. Five-year mortality rates in individuals with diabetes were 52% and 69% after minor and major LEA, respectively (individuals without diabetes: 45% and 63%, respectively). In the first six postoperative months, no differences in mortality rates were found between individuals with or without diabetes. Later, hazard ratios (HRs) for mortality in individuals with diabetes (compared with no diabetes) after minor LEA ranged from 1.38 to 1.52, and after major LEA from 1.35 to 1.46 (all p ≤ 0.005). Among individuals without LEA, HRs for mortality in diabetes (versus no diabetes) were systematically higher compared to the HRs for mortality in diabetes (versus no diabetes) after minor and major LEA. One-year survival rates did not change for individuals with diabetes. CONCLUSIONS In the first six postoperative months, mortality rates after LEA were not different between individuals with or without diabetes; later, diabetes was significantly associated with increased mortality. However, as HRs for mortality were higher in amputation-free individuals, diabetes impacts mortality less in the minor and major amputation groups relative to the comparison group of individuals without LEA.
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Affiliation(s)
- Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Antwerp University Hospital, Clinical Trial Center (CTC), CRC Antwerp, Edegem, Belgium
| | - Johan Vanoverloop
- IMA/AIM (Intermutualistisch Agentschap/Agence Intermutualiste), Brussels, Belgium
| | - Hervé Avalosse
- IMA/AIM (Intermutualistisch Agentschap/Agence Intermutualiste), Brussels, Belgium
- Landsbond der Christelijke Mutualiteiten/Alliance Nationale des Mutualités Chrétiennes, Brussels, Belgium
| | - Jeroen M H Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Frank Nobels
- Department of Endocrinology, Onze Lieve Vrouw Ziekenhuis Aalst, Aalst, Belgium
| | - Eveline Dirinck
- Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Edegem, Belgium
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Lauwers P, Hendriks JMH, Wouters K, Vanoverloop J, Avalosse H, Dirinck E, Nobels F. Impact of diabetes on medical costs in the pre- and postoperative year of lower extremity amputations in Belgium. Diabetes Res Clin Pract 2024; 207:111072. [PMID: 38142745 DOI: 10.1016/j.diabres.2023.111072] [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: 09/27/2023] [Revised: 12/10/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
AIMS To compare the medical costs of individuals undergoing lower extremity amputation (LEA) in Belgium with those of amputation-free individuals. METHODS Belgian citizens undergoing LEAs in 2014 were identified. The median costs per capita in euros for the 12 months preceding and following minor and major LEAs were compared with those of matched amputation-free individuals. RESULTS A total of 3324 Belgian citizens underwent LEAs (2295 minor, 1029 major), 2130 of them had diabetes. The comparison group included 31,716 individuals. Amputation was associated with high medical costs (individuals with diabetes: major LEA €49,735, minor LEA €24,243, no LEA €2,877 in the year preceding amputation; €45,740, €21,445 and €2,284, respectively, in the post-amputation year). Significantly higher costs were observed in the individuals with (versus without) diabetes in all groups. This difference diminished with higher amputation levels. Individuals undergoing multiple LEAs generated higher costs (individuals with diabetes: €39,313-€89,563 when LEAs preceded index amputation; €46,629-€92,877 when LEAs followed index amputation). Individuals dying in the year after a major LEA generated remarkably lower costs. CONCLUSIONS LEA-related medical costs were high. Diabetes significantly impacted costs, but differences in costs diminished with higher amputation levels. Individuals with multiple amputations generated the highest costs.
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Affiliation(s)
- Patrick Lauwers
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Drie Eikenstraat 655, B-2650 Edegem, Belgium; University of Antwerp, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Universiteitsplein 1, B-2610 Wilrijk, Belgium.
| | - Jeroen M H Hendriks
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Drie Eikenstraat 655, B-2650 Edegem, Belgium; University of Antwerp, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - Kristien Wouters
- Antwerp University Hospital, Clinical Trial Centre (CTC), CRC Antwerp, Drie Eikenstraat 655, B-2650 Edegem, Belgium
| | - Johan Vanoverloop
- Intermutualistisch Agentschap/Agence Intermutualiste (IMA/AIM), Bolwerklaan 21 B 7, B-1210 Brussels, Belgium
| | - Hervé Avalosse
- Intermutualistisch Agentschap/Agence Intermutualiste (IMA/AIM), Bolwerklaan 21 B 7, B-1210 Brussels, Belgium; Landsbond der Christelijke Mutualiteiten/Alliance Nationale des Mutualités Chrétiennes, Haachtsesteenweg 579 B 40, B-1031 Brussels, Belgium
| | - Eveline Dirinck
- Antwerp University Hospital, Department of Endocrinology, Diabetology and Metabolism, Drie Eikenstraat 655, B-2650 Edegem, Belgium; University of Antwerp, Laboratory of Experimental Medicine and Paediatrics (LEMP), Universiteitsplein 1, B-2610 Wilrijk, Belgium
| | - Frank Nobels
- Onze Lieve Vrouw Ziekenhuis Aalst, Department of Endocrinology, Moorselbaan 164, B-9300 Aalst, Belgium
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Vloeberghs V, De Munck N, Racca A, Mateizel I, Wouters K, Tournaye H. Enzymatic tissue processing after testicular biopsy in non-obstructive azoospermia enhances sperm retrieval. Hum Reprod Open 2023; 2023:hoad039. [PMID: 37936829 PMCID: PMC10627277 DOI: 10.1093/hropen/hoad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/01/2023] [Indexed: 11/09/2023] Open
Abstract
STUDY QUESTION What is the added value of enzymatic processing of testicular biopsies on testicular sperm retrieval (SR) rates for patients with non-obstructive azoospermia (NOA)? SUMMARY ANSWER In addition to mechanical mincing, enzymatic digestion increased SR rates in testicular biopsies of NOA patients. WHAT IS KNOWN ALREADY Many studies focus on the surgical approach to optimize recovery of testicular sperm in NOA, and in spite of that, controversy still exists about whether the type of surgery makes any difference as long as multiple biopsies are taken. Few studies, however, focus on the role of the IVF laboratory and the benefit of additional lab procedures, e.g. enzymatic digestion, in order to optimize SR rates. STUDY DESIGN SIZE DURATION This retrospective single-center cohort study included all patients who underwent their first testicular sperm extraction (TESE) by open multiple-biopsy method between January 2004 and July 2022. Only patients with a normal karyotype, absence of Y-q deletions and a diagnosis of NOA based on histology were included. The primary outcome was SR rate after mincing and/or enzymes. The secondary outcome was cumulative live birth (CLB) after ICSI with fresh TESE and subsequent ICSI cycles with frozen TESE. PARTICIPANTS/MATERIALS SETTING METHODS Multiple biopsies were obtained from the testis, unilaterally or bilaterally, on the day of oocyte retrieval. Upon mechanical mincing, biopsies were investigated for 30 min; when no or insufficient numbers of spermatozoa were observed, enzymatic treatment was performed using Collagenase type IV. Multivariable regression analysis was performed to predict CLB per TESE by adjusting for the following confounding factors: male FSH level, female age, and requirement of enzymatic digestion to find sperm. MAIN RESULTS AND THE ROLE OF CHANCE We included 118 patients, of whom 72 (61.0%) had successful SR eventually. Spermatozoa were retrieved after mechanical mincing for 28 patients (23.7%; 28/118) or after additional enzymatic digestion for another 44 patients (37.2%; 44/118). Thus, of the 90 patients requiring enzymatic digestion, sperm were retrieved for 44 (48.9%). Male characteristics were not different between patients with SR after mincing or enzymatic digestion, in regard to mean age (34.5 vs 34.5 years), testis volume (10.2 vs 10.6 ml), FSH (17.8 vs 16.9 IU/l), cryptorchidism (21.4 vs 34.1%), varicocele (3.6 vs 4.6%), or histological diagnosis (Sertoli-cell only 53.6 vs 47.7%, maturation arrest 21.4 vs 38.6%, sclerosis/atrophy 25.0 vs 13.6%).Of the 72 patients with sperm available for ICSI, 23/72 (31.9%) achieved a live birth (LB) after the injection with fresh testicular sperm (and fresh or frozen embryo transfers). Of the remaining 49 patients without LB, 34 (69.4%) had supernumerary testicular sperm frozen. Of these 34 patients, 19 (55.9%) continued ICSI with frozen testicular sperm, and 9/19 (47.4%) had achieved an LB after ICSI with frozen testicular sperm. Thus, the total CLB was 32/118 (27.1%) per TESE or 32/72 (44.4%) per TESE with sperm retrieved.Of the female characteristics (couples with sperm available), only female age (30.3 vs 32.7 years; P = 0.042) was significantly lower in the group with a LB, compared to those without.The CLB with testicular sperm obtained after enzymatic digestion was 31.8% (14/44), while the CLB with sperm obtained after mincing alone was 64.3% (18/28). Multivariable logistic regression analysis showed that when enzymatic digestion was required, it was associated with a significant decrease in CLB per TESE (OR: 0.23 (0.08-0.7); P = 0.01). LIMITATIONS REASONS FOR CAUTION Limitations of the study are related to the retrospective design. However, the selection of only patients with NOA, and specific characteristics (normal karyotype and absence Y-q deletion) and having their first TESE, strengthens our findings. WIDER IMPLICATIONS OF THE FINDINGS Enzymatic processing increases the SR rate from testicular biopsies of NOA patients compared to mechanical mincing only, demonstrating the importance of an appropriate laboratory protocol. However, NOA patients should be counseled that when sperm have been found after enzymatic digestion, their chances to father a genetically own child may be lower compared to those not requiring enzymatic digestion. STUDY FUNDING/COMPETING INTERESTS None reported. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- V Vloeberghs
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - N De Munck
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - A Racca
- Department of Obstetrics, Gynaecology and Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - I Mateizel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - K Wouters
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - H Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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8
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de Bruyn B, Ní Dhubhghaill S, Claerhout I, Claes K, Deconinck A, Delbeke H, Huizing M, Krolo I, Muijzer M, Oellerich S, Roels D, Termote K, Van den Bogerd B, Van Gerwen V, Verhaegen I, Wisse R, Wouters K, Consortium TBC, Duchesne B, Koppen C. Belgian Endothelial Surgical Transplant of the Cornea (BEST cornea) protocol: clinical and patient-reported outcomes of Ultra-Thin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) versus Descemet Membrane Endothelial Keratoplasty (DMEK) - a multicentric, randomised, parallel group pragmatic trial in corneal endothelial decompensation. BMJ Open 2023; 13:e072333. [PMID: 37714670 PMCID: PMC10510864 DOI: 10.1136/bmjopen-2023-072333] [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: 02/08/2023] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVES Corneal blindness is the third most frequent cause of blindness globally. Damage to the corneal endothelium is a leading indication for corneal transplantation, which is typically performed by lamellar endothelial keratoplasty. There are two conventional surgical techniques: Ultra-Thin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) and Descemet Membrane Endothelial Keratoplasty (DMEK). The purpose of this study is to compare both techniques. METHODS AND ANALYSIS The trial compares UT-DSAEK and DMEK in terms of clinical and patient reported outcomes using a pragmatic, parallel, multicentric, randomised controlled trial with 1:1 allocation with a sample size of 220 participants across 11 surgical centres. The primary outcome is the change in best-corrected visual acuity at 12 months. Secondary outcomes include corrected and uncorrected vision, refraction, proportion of high vision, quality of life (EQ-5D-5L and VFQ25), endothelial cell counts and corneal thickness at 3, 6 and 12 months follow-up appointments. Adverse events will also be compared 12 months postoperatively. ETHICS AND DISSEMINATION The protocol was reviewed by ethical committees of 11 participating centres with the sponsor centre issuing the final definitive approval. The results will be disseminated at clinical conferences, by patient partner groups and open access in peer-reviewed journals. GOVERNANCE OF THE TRIAL Both, trial management group and trial steering committee, are installed with representatives of all stakeholders involved including surgeons, corneal bankers, patients and external experts. TRIAL REGISTRATION NUMBER NCT05436665.
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Affiliation(s)
- Barbara de Bruyn
- Ophthalmology, University Hospital Antwerp, Edegem, Belgium
- Faculty of Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Sorcha Ní Dhubhghaill
- Ophthalmology, University Hospital Antwerp, Edegem, Belgium
- Ophtalmology, UZ Brussel, Brussel, Belgium
| | - Ilse Claerhout
- Ophtalmology, AZ Maria Middelares, Sint-Niklaas, Belgium
- Faculty of Health Sciences, Ghent University, Gent, Belgium
| | - Kim Claes
- Ophthalmology, University Hospital Antwerp, Edegem, Belgium
| | - Ann Deconinck
- Clinical Research Centre, University Hospital Antwerp, Edegem, Belgium
| | - Heleen Delbeke
- Ophthalmology, KU Leuven University Hospitals, Leuven, Belgium
- Health Sciences, KU Leuven Biomedical Sciences Group, Leuven, Belgium
| | - Manon Huizing
- Cell and Tissue Bank, University Hospital Antwerp, Edegem, Belgium
- Faculty of Health Sciences, University Hospital Antwerp, Edegem, Belgium
| | - Iva Krolo
- Ophtalmology, UZ Brussel, Brussel, Belgium
| | - Marc Muijzer
- Ophtalmology, University Medical Centre, Utrecht, The Netherlands
| | - Silke Oellerich
- Ophthalmology, Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands
| | - Dimitri Roels
- Faculty of Health Sciences, Ghent University, Gent, Belgium
- Ophthalmology, University Hospital Ghent, Gent, Belgium
| | - Karolien Termote
- Ophtalmology, UZ Brussel, Brussel, Belgium
- Ophthalmology, Imelda Hospital, Bonheiden, Belgium
| | | | - Veerle Van Gerwen
- Clinical Research Centre, University Hospital Antwerp, Edegem, Belgium
| | - Iris Verhaegen
- Clinical Trial Centre, Antwerp University Hospital, Edegem, Belgium
| | - Robert Wisse
- Ophtalmology, University Medical Centre, Utrecht, The Netherlands
| | - Kristien Wouters
- Clinical Research Centre, University Hospital Antwerp, Edegem, Belgium
| | | | - Bernard Duchesne
- Ophtalmology, Central University Hospital, Liege, Belgium
- Faculty of Health Sciences, University of Liege, Liege, Belgium
| | - Carina Koppen
- Ophthalmology, University Hospital Antwerp, Edegem, Belgium
- Faculty of Health Sciences, University of Antwerp, Antwerp, Belgium
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9
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Heyrman B, Meers S, De Becker A, Wouters K, Van Hoof A, Van De Velde A, Graux C, Mazure D, Selleslag D, Maes H, Lemmens J, Beckers M, Breems D, Sid S, Berneman Z, Anguille S. Disease Perception Is Correlated with Health-Related Quality of Life in Patients Suffering from Myelodysplastic Syndromes: Results of the Belgian Be-QUALMS Study. Cancers (Basel) 2023; 15:3296. [PMID: 37444406 DOI: 10.3390/cancers15133296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Patients with myelodysplastic syndromes suffer from an impaired quality of life that is only partially explained by physical symptoms. In an observational study, we aimed to investigate the impact of current MDS treatments and the influence of disease perception on quality of life. Serial measurement of health-related quality of life was performed by 'the QUALMS', a validated MDS-specific patient reported outcome tool. Disease perception was evaluated by means of the Brief Illness Perception Questionnaire (B-IPQ). We prospectively collected data on 75 patients that started on a new treatment and could not demonstrate a significant change in QUALMS score or B-IPQ score during treatment. Six out of eight items evaluated in the B-IPQ correlated significantly with QUALMS score. In this small sample, no significant difference in QUALMS score was found between lower vs. higher risk MDS patients or other studied variables, e.g., targeted hemoglobin showed no correlation with QUALMS score. In daily practice attention must be paid to initial formation of disease perception as it correlates independently with health-related quality of life and does not change during treatment (clinicaltrials.gov identifier: NCT04053933).
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Affiliation(s)
- Bert Heyrman
- Ziekenhuis Netwerk Antwerpen, Department of Haematology, 2020 Antwerp, Belgium
| | - Stef Meers
- Algemeen Ziekenhuis KLINA, Department of Haematology, 2930 Brasschaat, Belgium
| | - Ann De Becker
- Department of Haematology, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium
| | - Kristien Wouters
- Clinical Trial Center (CTC), CRC Antwerp, Universitair Ziekenhuis Antwerpen, 2650 Edegem, Belgium
| | - Achiel Van Hoof
- Algemeen Ziekenhuis Damiaan, Department of Haematology, 8400 Ostend, Belgium
| | - Ann Van De Velde
- Department of Haematology, Universitair Ziekenhuis Antwerpen, 2650 Edegem, Belgium
- Department of Haematology, Heilig Hart Ziekenhuis, 2500 Lier, Belgium
| | - Carlos Graux
- Centre Hospitalier Universitaire UCL Mont-Godinne, Department of Haematology, 5500 Dinant, Belgium
| | - Dominiek Mazure
- Department of Haematology, Universitair Ziekenhuis Gent, 9000 Gent, Belgium
| | - Dominik Selleslag
- Department of Haematology, Algemeen Ziekenhuis Sint-Jan, 8000 Bruges, Belgium
| | - Helena Maes
- Imelda, Department of Haematology, 2820 Bonheiden, Belgium
| | - Jan Lemmens
- Gasthuiszusters Antwerpen, Department of Haematology, 2610 Wilrijk, Belgium
| | - Marielle Beckers
- Department of Haematology, Universitair Ziekenhuis Leuven, 3000 Leuven, Belgium
| | - Dimitri Breems
- Ziekenhuis Netwerk Antwerpen, Department of Haematology, 2020 Antwerp, Belgium
| | - Sélim Sid
- Department of Haematology, Cente Hospitalier Régional Verviers East Belgium, 4800 Verviers, Belgium
| | - Zwi Berneman
- Department of Haematology, Universitair Ziekenhuis Antwerpen, 2650 Edegem, Belgium
| | - Sébastien Anguille
- Department of Haematology, Universitair Ziekenhuis Antwerpen, 2650 Edegem, Belgium
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10
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Delombaerde D, De Sutter J, Croes L, Vervloet D, Moerman V, Van de Veire N, Willems AM, Wouters K, Peeters M, Prenen H, Vulsteke C. Extensive CArdioVAscular Characterization and Follow-Up of Patients Receiving Immune Checkpoint Inhibitors: A Prospective Multicenter Study. Pharmaceuticals (Basel) 2023; 16:ph16040625. [PMID: 37111382 PMCID: PMC10142365 DOI: 10.3390/ph16040625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The increasing use of immune checkpoint inhibitors (ICIs) in the treatment of both advanced and early stages of various malignancies has resulted in a substantial increase in the incidence of cardiovascular (CV) immune-related adverse events (irAEs). The current follow-up guidelines are based on anecdotal evidence and expert opinions, due to a lack of solid data and prospective studies. As many questions remain unanswered, cardiac monitoring, in patients receiving ICIs, is not always implemented by oncologists. Hence, an urgent need to investigate the possible short- and long-term CV effects of ICIs, as ICI approval is continuing to expand to the (neo)adjuvant setting. METHODS We have initiated a prospective, multicenter study, i.e., the CAVACI trial, in which a minimum of 276 patients with a solid tumor, eligible for ICI treatment, will be enrolled. The study consists of routine investigations of blood parameters (troponin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, in particular) and a thorough CV follow-up (electrocardiograms, transthoracic echocardiograms, and coronary calcium scoring) at fixed time points for a total period of two years. The primary endpoint is the cumulative incidence of troponin elevation in the first three months of ICI treatment, compared to baseline levels. Furthermore, secondary endpoints include incidence above the upper limit of normal of both troponin and NT-proBNP levels, evolution in troponin and NT-proBNP levels, the incidence of CV abnormalities/major adverse cardiac events, evaluation of associations between patient characteristics/biochemical parameters and CV events, transthoracic echocardiography parameters, electrocardiography parameters, and progression of coronary atherosclerosis. Recruitment of patients started in January 2022. Enrolment is ongoing in AZ Maria Middelares, Antwerp University Hospital, AZ Sint-Vincentius Deinze, and AZ Sint-Elisabeth Zottegem. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05699915, registered 26 January 2023.
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Affiliation(s)
- Danielle Delombaerde
- Integrated Cancer Center Ghent, Department of Medical Oncology, AZ Maria Middelares, 9000 Ghent, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, 2610 Wilrijk, Belgium
| | - Johan De Sutter
- Department of Cardiology, AZ Maria Middelares, 9000 Ghent, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Lieselot Croes
- Integrated Cancer Center Ghent, Department of Medical Oncology, AZ Maria Middelares, 9000 Ghent, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, 2610 Wilrijk, Belgium
| | | | | | - Nico Van de Veire
- Department of Cardiology, AZ Maria Middelares, 9000 Ghent, Belgium
- Department of Cardiology, Free University Brussels, 1000 Brussels, Belgium
| | | | - Kristien Wouters
- Antwerp University Hospital, Clinical Trial Center (CTC), CRC Antwerp, 2650 Edegem, Belgium
| | - Marc Peeters
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, 2610 Wilrijk, Belgium
- Multidisciplinary Oncologic Center Antwerp (MOCA), Antwerp University Hospital, 2650 Edegem, Belgium
| | - Hans Prenen
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, 2610 Wilrijk, Belgium
- Multidisciplinary Oncologic Center Antwerp (MOCA), Antwerp University Hospital, 2650 Edegem, Belgium
| | - Christof Vulsteke
- Integrated Cancer Center Ghent, Department of Medical Oncology, AZ Maria Middelares, 9000 Ghent, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, 2610 Wilrijk, Belgium
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11
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Van Landeghem E, Dielen S, Semaan A, Rotsaert A, Vanhamel J, Masquillier C, Wouters E, Wouters K, Vuylsteke B, Reyniers T, Nöstlinger C. Insights into barriers and facilitators in PrEP uptake and use among migrant men and transwomen who have sex with men in Belgium. BMC Public Health 2023; 23:712. [PMID: 37076823 PMCID: PMC10113984 DOI: 10.1186/s12889-023-15540-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/27/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND PrEP uptake is low among non-Belgian men and transwomen who have sex with men, although the HIV epidemic among men who have sex with men in Belgium is diversifying in terms of nationalities and ethnicity. We lack an in-depth understanding of this gap. METHODS We conducted a qualitative study using a grounded theory approach. The data consists of key informants interviews and in-depth interviews with migrant men or transwomen who have sex with men. RESULTS We identified four underlying determinants which shape our participants' experiences and contextualize the barriers to PrEP use. These include (1) the intersectional identities of being migrant and men and transwomen who have sex with men, (2) migration related stressors, (3) mental health and (4) socio-economic vulnerability. Identified barriers include: the accessibility of services; availability of information, social resources and providers' attitudes. These barriers influence PrEP acceptance and mediated by individual agency this influences their PrEP uptake. CONCLUSION An interplay of several underlying determinants and barriers impacts on PrEP uptake among migrant men and transwomen who have sex with men, illustrating a social gradient in access to PrEP. We need equitable access to the full spectrum of HIV prevention and care for all priority populations, including undocumented migrants. We recommend social and structural conditions that foster exercising these rights, including adapting PrEP service delivery, mental health and social support.
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Affiliation(s)
- Ella Van Landeghem
- Department of Public Health, Institute of Tropical Medicine Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Stef Dielen
- Department of Public Health, Institute of Tropical Medicine Nationalestraat 155, 2000, Antwerp, Belgium
| | - Aline Semaan
- Department of Public Health, Institute of Tropical Medicine Nationalestraat 155, 2000, Antwerp, Belgium
| | - Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine Nationalestraat 155, 2000, Antwerp, Belgium
| | - Jef Vanhamel
- Department of Public Health, Institute of Tropical Medicine Nationalestraat 155, 2000, Antwerp, Belgium
| | | | - Edwin Wouters
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Kristien Wouters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine Nationalestraat 155, 2000, Antwerp, Belgium
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine Nationalestraat 155, 2000, Antwerp, Belgium
| | - Christiana Nöstlinger
- Department of Public Health, Institute of Tropical Medicine Nationalestraat 155, 2000, Antwerp, Belgium
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Boudewyns A, van den Ende J, Peeters N, Van Camp G, Hofkens-Van den Brandt A, Van Schil K, Wouters K, Wuyts W. Targeted Next-Generation Sequencing in Children With Bilateral Sensorineural Hearing Loss: Diagnostic Yield and Predictors of a Genetic Cause. Otol Neurotol 2023; 44:360-366. [PMID: 36804529 DOI: 10.1097/mao.0000000000003841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To investigate the diagnostic yield of targeted next-generation sequencing using hearing loss panels and to identify patient-related factors that are associated with a definite genetic cause. STUDY DESIGN Retrospective chart review. SETTING Tertiary referral center. PATIENTS Children with congenital or late-onset, bilateral sensorineural hearing loss. INTERVENTIONS Diagnostic. MAIN OUTCOME MEASURES The number of patients with a definite genetic diagnosis. RESULTS We report on 238 patients with hearing loss: 130 were male and 108 were female. About 55% had congenital hearing loss. A genetic cause was identified in 94 of the patients (39.5%), with 72.3% of these showing nonsyndromic and 27.6% showing syndromic hearing loss. The diagnostic yield was highest among North African patients (66.7%). A multiple linear regression model shows that profound hearing loss, family history of hearing loss, congenital hearing loss, and North African ethnicity are significantly related to identifying a genetic cause. CONCLUSIONS Targeted next-generation sequencing using a panel of hearing loss genes identified a genetic diagnosis in almost 40% of children with bilateral sensorineural hearing loss. We describe the predictors of a genetic diagnosis, and this information may be used during genetic counseling.
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Affiliation(s)
| | - Jenneke van den Ende
- Department of Medical Genetics, Antwerp University Hospital and University of Antwerp
| | - Nils Peeters
- Department of Medical Genetics, Antwerp University Hospital and University of Antwerp
| | - Guy Van Camp
- Department of Medical Genetics, Antwerp University Hospital and University of Antwerp
| | | | - Kristof Van Schil
- Department of Medical Genetics, Antwerp University Hospital and University of Antwerp
| | - Kristien Wouters
- Clinical Trial Center, CRC Antwerp, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Wim Wuyts
- Department of Medical Genetics, Antwerp University Hospital and University of Antwerp
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13
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Haverals L, Roosens L, Wouters K, Marquet P, Monchaud C, Massart A, Abramowicz D, Hellemans R. Does the Tacrolimus Trough Level Adequately Predict Drug Exposure in Patients Requiring a High Tacrolimus Dose? Transplant Direct 2023; 9:e1439. [PMID: 37009168 PMCID: PMC10065838 DOI: 10.1097/txd.0000000000001439] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/08/2022] [Accepted: 12/01/2022] [Indexed: 04/04/2023] Open
Abstract
Tacrolimus (Tac) has a narrow therapeutic range. Dosing is generally targeted at Tac trough levels (C 0), notwithstanding conflicting reports on the correlation between Tac C 0 and systemic exposure measured by the area-under-the-concentration-over-time curve (AUC). The Tac dose required to meet the target C 0 varies highly among patients. We hypothesized that patients requiring a relatively high Tac dose for a certain C 0 may show a higher AUC. Methods We retrospectively analyzed data from 53 patients in which a 24-h Tac AUC24 estimation was performed at our center. Patients were divided into those taking a low (≤0.15 mg/kg) or high (>0.15 mg/kg) once-daily Tac dose. Multiple linear regression models were used to investigate if the association between C 0 and AUC24 changes according to dose level. Results Despite the large difference in mean Tac dose between the low- and high-dose group (7 versus 17 mg/d), C 0 levels were similar. However, the mean AUC24 was substantially higher in the high-dose group (320 ± 96 h·μg/L versus 255 ± 81 h·μg/L, P < 0.001). This difference remained significant after adjusting for age and race. For a same C 0, every 0.01 mg/kg increase in Tac dose resulted in an AUC24 increase of 3.59 h·μg/L. Conclusions This study challenges the general belief that C 0 levels are sufficiently reliable to estimate systemic drug exposure. We demonstrated that patients requiring a relatively high Tac dose to attain therapeutic C 0 levels have higher drug exposure and could therefore potentially be overdosed.
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Affiliation(s)
- Lien Haverals
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Laurence Roosens
- Department of Clinical and Biological Sciences, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Department of Statistics, Antwerp University Hospital, Edegem, Belgium
| | - Pierre Marquet
- Department of Pharmacology and Transplantation, University of Limoges, CHU Limoges, Limoges, France
| | - Caroline Monchaud
- Department of Pharmacology and Transplantation, University of Limoges, CHU Limoges, Limoges, France
| | - Annick Massart
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Edegem, Belgium
| | - Rachel Hellemans
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Edegem, Belgium
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14
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Philips C, Jacquemin L, Lammers MJ, Wouters K, Moyaert J, Vanderveken O, Van Rompaey V. Impact of hearing impairment and cochlear implantation on productivity and social well-being in a professionally active but severely hearing-impaired group: protocol of the 'Hear again, work again' longitudinal prospective cohort study. BMJ Open 2023; 13:e064514. [PMID: 36889821 PMCID: PMC10008330 DOI: 10.1136/bmjopen-2022-064514] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Severe hearing loss is a sensory deficit with considerable impact on the patient's daily life and on society. Previous research has established occupational obstacles in professionally active patients with hearing loss. However, studies investigating the impact of severe hearing loss and cochlear implantation (CI) on work performance using a quantitative and longitudinal study design and validated questionnaires are lacking. This study aims to answer the following research question: 'What is the impact of unilateral and bilateral severe hearing loss and CI on the cost for society, health state, employment, productivity and social well-being?'. We hypothesise hearing impairment to influence work performance. After establishing the impact, we will be able to enhance the support of hearing impaired patients to maintain employed. METHODS AND ANALYSIS A total of 200 professionally active adults between 18 and 65 years old with severe hearing loss will be included for assessment at baseline and reassessment at 3, 6 and 12 months. The following four study groups are included: bilateral severely hearing impaired participants without CI (1) and with CI (2) and unilateral severely hearing impaired participants in acute (3) and chronic (4) setting. The primary outcome of this study is the change in index score on the Work Limitations Questionnaire, which evaluates the degree of limitations and health-related productivity loss. Secondary outcome measures include audiometric and cognitive evaluations and validated questionnaires evaluating employment, work productivity, quality of life and direct healthcare costs. Linear mixed models will assess the evolution in time and the difference in evolution between groups. ETHICS AND DISSEMINATION This study protocol (project ID 2021-0306) received ethical approval from the ethics committee of the Antwerp University Hospital on 22 November 2021. Our findings will be disseminated by peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER NCT05196022.
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Affiliation(s)
- Cato Philips
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Laure Jacquemin
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Marc Jw Lammers
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Kristien Wouters
- Clinical Trail Center, Clinical Research Center Antwerp, Antwerp University Hospital, Edegem, Antwerp, Belgium
- Faculty of Medicine, University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Julie Moyaert
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Olivier Vanderveken
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Vincent Van Rompaey
- Experimental Laboratory of Translational Neurosciences and Dento-Otolaryngology, University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium
- Department of Otorhinolaryngology/Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
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15
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Van Dijck C, De Baetselier I, Kenyon C, Liesenborghs L, Vercauteren K, Van Esbroeck M, De Baetselier I, Kenyon C, Brosius I, Liesenborghs L, Van den Bossche D, Florence E, van Griensven J, Bottieau E, Soentjens P, Berens-Riha N, Vanbaelen T, Van Frankenhuijsen M, Vandenbruaene M, Huyst V, Wouters K, Apers L, Kint I, Caluwaerts S, Coppens J, Van Esbroeck M, Vercauteren K. Mpox screening in high-risk populations finds no asymptomatic cases. Lancet Microbe 2023; 4:e132-e133. [PMID: 36509096 PMCID: PMC9733947 DOI: 10.1016/s2666-5247(22)00357-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium.
| | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium; Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - Laurens Liesenborghs
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | | | - Koen Vercauteren
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
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16
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Hens M, Brosius I, Berens-Riha N, Coppens J, Van Gestel L, Rutgers J, Kenyon C, Soentjens P, van Henten S, Bracke S, Vanbaelen T, Vandenhoven L, Bottieau E, Vercauteren K, Van Esbroeck M, Liesenborghs L, Van Dijck C, Van Esbroeck M, Brosius I, Liesenborghs L, Van Gestel L, Rutgers J, Kenyon C, De Baetselier I, Coppens J, Van den Bossche D, Florence E, Vercauteren K, van Griensven J, Bottieau E, Soentjens P, Berens-Riha N, van Henten S, Bracke S, Vanbaelen T, Vandenhoven L, Van Frankenhuijsen M, Vandenbruaene M, Huyst V, Wouters K, Apers L, Kint I, Caluwaerts S, Vanroye F, Verschueren J, Ariën K. Characteristics of confirmed mpox cases among clinical suspects: A prospective single-centre study in Belgium during the 2022 outbreak. New Microbes New Infect 2023; 52:101093. [PMID: 36874154 PMCID: PMC9982023 DOI: 10.1016/j.nmni.2023.101093] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
Background The presentation of mpox clade IIb during the 2022 outbreak overlaps with a range of other diseases. Understanding the factors associated with mpox is important for clinical decision making. Methods We described the characteristics of mpox patients who sought care at Belgian sexual health clinic. Furthermore we compared their characteristics to those of patients with a clinical suspicion of mpox but who tested negative on polymerase chain reaction. Results Between May 23 and September 20, 2022, 155 patients were diagnosed with mpox, and 51 patients with suspected symptoms tested negative. All mpox patients self-identified as men and 148/155 (95.5%) as gay or bisexual MSM. Systemic symptoms were present in 116/155 (74.8%) patients. All but 10 patients (145/155, 93.5%) presented with skin lesions. Other manifestations were lymphadenopathy (72/155, 46.5%), proctitis (50/155, 32.3%), urethritis (12/155, 7.7%), tonsillitis (2/155, 1.3%). Complications involved bacterial skin infection (13/155, 8.4%) and penile oedema with or without paraphimosis (4/155, 2.6%). In multivariable logistic regression models, the presence of lymphadenopathy (OR 3.79 95% CI 1.44-11.49), skin lesions (OR 4.35 95% CI 1.15-17.57) and proctitis (OR 9.41 95% CI 2.72-47.07) were associated with the diagnosis of mpox. There were no associations with age, HIV status, childhood smallpox vaccination, number of sexual partners and international travel. Conclusions The presence of proctitis, lymphadenopathies and skin lesions should increase clinical suspicion of mpox in patients with compatible symptoms.
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Affiliation(s)
- Matilde Hens
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Nicole Berens-Riha
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Jasmine Coppens
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Liesbeth Van Gestel
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Jojanneke Rutgers
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Patrick Soentjens
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Saskia van Henten
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Stefanie Bracke
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Thibaut Vanbaelen
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Leen Vandenhoven
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Koen Vercauteren
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Laurens Liesenborghs
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium
| | - Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine, 2000 Antwerp, Belgium.,Laboratory of Medical Microbiology, University of Antwerp, Belgium
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17
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Lemoyne SEE, Van Bogaert P, Calle P, Wouters K, Deblick D, Herbots H, Monsieurs K. Transferring nursing home residents to emergency departments by emergency physician-staffed emergency medical services: missed opportunities to avoid inappropriate care? Acta Clin Belg 2023; 78:3-10. [PMID: 35234573 DOI: 10.1080/17843286.2022.2042644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The decision to transfer a nursing home (NH) resident to an emergency department (ED) is multifactorial and challenging but many of the emergency physician-staffed emergency medical service (EP-EMS) interventions and ED transfers are probably inappropriate. METHODS We conducted a retrospective, cross-sectional study in three EP-EMSs in Belgium over a period of three years. We registered indicators that are potentially associated with inappropriate transfers: patient characteristics, availability of written do not resuscitate (DNR) orders or treatment restrictions, involvement of a general practitioner (GP) and availability of transfer notes. We also explored the association between age, the Charlson Comordity Index (CCI), polypharmacy, dementia, and the availability of DNR documents. RESULTS We registered 308 EP-EMS interventions in NH residents. In 98% the caller was a health-care professional. In 75% there was no GP present and 40% had no transfer note. Thirty-two percentage of the patients had dementia, 45% had more than two comorbidities and 68% took five medications or more. In 6% cardiopulmonary resuscitation was performed. DNR orders were available in 25%. Eighty-eight percentage of the NH residents were transferred to the ED. Forty-four percent had a CCI >5. In patients of ≥90 years, with a CCI >5, with dementia and with polypharmacy, DNR orders were not available in 81%, 67%%,and 69%, respectively. CONCLUSIONS Improved EMS dispatch centre-NH caller interaction, more involvement of GP's, higher availability of DNR orders and better communication between GPs/NHs and EP-EMS could prevent inappropriate interventions, futile prehospital aactions,and ED transfers.
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Affiliation(s)
- Sabine E E Lemoyne
- Emergency Department, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care, University of Antwerp, Edegem, Belgium
| | - Paul Calle
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Kristien Wouters
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Dennis Deblick
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Hanne Herbots
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Kg Monsieurs
- Emergency Department, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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18
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Hellemans R, Bertels A, Wijtvliet V, Wouters K, Massart A, Bergs K, Matheeussen V, Abramowicz D. Is Polyomavirus-Associated Nephropathy More Common in Kidney Transplant Recipients Exposed to Valganciclovir? A Retrospective Single Center Analysis. Transplant Proc 2023; 55:123-128. [PMID: 36609024 DOI: 10.1016/j.transproceed.2022.10.063] [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] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/18/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND BK polyomavirus-associated nephropathy (PVAN) is a frequent complication in the early phase after kidney transplantation. The most important risk factor for PVAN is the intensity of immunosuppression. A recent study suggests that exposure to valganciclovir (VGC) could also be a risk factor. METHODS We performed a retrospective, single-center study to investigate the effect of valganciclovir exposure on the risk for PVAN during the first 100 days post transplant. Cytomegalovirus (CMV) seronegative recipients of a CMV seropositive donor kidney received VGC prophylaxis, whereas CMV seropositive recipients were managed by a pre-emptive CMV strategy. Cox regression analysis was used to identify risk factors for PVAN development with VGC treatment and strength of immunosuppressive therapy as time-dependent variables. RESULTS A total of 211 adults who received a kidney transplant between 2014 and 2019 were included. Eighteen (9%) developed PVAN. Multivariate regression analysis showed that women have a lower risk of developing PVAN (hazard ratio [HR] 0.08 (confidence interval [CI] 0.01-0.58), P = .013), whereas age was associated with an increased risk for PVAN (HR 1.04 for every additional year [CI 1.00-1.08], P = .029). There was a trend toward a lower risk of PVAN for patients on reduced immunosuppressive therapy (HR 0.44 [CI 0.15-1.24], P = .12). VGC use was not associated with the risk for PVAN (HR 0.99 [CI 0.35-2.78], P = .98). CONCLUSIONS In our study, VGC exposure was not associated with the risk for PVAN. Our study is the first to reassess in depth the hypothesis that VGC treatment increases the risk of PVAN. The unique strength of this study is the correction for the degree of immunosuppression and the statistical use of time-dependent covariates. This methodological approach can provide a foundation for further studies needed to confirm our findings.
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Affiliation(s)
- Rachel Hellemans
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium.
| | - Andrea Bertels
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Veerle Wijtvliet
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium
| | - Kristien Wouters
- Clinical Trial Center, Antwerp University Hospital, Edegem, Belgium
| | - Annick Massart
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Wilrijk, Belgium
| | - Kristof Bergs
- Department of Microbiology, Antwerp University Hospital, Edegem, Belgium
| | - Veerle Matheeussen
- Department of Microbiology, Antwerp University Hospital, Edegem, Belgium
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Edegem, Belgium; Clinical Trial Center, Antwerp University Hospital, Edegem, Belgium
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19
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Soares A, Edwards A, An D, Bagnoud A, Bradley J, Barnhart E, Bomberg M, Budwill K, Caffrey SM, Fields M, Gralnick J, Kadnikov V, Momper L, Osburn M, Mu A, Moreau JW, Moser D, Purkamo L, Rassner SM, Sheik CS, Sherwood Lollar B, Toner BM, Voordouw G, Wouters K, Mitchell AC. A global perspective on bacterial diversity in the terrestrial deep subsurface. Microbiology (Reading) 2023; 169:001172. [PMID: 36748549 PMCID: PMC9993121 DOI: 10.1099/mic.0.001172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/07/2022] [Indexed: 01/19/2023]
Abstract
While recent efforts to catalogue Earth's microbial diversity have focused upon surface and marine habitats, 12-20 % of Earth's biomass is suggested to exist in the terrestrial deep subsurface, compared to ~1.8 % in the deep subseafloor. Metagenomic studies of the terrestrial deep subsurface have yielded a trove of divergent and functionally important microbiomes from a range of localities. However, a wider perspective of microbial diversity and its relationship to environmental conditions within the terrestrial deep subsurface is still required. Our meta-analysis reveals that terrestrial deep subsurface microbiota are dominated by Betaproteobacteria, Gammaproteobacteria and Firmicutes, probably as a function of the diverse metabolic strategies of these taxa. Evidence was also found for a common small consortium of prevalent Betaproteobacteria and Gammaproteobacteria operational taxonomic units across the localities. This implies a core terrestrial deep subsurface community, irrespective of aquifer lithology, depth and other variables, that may play an important role in colonizing and sustaining microbial habitats in the deep terrestrial subsurface. An in silico contamination-aware approach to analysing this dataset underscores the importance of downstream methods for assuring that robust conclusions can be reached from deep subsurface-derived sequencing data. Understanding the global panorama of microbial diversity and ecological dynamics in the deep terrestrial subsurface provides a first step towards understanding the role of microbes in global subsurface element and nutrient cycling.
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Affiliation(s)
- A. Soares
- Department of Geography and Earth Sciences (DGES), Aberystwyth University (AU), Aberystwyth, UK
- Institute of Biology, Environmental and Rural Sciences (IBERS), AU, Aberystwyth, UK
- Department of Plant and Microbial Biology, University of Minnesota, Minneapolis, MN, USA
- Present address: Group for Aquatic Microbial Ecology (GAME), University of Duisburg-Essen, Campus Essen - Environmental Microbiology and Biotechnology, Universitätsstr. 5, 45141 Essen, Germany
| | - A. Edwards
- Institute of Biology, Environmental and Rural Sciences (IBERS), AU, Aberystwyth, UK
- Interdisciplinary Centre for Environmental Microbiology (iCEM), AU, Aberystwyth, UK
| | - D. An
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - A. Bagnoud
- Institut de Génie Thermique (IGT), Haute École d'Ingénierie et de Gestion du Canton de Vaud (HEIG-VD), Yverdon-les-Bains, Switzerland
| | - J. Bradley
- School of Geography, Queen Mary University of London, London, UK
| | - E. Barnhart
- U.S. Geological Survey (USGS), USA, Reston, VA, USA
- Center for Biofilm Engineering (CBE), Montana State University, Bozeman, MT, USA
| | - M. Bomberg
- VTT Technical Research Centre of Finland, Finland
| | | | | | - M. Fields
- Center for Biofilm Engineering (CBE), Montana State University, Bozeman, MT, USA
- Department of Microbiology & Immunology, MSU, Bozeman, MT, USA
| | - J. Gralnick
- Department of Plant and Microbial Biology, University of Minnesota, Minneapolis, MN, USA
| | - V. Kadnikov
- Institute of Bioengineering, Research Center of Biotechnology, Russian Academy of Sciences, Russia
| | - L. Momper
- Department of Earth, Atmospheric and Planetary Sciences (DEAPS), The Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - M. Osburn
- Department of Earth and Planetary Sciences, Northwestern University, Evanston, IL, USA
| | - A. Mu
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
- Doherty Applied Microbial Genomics, Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Melbourne, Australia
| | - J. W. Moreau
- School of Earth Sciences, The University of Melbourne, Parkville, Australia
| | - D. Moser
- Division of Hydrologic Sciences, Desert Research Institute (DRI), Las Vegas, NV, USA
| | - L. Purkamo
- VTT Technical Research Centre of Finland, Finland
- School of Earth and Environmental Sciences (SEES), University of St. Andrews, St. Andrews, UK
- Geological Survey of Finland (GTK), Finland
| | - S. M. Rassner
- Department of Geography and Earth Sciences (DGES), Aberystwyth University (AU), Aberystwyth, UK
- Interdisciplinary Centre for Environmental Microbiology (iCEM), AU, Aberystwyth, UK
| | - C. S. Sheik
- Large Lakes Observatory, University of Minnesota, Duluth, MN, USA
| | | | - B. M. Toner
- Department of Soil, Water & Climate, University of Minnesota, Minneapolis/Saint Paul, MN, USA
| | - G. Voordouw
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - K. Wouters
- Institute for Environment, Health and Safety (EHS), Belgian Nuclear Research Centre SCK•CEN, Mol, Belgium
| | - A. C. Mitchell
- Department of Geography and Earth Sciences (DGES), Aberystwyth University (AU), Aberystwyth, UK
- Interdisciplinary Centre for Environmental Microbiology (iCEM), AU, Aberystwyth, UK
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Ledeganck KJ, Van Eyck A, Wouters K, Vermeiren E, De Winter BY, Verhulst S, Van Hoorenbeeck K, France A, Dotremont H, den Brinker M, Trouet D. Urinary epidermal growth factor reflects vascular health in boys with either obesity or type 1 diabetes. A role for renin, or beyond? PLoS One 2023; 18:e0283716. [PMID: 36996194 PMCID: PMC10062545 DOI: 10.1371/journal.pone.0283716] [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] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 03/15/2023] [Indexed: 04/01/2023] Open
Abstract
An increased blood pressure is a known comorbidity of both type 1 diabetes (T1DM) and obesity in children. Increasing evidence suggests a subtle interplay between epidermal growth factor (EGF) and renin along the juxtaglomerular system, regulating the impact of blood pressure on kidney health and the cardiovascular system. In this study, we investigated the relation between urinary EGF, serum renin and blood pressure in children with obesity or T1DM. 147 non-obese children with T1DM and 126 children with obesity, were included. Blood pressure was measured and mean arterial pressure (MAP) and the pulse pressure (PP) were calculated. Serum renin and urinary EGF levels were determined with a commercial ELISA kit. Partial Spearman rank correlation coefficients and multiple linear regression models were used to study the association between renin, the urinary EGF/urinary creatinine ratio and blood pressure parameters. The urinary EGF/urinary creatinine ratio is correlated with the SBP and the MAP in boys with obesity as well as in boys with T1DM. Multiple regression analysis showed that sex and pulse pressure in male subjects were found to be independently associated with renin. Sex, the presence of diabetes, age, the glomerular filtration rate and both pulse pressure and mean arterial pressure in male subjects were independently associated with urinary EGF/urinary creatinine. In conclusion, in boys with either obesity or diabetes, pulse pressure and mean arterial pressure are negatively associated with the functional integrity of the nephron, which is reflected by a decreased expression of urinary EGF.
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Affiliation(s)
- Kristien J Ledeganck
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Annelies Van Eyck
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Clinical Trial Center, Clinical Research Center Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Eline Vermeiren
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
| | - Benedicte Y De Winter
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Stijn Verhulst
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Paediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Annick France
- Department of Paediatric Endocrinology, Antwerp University Hospital, Antwerp, Belgium
| | - Hilde Dotremont
- Department of Paediatric Endocrinology, Antwerp University Hospital, Antwerp, Belgium
| | - Marieke den Brinker
- Department of Paediatric Endocrinology, Antwerp University Hospital, Antwerp, Belgium
| | - Dominique Trouet
- Laboratory of Experimental Medicine and Paediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium
- Department of Paediatric Nephrology, Antwerp University Hospital, Antwerp, Belgium
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21
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Baudelet M, Duprez F, Van den Steen L, Nuyts S, Nevens D, Goeleven A, Vandenbruaene C, Massonet H, Vergauwen A, Bollen H, Deschuymer S, Wouters K, Peeters M, Van Laer C, Mariën S, Van den Brekel M, van der Molen L, Vauterin T, van Dinther J, Verstraete H, Hutsebaut I, Meersschout S, Vanderveken O, De Bodt M, Van Nuffelen G. Increasing Adherence to Prophylactic Swallowing Exercises During Head and Neck Radiotherapy: The Multicenter, Randomized Controlled PRESTO-Trial. Dysphagia 2022; 38:886-895. [PMID: 36121560 PMCID: PMC9484351 DOI: 10.1007/s00455-022-10513-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/15/2022] [Indexed: 12/02/2022]
Abstract
Background Prophylactic swallowing exercises (PSE) during radiotherapy can significantly reduce dysphagia after radiotherapy in head and neck cancer (HNC). However, its positive effects are hampered by low adherence rates during the burdensome therapy period. Hence, the main goal of this multicenter randomized controlled trial (RCT) was to investigate the effect of 3 different service-delivery modes on actual patients’ adherence. Methods A total of 148 oropharyngeal cancer patients treated with primary (chemo)radiotherapy were randomly assigned to a 4 weeks PSE program, either diary-supported (paper group; n = 49), app-supported (app group; n = 49) or therapist-supported (therapist group; n = 50). Participants practiced 5 days/week, daily alternating tongue strengthening exercises with chin tuck against resistance exercises. Adherence was measured as the percentage of completed exercise repetitions per week (%reps). Statistical analysis was performed by means of SPSSv27, using Linear Mixed-effects Models with post hoc pairwise testing and Bonferroni-Holm correction. Results Adherence and evolution of adherence over time was significantly different between the three groups (p < .001). Adherence rates decreased in all three groups during the 4 training weeks (p < .001). During all 4 weeks, the therapist group achieved the highest adherence rates, whilst the app group showed the lowest adherence rates. Conclusions PSE adherence decreased during the first 4 radiotherapy weeks regardless of group, but with a significant difference between groups. The therapist group achieved the highest adherence rates with a rather limited decline, therefore, increasing the face-to-face contact with a speech-language therapist can overcome the well-known problem of low adherence to PSE in this population. Trial Registration Trial registration: ISRCTN, ISRCTN98243550. Registered December 21, 2018 – retrospectively registered, https://www.isrctn.com/ISRCTN98243550?q=gwen%20van%20nuffelen&filters=&sort=&offset=1&totalResults=2&page=1&pageSize=10&searchType=basic-search.
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Affiliation(s)
- Margot Baudelet
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium. .,Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Fréderic Duprez
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Antwerp University Hospital, Antwerp, Belgium
| | - Sandra Nuyts
- University Hospital Leuven, Louvain, Belgium.,KU Leuven, Louvain, Belgium
| | - Daan Nevens
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium.,Iridium Network, Antwerp, Belgium
| | - Ann Goeleven
- University Hospital Leuven, Louvain, Belgium.,KU Leuven, Louvain, Belgium
| | | | - Hanne Massonet
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,KU Leuven, Louvain, Belgium
| | | | - Heleen Bollen
- University Hospital Leuven, Louvain, Belgium.,KU Leuven, Louvain, Belgium
| | - Sarah Deschuymer
- Department of Radiation Oncology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.,KU Leuven, Louvain, Belgium
| | - Kristien Wouters
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Marc Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Carl Van Laer
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Steven Mariën
- Antwerp University Hospital, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Michiel Van den Brekel
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Joost van Dinther
- Department of ENT-HNS, European Institute for ORL-HNS, Sint-Augustinus Hospital, GZA, Antwerp, Belgium
| | - Hilde Verstraete
- Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium.,Iridium Network, Antwerp, Belgium
| | | | | | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Antwerp University Hospital, Antwerp, Belgium.,Multi-Disciplinary Oncology Center Antwerp, Antwerp, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Antwerp, Belgium.,Antwerp University Hospital, Antwerp, Belgium
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22
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Van Goethem S, Boogaerts H, Cuykx M, van den Bremen P, Wouters K, Goossens H, Jansens H, Ten Kate GL. Follow-up blood cultures in Staphylococcus aureus bacteremia: a probability-based optimization. Eur J Clin Microbiol Infect Dis 2022; 41:1263-1268. [PMID: 36066759 DOI: 10.1007/s10096-022-04487-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/26/2022] [Indexed: 11/26/2022]
Abstract
Staphylococcus aureus bacteremia (SAB) is a relevant finding which prompts a thorough diagnostic work-up. Follow-up blood cultures (BC) are essential in this work-up. We investigate the probability of detecting an ongoing bacteremia after initiation of active therapy according to the number of BC taken at key time points. A retrospective analysis of all patients with SAB in a 6-year period was performed. Total number of BCs taken and the positivity was registered for each day after start of therapy. A positivity-rate was corrected using a logistic mixed effects model. Observed detection frequencies were applied to calculate detection probabilities using binomial distributions. Three hundred and seventeen cases were withheld for analysis. A BC bottle positivity rate of 66.7% was found 1 day after initiation of active therapy, which decreased to 48.5% on day 4. When using 1 set of FU-BC, 73.4% of persisting SABs are detected. To maintain a probability of detection of ≥ 90%, 2 BC sets should be taken on day 2 and day 4 after start of therapy. In 10 of 109 patients with positive FU-BC, skip phenomena were registered, with a significant higher proportion in patients with < 4 BC bottles taken (14%) than when ≥ 4 BC bottles were taken (4.1%). We recommend taking 2 BC sets on days 2 and 4 after start of therapy in order to detect ≥ 90% of persisting SABs, limiting skip phenomena and blood volume required. We strongly advice against taking a single BC set as follow-up for SAB.
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Affiliation(s)
- Sam Van Goethem
- Laboratory of Medical Microbiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.
| | - Hélène Boogaerts
- Laboratory of Medical Microbiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Matthias Cuykx
- Laboratory of Medical Microbiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | | | - Kristien Wouters
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Hilde Jansens
- Laboratory of Medical Microbiology, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Gerrit Luit Ten Kate
- Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.
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23
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Lauwers P, Wouters K, Vanoverloop J, Avalosse H, Hendriks J, Nobels F, Dirinck E. Temporal trends in major, minor and recurrent lower extremity amputations in people with and without diabetes in Belgium from 2009 to 2018. Diabetes Res Clin Pract 2022; 189:109972. [PMID: 35760154 DOI: 10.1016/j.diabres.2022.109972] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/14/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
AIMS This study assessed temporal trends in the incidence of lower extremity amputations (LEA) in Belgium from 2009 to 2018, and subsequent secondary amputation rates. METHODS Nationwide data on LEA were collected. Sex- and age-adjusted annual incidence rates were calculated. Time trends were analysed in negative binomial models. The incidence of secondary interventions, defined as either any ipsilateral reamputation or any contralateral amputation, was studied with death as competing risk. RESULTS 41 304 amputations were performed (13 247 major, 28 057 minor). In individuals with diabetes, the amputation rate (first amputation per patient per year) decreased from 143.6/100.000 person-years to 109.7 (IRR 0.97 per year, 95 %CI 0.96-0.98, p < 0.001). The incidence of major LEAs decreased from 56.2 to 30.7 (IRR 0.93, 95 %CI 0.91-0.94, p < 0.001); the incidence of minor amputations showed a non-significant declining trend in women (54.3 to 45.0/100 000 person years, IRR 0.97 per year, 95 %CI 0.96-0.99), while this remained stable in men with diabetes (149.2 to 135.3/100 000 person years, IRR 1.00 per year, 95 %CI 0.98-1.01). In individuals without diabetes, the incidence of major amputation didn't change significantly, whereas minor amputation incidence increased (8.0 to 10.6, IRR 1.04, 95 %CI 1.03-1.05, p < 0.001). In individuals with diabetes, one-year secondary intervention rates were high (31.3% after minor, 18.4% after major LEA); the incidence of secondary amputations didn't change. CONCLUSIONS A significant decline in the incidence rate of major LEA was observed in people with diabetes. This decline was not accompanied by a significant rise in minor LEA. The incidence of secondary interventions remained stable.
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Affiliation(s)
- Patrick Lauwers
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Drie Eikenstraat 655, B 2650 Edegem, Belgium.
| | - Kristien Wouters
- Antwerp University Hospital, Clinical Trial Center (CTC), CRC Antwerp, Drie Eikenstraat 655, B 2650 Edegem, Belgium
| | - Johan Vanoverloop
- IMA/AIM (Intermutualistisch Agentschap/Agence Intermutualiste), Bolwerklaan 21 B 7, 1210 Brussels, Belgium
| | - Hervé Avalosse
- IMA/AIM (Intermutualistisch Agentschap/Agence Intermutualiste), Bolwerklaan 21 B 7, 1210 Brussels, Belgium; Landsbond der Christelijke Mutualiteiten/Alliance Nationale des Mutualités Chrétiennes, Haachtsesteenweg 579 B 40, B 1031 Brussels, Belgium
| | - Jeroen Hendriks
- Antwerp University Hospital, Department of Thoracic and Vascular Surgery, Drie Eikenstraat 655, B 2650 Edegem, Belgium
| | - Frank Nobels
- Onze Lieve Vrouw Ziekenhuis Aalst, Department of Endocrinology, Moorselbaan 164, B 9300 Aalst, Belgium
| | - Eveline Dirinck
- Antwerp University Hospital, Department of Endocrinology, Diabetology and Metabolism, Drie Eikenstraat 655, B 2650 Edegem, Belgium
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24
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Wouters K, Regin M, Segers I, De Vos A, Van Landuyt L, Tournaye H, Verheyen G, Van de Velde H, De Munck N. P-253 Shorter duration of compaction during human in-vitro preimplantation embryo development is associated with a higher clinical pregnancy rate. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.243] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is the duration of compaction, KID- (Known Implantation Data) and iDAScore (Intelligent Data Analysis for embryo evaluation) associated to clinical pregnancy rate?
Summary answer
Duration of compaction, KID- or iDAScore can be used to select the best embryo for transfer to increase clinical pregnancy rate.
What is known already
The development of human preimplantation embryos follows a programmed timeline in which a series of critical events occur. Compaction is a typical event at 3 to 4 days post fertilisation that is characterised by flattening of the blastomeres and the formation of tight junctions between the blastomeres. It is considered the first morphological event in the differentiation process of the embryo. Time-lapse technology introduced continuous monitoring of the embryo throughout development in the IVF laboratory. Evaluation of the developmental events combined with calculating KID- and iDAScore can optimise the selection of the most competent embryos for transfer and/or cryopreservation.
Study design, size, duration
This single-centre retrospective observational study included 158 IVF/ICSI cycles with fresh single embryo transfer (SET) was performed between December 2018 and November 2021. Embryos were cultured during 5 days in cleavage/blastocyst medium (Coopersurgical) in the EmbryoScope + (Vitrolife). Transferred embryos were evaluated for start of compaction, time to full compaction and duration of compaction. Embryo quality was calculated using KID- and iDAScore. These parameters were compared between the clinically pregnant and non-pregnant group (primary outcome).
Participants/materials, setting, methods
Only IVF/ICSI cycles with ejaculated sperm and fresh SET on day 5 were included. MNC, IVM and PGT cycles were excluded. Time zero was the start of injection or insemination. Pregnancy was confirmed by hCG and clinical pregnancy was defined by gestational sac visualisation at ultrasound.
GraphPad Prism and R-studio were used for statistical analysis. For prediction of clinical pregnancy, univariate logistic regression was used. Other significant differences were determined using t-test.
Main results and the role of chance
Out of 158 fresh ET, 101 (63.9%) had a positive hCG, of which 88 (55.6%) achieved clinical pregnancy. All 158 transferred blastocysts were annotated to calculate KID- and iDAScore.
There was no statistical difference in age between the two groups (34.7 years vs 35.0 years; p = 0.69).
Start of compaction was heterogeneous (between 50.9 and 98.3 hours post injection/insemination; mean=76.5±7.7), as well as the blastomere number at its initiation (between 4 and 16 blastomeres; mean=11.8±2.1).
Univariate logistic regression showed that each individual parameter, i.e. duration of compaction (p = 0.02), KID-score (p = 0.001) and iDAScore (p = 0.0006) was different between the clinically pregnant and non-pregnant group.
The total duration of compaction was significantly shorter in the clinical pregnant group (mean=8.6±3.4 hours vs 10.2±4.7 hours; p = 0.01; t-test). In the pregnant group the KIDscore (mean=7.7±1.4 vs 6.7±2.3; p = 0.0007) and iDAScore (mean=8.9±0.7 vs 8.3±1.3; p = 0.0002) were significantly higher.
During partial compaction, cells were rather excluded (93%) than extruded from the process; 17 embryos underwent this process, 10 of which resulted in a clinical pregnancy.
Limitations, reasons for caution
As this is a retrospective study, the influence of uncontrolled variables cannot be excluded. In the future, different models will be applied that can combine duration of compaction, KID- and iDAScore in a larger study.
Wider implications of the findings
Our analysis confirms previous findings that KID- and iDAScore are good predictors of clinical pregnancy.
We also show that duration of compaction can be used as a potential predictor for pregnancy, especially in IVF clinics that have no access to KID- or iDAScore.
Trial registration number
not applicable
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Affiliation(s)
- K Wouters
- UZ Brussel, Brussels IVF , Brussel, Belgium
| | - M Regin
- Vrije Universiteit Brussel, Reproduction and Genetics , Brussels, Belgium
| | - I Segers
- UZ Brussel, Brussels IVF , Brussel, Belgium
| | - A De Vos
- UZ Brussel, Brussels IVF , Brussel, Belgium
| | | | - H Tournaye
- UZ Brussel, Brussels IVF , Brussel, Belgium
| | - G Verheyen
- UZ Brussel, Brussels IVF , Brussel, Belgium
| | | | - N De Munck
- UZ Brussel, Brussels IVF , Brussel, Belgium
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25
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He P, Hariharan R, Karpavičiūtė N, Croft N, Firminger L, Chambost J, Jacques C, Saravelos S, Wouters K, Fréour T, Zaninovic N, Malmsten J, Vasconcelos F, Hickman C. O-177 Towards 3D Reconstructions of Human Preimplantation Embryo Development. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.091] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Can we use focal stacks collected through Hoffman modulation contrast (HMC) microscopy to generate 3D reconstructions of preimplantation embryos?
Summary answer
A machine learning system was designed to generate 3D meshes that approximate the structures of embryos captured on HMC microscopes up to the 8-cell stage.
What is known already
The 3D arrangement of cells in preimplantation human embryos is a topic of clinical interest, with significant associations between the cell arrangement and blastulation potential from as early as the 4-cell stage. In basic research, the use of confocal microscopy for generating 3D reconstructions is commonplace. However, the use of confocal microscopy in the IVF clinic is often infeasible due to cost and concerns for embryos’ wellbeing. The assessment of 3D cell arrangement in clinical settings can thus prove difficult and time-consuming as many embryologists rely on focal stacks captured through the HMC microscopes widely integrated into incubators.
Study design, size, duration
The study was a retrospective analysis of 581 Embryoscope focal stacks of embryos from 4 clinics collected between 2018 and 2020. The number of planes in each stack ranged from 7-11 and cell outlines were annotated along with the depths at which they were most in-focus. A deep learning system was designed to generate 3D reconstructions of the embryos. Two clinics’ data were used for training (N = 551) and the others’ for evaluation (N = 30).
Participants/materials, setting, methods
The deep learning system consisted of three stages: a super-resolution module, a cell segmentation module and a depth regression module. The super-resolution stage was used to predict missing planes in focal stacks that did not contain 11 focal planes; the segmentation module identified individual cells; the depth regression module identified the focal plane at which each cell was most “in-focus”. Meshes were then generated under the assumption that blastomeres’ dimensions are similar along each axis.
Main results and the role of chance
The superresolution module was evaluated by calculating the structural similarity index (SSIM; an image similarity measure ranging from 0-1) between predicted and true planes when tasked with predicting missing frames in focal stacks with up to 4 planes artificially removed (by uniform random sampling). The module achieved an SSIM of 0.80. The predictions were also evaluated by 2 embryologists, a clinician and a developmental biologist on a scale of 1-5 (1=very unrealistic; 3=usable; 5=very realistic), achieving a mean score of 4.11.
The segmentation module was evaluated on the proportion of cells it managed to identify (91%) as well as the mean overlap between predicted cell segmentations and the ground truth (intersection-over-union of 0.86). The depth module was evaluated on the mean deviation of predictions from the true most “in-focus” plane (0.73 planes).
3D reconstructions generated by the system were evaluated with reference to the original focal stacks by 2 embryologists on a 1-5 scale similar to before, with a mean score of 3.72. The most common issues with the reconstructions identified by the embryologists were missing cells/fragments, incorrect cell shape due to obstruction by the well’s edge and imprecise depth predictions (with the “true” depth being between focal planes).
Limitations, reasons for caution
As previously mentioned, some reconstructions had inaccuracies. These would likely be ameliorated through modifications to the system modules and more training data. Moreover, the system was not trained or evaluated on morulae/blastocysts. Finally, each focal stack was analysed independently - future work may examine enforcing temporal consistency within timelapses.
Wider implications of the findings
This work serves as a first step towards unlocking data captured in IVF clinics for research into cell arrangement in preimplantation embryos. Combined with cell tracking, the system may be useful for research into cell fate. Moreover, the work may find clinical relevance in enabling easier assessment of cell arrangement.
Trial registration number
N/A
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Affiliation(s)
- P He
- Apricity, AI Team , London, United Kingdom
- University College London, Department of Computer Science , London, United Kingdom
- University College London , Wellcome / , London, United Kingdom
- EPSRC Centre for Interventional and Surgical Sciences , Wellcome / , London, United Kingdom
| | - R Hariharan
- Apricity, AI Team , London, United Kingdom
- University Hospitals of Morecambe Bay NHS Foundation Trust, Furness General Hospital , Barrow-in-Furness, United Kingdom
| | | | - N Croft
- Apricity, AI Team , London, United Kingdom
- University of Surrey, Department of Health and Medical Sciences , Guildford, United Kingdom
| | - L Firminger
- Apricity, AI Team , London, United Kingdom
- Manchester Metropolitan University, Department of Life Sciences , Manchester, United Kingdom
| | | | | | - S Saravelos
- Apricity, Care Team , London, United Kingdom
- Imperial College London, Faculty of Medicine , London, United Kingdom
| | - K Wouters
- University Hospital Brussels, Centre for Reproductive Medicine , Jette, Belgium
| | - T Fréour
- Nantes University Hospital, ART Centre , Nantes, France
| | - N Zaninovic
- Weill Cornell Medical College, Department of Obstetrics and Gynecology , New York City, U.S.A
- Weill Cornell Medical College, Department of Reproductive Medicine , New York City, U.S.A
| | - J Malmsten
- Weill Cornell Medical College, Department of Reproductive Medicine , New York City, U.S.A
| | - F Vasconcelos
- University College London, Department of Computer Science , London, United Kingdom
- University College London , Wellcome / , London, United Kingdom
- EPSRC Centre for Interventional and Surgical Sciences , Wellcome / , London, United Kingdom
| | - C Hickman
- Apricity, AI Team , London, United Kingdom
- Imperial College London, Faculty of Medicine , London, United Kingdom
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Sterckx J, Wouters K, Mateizel I, Janssens R, Tournaye H, Verheyen G, De Munck N. P-780 Ten years electronic witnessing in the IVF laboratory. Hum Reprod 2022. [DOI: 10.1093/humrep/deac105.086] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
What did we learn after 10 years of electronic witnessing?
Summary answer
Only when applied correctly, electronic witnessing can prevent sample mix-up.
What is known already
In the early days of IVF, manual double witnessing was used to reduce the misidentification of gametes for insemination. However, risk for human errors due to fatigue, automatism, distraction or work load make this a mistake-prone approach. Hence, there is increasing interest in using electronic witnessing systems for patient and sample identification. Although not always mandatory, such systems have been implemented in many fertility laboratories to avoid identification errors. A mismatch is generated when non-matching samples are simultaneously present in a single workstation. Yet, when the system is incorrectly used, corrective intervention by an administrator (administrator assign) may be required.
Study design, size, duration
This evaluation investigates the mismatch (MM) rate and administrator assigns (AA) over a 10-year period (March 2011- December 2021) with the use of RI Witness (RIW) (CooperSurgical). Radio frequency identification tags (RFID) were used for patient and sample identification. Conventional IVF and ICSI cycles, and frozen embryo cycles (FET) were included since 10 years, IUI cycles since 8 years.
Participants/materials, setting, methods
The total number of tags and witness points (WP) were recorded. Witness points represent all the actions in RIW that have been performed during the entire process. MM and AA were collected and stratified by procedure (sperm preparation, oocyte retrieval, IVF/ICSI, (embryo)biopsy, vitrification/warming, embryo transfer, medium changeover and IUI). Critical MM (such as mis-labeling or non-matching samples within one work area) and critical AA (such as non-RIW-identified samples and unconfirmed WP) were selected.
Main results and the role of chance
A total of 109,655 cycles were included: 53,023 IVF/ICSI, 36,347 FET, and 20,285 IUI cycles. The 724,096 used tags, led to a total of 849,650 WP. The overall MM rate per WP was 0.25% (2,132/849,650), 1.9% per cycle, of which 144 critical mismatches occurred in the different procedures: sperm preparation: 66, oocyte retrieval: 5, IVF/ICSI: 33, (embryo)biopsy: 1, vitrification/warming: 26, embryo transfer: 8, medium changeover: 3 and IUI: 2. The mean critical MM rate per WP per year was 0.017% ± 0.007% and 0.13 ± 0.05% per cycle. The overall AA rate per WP was 0.11% (940/849,650), 0.86% per cycle, including 320 critical assigns: sperm preparation: 83, oocyte retrieval: 34, IVF/ICSI: 173, (embryo)biopsy: 3, vitrification/warming: 6, embryo transfer: 0, medium changeover: 21. Critical AA rate per year was on average 0.041%/WP ± 0.01% and 0.30 ± 0.07% per cycle. All MM and AA rates remained stable during this 10-year period, except for sperm preparation, where the removal of a single witness point led to a huge increase in AA. RIW should still be used in combination with the manual labelling of bottom and lid of dishes and tubes to guarantee correct assignment in case of RFID malfunction or AA.
Limitations, reasons for caution
The procedures and method of integration of RIW may vary from one laboratory to another and result in differences in the potential risks. RIW cannot (yet) identify individual embryos, making double manual witnessing indispensable at certain critical steps, where potential errors are not recorded.
Wider implications of the findings
Using an electronic witnessing is considered to be the ultimate tool to safeguard correct identification of gametes and embryos. But this is only possible when used correctly and requires proper training and attention of the staff. It may also induce new risks, i.e. blind witnessing of samples by the operator.
Trial registration number
not applicable
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Affiliation(s)
- J Sterckx
- UZ Brussel, Brussels IVF , Jette- Brussels, Belgium
| | - K Wouters
- UZ Brussel, Brussels IVF , Jette- Brussels, Belgium
| | - I Mateizel
- UZ Brussel, Brussels IVF , Jette- Brussels, Belgium
| | - R Janssens
- UZ Brussel, Brussels IVF , Jette- Brussels, Belgium
| | - H Tournaye
- UZ Brussel, Brussels IVF , Jette- Brussels, Belgium
| | - G Verheyen
- UZ Brussel, Brussels IVF , Jette- Brussels, Belgium
| | - N De Munck
- UZ Brussel, Brussels IVF , Jette- Brussels, Belgium
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Hariharan R, He P, Karpavičiūtė N, Derrick R, Jacques C, Chambost J, Ebner T, Rosselot M, Loubersac S, Wouters K, Zaninovic N, Miller R, Malmsten J, Badalotti M, Hickman C. P-281 A multi-centre evaluation of a novel 4-cell embryo classification system based on intercellular contact points. Hum Reprod 2022. [DOI: 10.1093/humrep/deac107.270] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is there any prognostic value to classifying 4-cell embryos according to intercellular contact points (ICPs)?
Summary answer
A significant association was found between the new blastomere arrangement classifications and blastulation, as well as blastocyst quality. No significant association was found for pregnancy.
What is known already
Current literature states that the geometric arrangement of blastomeres in 4-cell embryos is usually classified as either “tetrahedral” or “non-tetrahedral/planar”. Though tetrahedral embryos have been associated with greater developmental capacity, their prevalence has varied between studies. At ESHRE 2021, Hickman et al. proposed a more fine-grained classification system; each class was associated with a 4-digit code, where the Nth digit in said code gave the number of cells with N-1 ICPs. This gave rise to 6 classes: tetrahedral (0004), pseudotetrahedral (0022), planar (0040), closed-Y (0121), open-Y (0301) and linear (0220). In our study, we evaluate this new system.
Study design, size, duration
This study was a retrospective analysis of 844 4-cell embryos across 3 clinics in 3 countries. Focal stacks of the embryos were captured on Embryoscope/MIRI time-lapse incubators between 2018 and 2020. Embryos were annotated by their respective clinics using the original “tetrahedral/planar” system. Additionally, data on blastulation, blastocyst grade (Gardner scale) and biochemical pregnancy rates were obtained for each embryo.
Participants/materials, setting, methods
The embryos were annotated according to the new system by a panel of three researchers without knowledge of the clinics’ or each other’s classifications. Afterwards, the panelists assembled for discussion and a unanimous consensus was reached for each embryo. The cell arrangement classes were analysed with respect to blastulation rates, blastocyst grade and pregnancy rates using chi-squared tests. The distribution of classes across the clinics was also analysed, as well as agreement among the panelists.
Main results and the role of chance
Under the new system, tetrahedral and pseudotetrahedral embryos saw significantly higher rates of blastulation (P = 0.017) and good-quality blastocysts (p = 0.043; here, “good-quality” means that the grade contains no ‘C’s or numbers less than 3) compared to other arrangements. No association was found with respect to biochemical pregnancy (p = 0.77).
There was significant variation between the clinic-provided classifications (p < 0.001) with tetrahedral-to-planar ratios ranging from 1 to 9. Under the new system, there was no significant difference between the proportions of each arrangement (p = 0.66). The arrangements in order of decreasing prevalence across all the data were tetrahedral (63.7%), pseudotetrahedral (25.8%), planar (8.0%), closed-Y (2.2%) and linear (0.3%). No open-Y embryos were observed. Upon comparison with the clinic-provided tetrahedral/planar classifications, there were clear differences in the treatment of pseudotetrahedral embryos - some clinics predominantly classified them as “tetrahedral” while others as “planar”.
Prior to any discussions, the panelists’ annotations unanimously agreed on the classifications of 63% of the embryos; with 33% of the embryos having 2 different classifications and 4% of embryos causing total disagreement. The majority of disagreements regarded pseudotetrahedral embryos being confused for either tetrahedral or planar embryos.
Limitations, reasons for caution
It can be at times difficult to visualise the 3D structure of embryos from focal stacks. As a result, some annotations may be erroneous, though the use of a panel-based approach helped to mitigate this. Moreover, further studies will need to take place to validate the findings in this work.
Wider implications of the findings
The findings demonstrate the prognostic utility of Hickman et al.’s ICP-based classification system. Moreover, the findings suggest that much of the variability seen in the prevalence of tetrahedral embryos under the tetrahedral/planar system came from the mislabelling of pseudotetrahedral embryos which comprised 25.8% of the study population.
Trial registration number
N/A
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Affiliation(s)
- R Hariharan
- Apricity, AI Team , London, United Kingdom
- University Hospitals of Morecambe Bay NHS Foundation Trust, Furness General Hospital , Barrow-in-Furness, United Kingdom
| | - P He
- Apricity, AI Team , London, United Kingdom
- University College London, Department of Computer Science , London, United Kingdom
- University College London, Wellcome / EPSRC Centre for Interventional and Surgical Sciences , London, United Kingdom
| | | | - R Derrick
- Apricity, AI Team , London, United Kingdom
- Royal Surrey NHS Foundation Trust, Royal Surrey County Hospital , Guildford, United Kingdom
| | | | | | - T Ebner
- Kepler University Hospital, Department of Gynecology- Obstetrics and Gynecological Endocrinology , Linz, Austria
| | - M Rosselot
- Nantes University Hospital, ART Centre , Nantes, France
| | - S Loubersac
- Nantes University Hospital, ART Centre , Nantes, France
| | - K Wouters
- University Hospital Brussels, Centre for Reproductive Medicine , Brussels, Belgium
| | - N Zaninovic
- Weill Cornell Medical College, Department of Obstetrics and Gynecology , New York City, U.S.A
- Weill Cornell Medical College, Department of Reproductive Medicine , New York City, U.S.A
| | - R Miller
- Weill Cornell Medical College, Department of Reproductive Medicine , New York City, U.S.A
| | - J Malmsten
- Weill Cornell Medical College, Department of Reproductive Medicine , New York City, U.S.A
| | - M Badalotti
- Fertilitat, Reproductive Medicine Centre , Porto Alegre, Brazil
| | - C Hickman
- Apricity, AI Team , London, United Kingdom
- Imperial College London, Faculty of Medicine , London, United Kingdom
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Van den Bos J, Ouaamari YE, Wouters K, Cools N, Wens I. Are Cell-Based Therapies Safe and Effective in the Treatment of Neurodegenerative Diseases? A Systematic Review with Meta-Analysis. Biomolecules 2022; 12:340. [PMID: 35204840 PMCID: PMC8869169 DOI: 10.3390/biom12020340] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 12/13/2022] Open
Abstract
Over the past two decades, significant advances have been made in the field of regenerative medicine. However, despite being of the utmost clinical urgency, there remains a paucity of therapeutic strategies for conditions with substantial neurodegeneration such as (progressive) multiple sclerosis (MS), spinal cord injury (SCI), Parkinson's disease (PD) and Alzheimer's disease (AD). Different cell types, such as mesenchymal stromal cells (MSC), neuronal stem cells (NSC), olfactory ensheathing cells (OEC), neurons and a variety of others, already demonstrated safety and regenerative or neuroprotective properties in the central nervous system during the preclinical phase. As a result of these promising findings, in recent years, these necessary types of cell therapies have been intensively tested in clinical trials to establish whether these results could be confirmed in patients. However, extensive research is still needed regarding elucidating the exact mechanism of action, possible immune rejection, functionality and survival of the administered cells, dose, frequency and administration route. To summarize the current state of knowledge, we conducted a systematic review with meta-analysis. A total of 27,043 records were reviewed by two independent assessors and 71 records were included in the final quantitative analysis. These results show that the overall frequency of serious adverse events was low: 0.03 (95% CI: 0.01-0.08). In addition, several trials in MS and SCI reported efficacy data, demonstrating some promising results on clinical outcomes. All randomized controlled studies were at a low risk of bias due to appropriate blinding of the treatment, including assessors and patients. In conclusion, cell-based therapies in neurodegenerative disease are safe and feasible while showing promising clinical improvements. Nevertheless, given their high heterogeneity, the results require a cautious approach. We advocate for the harmonization of study protocols of trials investigating cell-based therapies in neurodegenerative diseases, adverse event reporting and investigation of clinical outcomes.
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Affiliation(s)
- Jasper Van den Bos
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), University of Antwerp, Universiteitsplein 1, B-2610 Antwerpen, Belgium; (Y.E.O.); (N.C.); (I.W.)
| | - Yousra El Ouaamari
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), University of Antwerp, Universiteitsplein 1, B-2610 Antwerpen, Belgium; (Y.E.O.); (N.C.); (I.W.)
| | - Kristien Wouters
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Drie Eikenstraat 655, B-2650 Edegem, Belgium;
| | - Nathalie Cools
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), University of Antwerp, Universiteitsplein 1, B-2610 Antwerpen, Belgium; (Y.E.O.); (N.C.); (I.W.)
- Center for Cell Therapy and Regenerative Medicine (CCRG), Antwerp University Hospital, Drie Eikenstraat 655, B-2650 Edegem, Belgium
| | - Inez Wens
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute (Vaxinfectio), University of Antwerp, Universiteitsplein 1, B-2610 Antwerpen, Belgium; (Y.E.O.); (N.C.); (I.W.)
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Van Praag DL, Wouters K, Van Den Eede F, Wilson L, Maas AI, Åkerlund C, Amrein K, Andelic N, Andreassen L, Anke A, Antoni A, Audibert G, Azouvi P, Azzolini ML, Bartels R, Barzó P, Beauvais R, Beer R, Bellander BM, Belli A, Benali H, Berardino M, Beretta L, Blaabjerg M, Bragge P, Brazinova A, Brinck V, Brooker J, Brorsson C, Buki A, Bullinger M, Cabeleira M, Caccioppola A, Calappi E, Calvi MR, Cameron P, Lozano GC, Carbonara M, Cavallo S, Chevallard G, Chieregato A, Citerio G, Ceyisakar I, Clusmann H, Coburn M, Coles J, Cooper JD, Correia M, Čović A, Curry N, Czeiter E, Czosnyka M, Dahyot-Fizelier C, Dark P, Dawes H, De Keyser V, Degos V, Della Corte F, Boogert HD, Depreitere B, Đilvesi Đ, Dixit A, Donoghue E, Dreier J, Dulière GL, Ercole A, Esser P, Ezer E, Fabricius M, Feigin VL, Foks K, Frisvold S, Furmanov A, Gagliardo P, Galanaud D, Gantner D, Gao G, George P, Ghuysen A, Giga L, Glocker B, Golubovic J, Gomez PA, Gratz J, Gravesteijn B, Grossi F, Gruen RL, Gupta D, Haagsma JA, Haitsma I, Helbok R, Helseth E, Horton L, Huijben J, Hutchinson PJ, Jacobs B, Jankowski S, Jarrett M, Jiang JY, Johnson F, Jones K, Karan M, Kolias AG, Kompanje E, Kondziella D, Koraropoulos E, Koskinen LO, Kovács N, Kowark A, Lagares A, Lanyon L, Laureys S, Lecky F, Ledoux D, Lefering R, Legrand V, Lejeune A, Levi L, Lightfoot R, Lingsma H, Maas AI, Castaño-León AM, Maegele M, Majdan M, Manara A, Manley G, Martino C, Maréchal H, Mattern J, McMahon C, Melegh B, Menon D, Menovsky T, Mikolic A, Misset B, Muraleedharan V, Murray L, Negru A, Nelson D, Newcombe V, Nieboer D, Nyirádi J, Olubukola O, Oresic M, Ortolano F, Palotie A, Parizel PM, Payen JF, Perera N, Perlbarg V, Persona P, Peul W, Piippo-Karjalainen A, Pirinen M, Ples H, Polinder S, Pomposo I, Posti JP, Puybasset L, Radoi A, Ragauskas A, Raj R, Rambadagalla M, Rhodes J, Richardson S, Richter S, Ripatti S, Rocka S, Roe C, Roise O, Rosand J, Rosenfeld JV, Rosenlund C, Rosenthal G, Rossaint R, Rossi S, Rueckert D, Rusnák M, Sahuquillo J, Sakowitz O, Sanchez-Porras R, Sandor J, Schäfer N, Schmidt S, Schoechl H, Schoonman G, Schou RF, Schwendenwein E, Sewalt C, Skandsen T, Smielewski P, Sorinola A, Stamatakis E, Stanworth S, Stevens R, Stewart W, Steyerberg EW, Stocchetti N, Sundström N, Synnot A, Takala R, Tamás V, Tamosuitis T, Taylor MS, Ao BT, Tenovuo O, Theadom A, Thomas M, Tibboel D, Timmers M, Tolias C, Trapani T, Tudora CM, Unterberg A, Vajkoczy P, Vallance S, Valeinis E, Vámos Z, van der Jagt M, Van der Steen G, van der Naalt J, van Dijck JT, van Essen TA, Van Hecke W, van Heugten C, Van Praag D, Vyvere TV, van Wijk RP, Vargiolu A, Vega E, Velt K, Verheyden J, Vespa PM, Vik A, Vilcinis R, Volovici V, von Steinbüchel N, Voormolen D, Vulekovic P, Wang KK, Wiegers E, Williams G, Wilson L, Winzeck S, Wolf S, Yang Z, Ylén P, Younsi A, Zeiler FA, Zelinkova V, Ziverte A, Zoerle T. Neurocognitive correlates of probable posttraumatic stress disorder following traumatic brain injury. Brain and Spine 2022; 2:100854. [PMID: 36248103 PMCID: PMC9560676 DOI: 10.1016/j.bas.2021.100854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/07/2021] [Accepted: 12/16/2021] [Indexed: 01/17/2023]
Abstract
Introduction Neurocognitive problems associated with posttraumatic stress disorder (PTSD) can interact with impairment resulting from traumatic brain injury (TBI). Research question We aimed to identify neurocognitive problems associated with probable PTSD following TBI in a civilian sample. Material and methods The study is part of the CENTER-TBI project (Collaborative European Neurotrauma Effectiveness Research) that aims to better characterize TBI. For this cross-sectional study, we included patients of all severities aged over 15, and a Glasgow Outcome Score Extended (GOSE) above 3. Participants were assessed at six months post-injury on the PTSD Checklist-5 (PCL-5), the Trail Making Test (TMT), the Rey Auditory Verbal Learning Test (RAVLT) and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Primary analysis was a complete case analysis. Regression analyses were performed to investigate the association between the PCL-5 and cognition. Results Of the 1134 participants included in the complete case analysis, 13.5% screened positive for PTSD. Probable PTSD was significantly associated with higher TMT-(B-A) (OR = 1.35, 95% CI: 1.14–1.60, p < .001) and lower RAVLT-delayed recall scores (OR = 0.74, 95% CI: 0.61–0.91, p = .004) after controlling for age, sex, psychiatric history, baseline Glasgow Coma Scale and education. Discussion and conclusion Poorer performance on cognitive tests assessing task switching and, to a lesser extent, delayed verbal recall is associated with probable PTSD in civilians who have suffered TBI. Six months after traumatic brain injury 13.5% of people screen positive for PTSD. Task switching performance and verbal memory are related to probable PTSD. PTSD severity is related to processing speed and task switching performance.
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Van Praag DLG, Van Den Eede F, Wouters K, Wilson L, Maas AIR. The Impact of Neurocognitive Functioning on the Course of Posttraumatic Stress Symptoms following Civilian Traumatic Brain Injury. J Clin Med 2021; 10:jcm10215109. [PMID: 34768628 PMCID: PMC8584567 DOI: 10.3390/jcm10215109] [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: 08/01/2021] [Revised: 10/15/2021] [Accepted: 10/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background: One out of seven individuals who have suffered a traumatic brain injury (TBI) develops a posttraumatic stress disorder (PTSD), which is often associated with neurocognitive impairment. The present study explores the impact of neurocognitive functioning after mild, moderate, and severe TBI on the course of PTSD symptoms. Methods: The data of 671 adults admitted to hospital for a TBI was drawn from the Collaborative European Neurotrauma Effectiveness Research (CENTER-TBI) study. After six- and 12-months post-injury, participants completed the PTSD Checklist-5 (PCL-5), from which change scores were calculated. At six months, participants also completed a neurocognitive assessment including the Rey Auditory Verbal Learning Test, the Trail Making Test, and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Linear regressions were performed to identify associations between cognitive functioning and PCL-5 change scores. Results: Overall, mean PCL-5 change scores showed no clear change (−0.20 ± 9.88), but 87 improved and 80 deteriorated by a change score of 10 or more. CANTAB Rapid Visual Information Processing scores were significantly associated with PCL-5 change scores. Conclusions: Strong sustained attention was associated with improvement in PTSD symptoms. Assessing cognitive performance may help identify individuals at risk of developing (persisting) PTSD post-TBI and offer opportunities for informing treatment strategies.
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Affiliation(s)
- Dominique L. G. Van Praag
- Department of Psychology, Antwerp University Hospital, 2650 Edegem, Belgium
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, 2610 Wilrijk, Belgium
- Correspondence: ; Tel.: +32-3-821-56-14
| | - Filip Van Den Eede
- Collaborative Antwerp Psychiatric Research Institute, University of Antwerp, 2610 Wilrijk, Belgium
- Department of Psychiatry, Antwerp University Hospital, 2650 Edegem, Belgium;
| | - Kristien Wouters
- Clinical Trial Center, Clinical Research Center Antwerp, Antwerp University Hospital, 2650 Edegem, Belgium;
- Antwerp Research Center, Faculty of Medicine, University of Antwerp, 2610 Wilrijk, Belgium
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling FK9 4LA, UK;
| | - Andrew I. R. Maas
- Department of Neurosurgery, Antwerp University Hospital, 2650 Edegem, Belgium;
- Translational Neurosciences, University of Antwerp, 2610 Wilrijk, Belgium
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Bosmans S, Sluyts Y, Lysens de Oliveira E Silva-Van Acker J, Van Caenegem O, Sinnaeve PR, Dubois P, Vranckx P, Gevaert S, Coussement P, Beauloye C, Evrard P, Argacha JF, De Raedt H, Wouters K, Claeys MJ. Adherence to quality indicators for ST-elevation myocardial infarction and its relation to mortality: a hospital network analysis from the Belgian STEMI database. Eur Heart J Qual Care Clin Outcomes 2021; 7:601-607. [PMID: 32941605 DOI: 10.1093/ehjqcco/qcaa067] [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] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/24/2020] [Indexed: 06/11/2023]
Abstract
AIMS To assess the adherence to established quality indicators (QIs) for ST-elevation myocardial infarction (STEMI) at the hospital-network level and its relation to outcome. METHODS AND RESULTS The data of 7774 STEMI patients admitted to 32 STEMI networks during the period 2014-18 were extracted from the Belgian STEMI database. Five QIs [primary percutaneous coronary intervention use, diagnosis-to-balloon time (DiaTB) <90 min, door-to-balloon time (DoTB) <60 min, P2Y12 inhibitor and statin prescription at discharge, and a composite QI score ranging from 0 to 10] were correlated with in-hospital mortality adjusted for differences in baseline risk profile (TIMI risk score). The median composite QI score was 6.5 [interquartile range (IQR) 6-8]. The most important gaps in quality adherence were related to time delays: the recommended DiaTB and DoTB times across the different networks were achieved in 68% (IQR 53-71) and 67% (IQR 50-78), respectively. Quality adherence was better in networks taking care of more high-risk STEMI patients. The median in-hospital mortality among the STEMI networks was 6.4% (IQR 4.1-7.9%). There was a significant independent inverse correlation between the composite QI score and in-hospital mortality (partial correlation coefficient: -0.45, P = 0.013). Stepwise regression analysis revealed that among the individual QIs, prolonged DiaTB was the most important independent outcome predictor. CONCLUSION Among established STEMI networks, the time delay between diagnosis and treatment was the most variable and the most relevant prognostic QI, underscoring the importance of assessing quality of care throughout the whole network.
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Affiliation(s)
- Sara Bosmans
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | - Yasmine Sluyts
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
| | | | | | - Peter R Sinnaeve
- Department of Cardiology, UZ Leuven, Ottignies-Louvain-la-Neuve, Belgium
| | | | - Pascal Vranckx
- Department of Cardiology, Virga Jesse Hasselt, Hasselt, Belgium
| | | | | | | | - Patrick Evrard
- Department of Intensive Care, UCL Mont-Godinne, Mont-Godinne, Belgium
| | | | | | - Kristien Wouters
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Antwerpen, Belgium
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium
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De Baetselier I, Reyniers T, Platteau T, Wouters K, Nöstlinger C, Cuylaerts V, Buyze J, Laga M, Kenyon C, Crucitti T, Vuylsteke B. Recurrent Sexually Transmitted Infections Among a Cohort of Men Who Have Sex With Men Using Preexposure Prophylaxis in Belgium Are Highly Associated With Sexualized Drug Use. Sex Transm Dis 2021; 48:726-732. [PMID: 34110745 DOI: 10.1097/olq.0000000000001424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) experiencing recurrent sexually transmitted infections (STIs) may play a crucial role in the STI epidemic. However, there is limited understanding of what kind of behavior leads to recurrent STIs. METHODS A total of 179 MSM using preexposure prophylaxis were followed up for 18 months and were screened quarterly for chlamydia, gonorrhea, and syphilis from 2015 to 2018 in Belgium. Participants were stratified into 3 different groups (no STI, one STI episode, recurrent STI episodes during the study). Sociodemographic and sexual behavioral characteristics were compared between the 3 groups, and significant associations with recurrent STI were explored using multivariate logistic regression models. RESULTS A total of 62.0% (n = 111/179) of participants experienced at least one STI during the study, and more than 1 in 3 became reinfected with an STI at another visit (n = 66/179 [36.9%]). Participants experiencing recurrent STIs reported the highest frequency of sexualized drug use (86.4%) compared with participants experiencing one (60.0%) or no STI (47.1%). Therefore, sexualized drug use was highly associated with recurrent STIs (adjusted odds ratio [aOR]. 4.35). Other factors associated with recurrent STIs were being younger than 40 years (aOR, 3.29), had a high number (>4) of nonsteady partners with whom receptive (aOR, 1.17) or insertive (aOR, 1.12) condomless anal intercourse occurred in the last 3 months. CONCLUSIONS Sexualized drug use was the greatest risk factor for having recurrent STIs. Tailoring prevention and care, including specialized services tackling problematic drug use in a sexual context, may help to curb the STI epidemic among MSM.
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Affiliation(s)
- Irith De Baetselier
- From the STI Reference Laboratory, Clinical Reference Laboratory, Department of Clinical Sciences
| | | | | | | | | | - Vicky Cuylaerts
- From the STI Reference Laboratory, Clinical Reference Laboratory, Department of Clinical Sciences
| | - Jozefien Buyze
- Clinical Trials Unit, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marie Laga
- HIV/STD Unit, Department of Public Health
| | | | - Tania Crucitti
- From the STI Reference Laboratory, Clinical Reference Laboratory, Department of Clinical Sciences
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Wouters K, Va. Landuyt L, Regin M, Tournaye H, Verheyen G, Va. d. Velde H. P–259 Blastocyst quality is associated with both the start and the duration of compaction after ICSI. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.258] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Study question
Is the start and the total duration of compaction related to embryo quality?
Summary answer
The timing of the start, the end and the total duration of compaction are associated with blastocyst quality grade in the IVF laboratory.
What is known already
Preimplantation embryo development follows a programmed timeline during which a series of critical events take place. One event typically occurring on day 3/4 post fertilisation is the formation of adherence junctions between blastomeres in a process called compaction. It is considered the first morphological event in the differentiation process of the mammalian embryo. Evaluation of developmental events are used to optimize the selection of the most competent embryos for transfer and/or cryopreservation in the IVF laboratory. It has already been shown that the time of full compaction is indicative for high-quality blastocysts with a higher implantation rate.
Study design, size, duration
A single-centre retrospective observational study including 74 ICSI cycles performed in 2020. Injected oocytes were cultured in blastocyst medium (Origio) in the EmbryoScope + (Vitrolife) for 5/6 days. Embryos that reached the blastocyst stage were evaluated for the start of compaction, the time to reach full compaction and the total duration of compaction. These parameters were compared between good- and poor-quality blastocysts; the primary outcome parameter of the study was embryo quality.
Participants/materials, setting, methods
Only ICSI cycles with ejaculated fresh/frozen-thawed sperm and monitored in time-lapse incubator were included. All MNC, IVM and PGT cycles were excluded. Time zero was the start of ICSI. Good-quality embryos were full and expanded blastocysts with good-quality inner cell mass and trophectoderm (AA, AB, BA and BB according to Gardner and Schoolcraft (1999)). GraphPad Prism was used for statistical analysis. After testing for normality and homogeneity, unpaired t-test or Mann-Whitney test determined significant differences.
Main results and the role of chance
In this study, of the 528 included 2PN oocytes, 229 (43.4%) reached the blastocyst stage and 299 (56.6%) were arrested. Among the former, 131 (57.2%) blastocysts were classified in the good-quality group and 98 (42.8%) blastocysts in the poor-quality group. In general, human embryos compacted slowly while dividing further and the blastomeres moved during the compaction process. The start of compaction was heterogeneous (between 50.9 and 102.7 hours post ICSI; mean=80.0 hours), as well as the cell number at the initiation (between 4 and 18 blastomeres; mean=12 blastomeres). The time analysis showed that the embryos in the good-quality group started to compact significantly earlier than those in the poor-quality group (mean=78.6 vs 82.2 hours; R²=0.06; p < 0.01). We confirmed that blastocysts in the good-quality group reached full compaction earlier than those in the poor-quality group (mean=86.8 vs 93.8 hours; R²=0.17; p < 0.01). Furthermore, the total duration of compaction was significantly lower in the good-quality than in the poor-quality group (median=7.4 vs 10.7 hours; p < 0.01).
Limitations, reasons for caution
As this is a retrospective study, the influence of uncontrolled variables cannot be excluded. The absence of the pregnancy outcome and live birth rate is a shortcoming and will be subject of a larger patient-to-patient study.
Wider implications of the findings: These results indicate that an earlier start and a shorter duration of compaction are associated with better blastocyst quality. These morphological events can be valuable additional parameters in selecting the embryo of better quality when using a time-lapse incubator.
Trial registration number
Not applicable
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Affiliation(s)
- K Wouters
- UZ Brussel, Centre for reproductive medicine, Brussel, Belgium
| | - L Va. Landuyt
- UZ Brussel, Centre for reproductive medicine, Brussel, Belgium
| | - M Regin
- Vrije Universiteit Brussel, Reproduction and Genetics, Brussel, Belgium
| | - H Tournaye
- UZ Brussel, Centre for reproductive medicine, Brussel, Belgium
| | - G Verheyen
- UZ Brussel, Centre for reproductive medicine, Brussel, Belgium
| | - H Va. d. Velde
- UZ Brussel, Centre for reproductive medicine, Brussel, Belgium
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Jongen VW, Reyniers T, Ypma ZMH, Schim van der Loeff MF, Davidovich U, Zimmermann HML, Coyer L, van den Elshout MAM, de Vries HJC, Wouters K, Smekens T, Vuylsteke B, Prins M, Laga M, Hoornenborg E. Choosing event-driven and daily HIV pre-exposure prophylaxis - data from two European PrEP demonstration projects among men who have sex with men. J Int AIDS Soc 2021; 24:e25768. [PMID: 34382345 PMCID: PMC8358711 DOI: 10.1002/jia2.25768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Daily and event-driven PrEP are both efficacious in reducing the risk for HIV infection. However, the practice of event-driven PrEP (edPrEP) is less well studied, in particular when provided as an alternative to daily PrEP. We studied regimen preferences and switches, and sexually transmitted infection (STI) incidence. METHODS We analysed pooled data from two prospective cohort studies among MSM: Be-PrEP-ared, Belgium and AMPrEP, the Netherlands. In both projects, participants could choose between daily and edPrEP at three-monthly study visits, when they were also screened for sexually transmitted infections including hepatitis C (HCV). We assessed the proportion choosing each regimen, and the determinants of choosing edPrEP at baseline. Additionally, we compared the incidence rates (IRs) of HCV, syphilis and chlamydia or gonorrhoea between regimens using Poisson regression. The study period was from 3 August 2015 until 24 September 2018. RESULTS AND DISCUSSION We included 571 MSM, of whom 148 (25.9%) chose edPrEP at baseline. 31.7% of participants switched regimen at least once. After 28 months, 23.5% used edPrEP. Older participants (adjusted odds ratio (aOR) = 1.38 per 10 years, 95% confidence interval (CI) = 1.15 to 1.64) and those unemployed (aOR = 1.68, 95% CI = 1.03 to 1.75) were more likely to initially choose edPrEP. IR of HCV and syphilis did not differ between regimens, but the IR of chlamydia/gonorrhoea was higher among daily users (adjusted incidence rate ratio = 1.61, 95% CI = 1.35 to 1.94). CONCLUSIONS A quarter of participants chose edPrEP at baseline and at 28 months this proportion was similar. Although the IR of HCV and syphilis were similar in the two regimens, the lower incidence of chlamydia and gonorrhoea among edPrEP users may suggest that less frequent STI testing of this group could be considered.
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Affiliation(s)
- Vita W Jongen
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | - Thijs Reyniers
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Zorah MH Ypma
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | - Maarten F Schim van der Loeff
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Internal MedicineAmsterdam Infection and Immunity (AII)Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Udi Davidovich
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Department of Social PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
| | - Hanne ML Zimmermann
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | - Liza Coyer
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
| | | | - Henry JC de Vries
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Department of DermatologyAmsterdam Infection and Immunity (AII), location Academic Medical CentreAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Kristien Wouters
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Tom Smekens
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Bea Vuylsteke
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Maria Prins
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
- Internal MedicineAmsterdam Infection and Immunity (AII)Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Marie Laga
- Department of Public HealthInstitute of Tropical MedicineAntwerpBelgium
| | - Elske Hoornenborg
- Department of Infectious DiseasesPublic Health Service AmsterdamAmsterdamThe Netherlands
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Willekens B, Wens I, Wouters K, Cras P, Cools N. Safety and immunological proof-of-concept following treatment with tolerance-inducing cell products in patients with autoimmune diseases or receiving organ transplantation: A systematic review and meta-analysis of clinical trials. Autoimmun Rev 2021; 20:102873. [PMID: 34119672 DOI: 10.1016/j.autrev.2021.102873] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 12/17/2022]
Abstract
In the past years, translational approaches have led to early-stage clinical trials assessing safety and efficacy of tolerance-inducing cell-based treatments in patients. This review aims to determine if tolerance-inducing cell-based therapies, including dendritic cells, regulatory T cells and mesenchymal stem cells, are safe in adult patients who underwent organ transplantation or in those with autoimmune diseases, including multiple sclerosis, diabetes mellitus type 1, Crohn's disease and rheumatoid arthritis. Immunological and clinical outcomes were reviewed, to provide evidence for proof-of-concept and efficacy. To summarize the current knowledge, a systematic review and meta-analysis were conducted. A total of 8906 records were reviewed by 2 independent assessors and 48 records were included in the final quantitative analysis. The overall frequency of serious adverse events was low: 0.018 (95% CI: 0.006-0.051). Immunological outcomes could not be assessed quantitatively because of heterogeneity in outcome assessments and description as well as lack of individual data. Most randomized controlled studies were at a medium risk of bias due to open-label treatment without masking of assessors and/or patients to the intervention. In conclusion, tolerance-inducing cell-based therapies are safe. We advocate for harmonization of study protocols of trials investigating cell-based therapies, adverse event reporting and systematic inclusion of immunological outcome measures in clinical trials evaluating tolerance-inducingcell-basedtreatment. Registration: PROSPERO, registration number CRD42020170557.
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Affiliation(s)
- Barbara Willekens
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium; Neurology, Translational Neurosciences, Born Bunge Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Inez Wens
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Center for Cell Therapy and Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Belgium
| | - Patrick Cras
- Department of Neurology, Antwerp University Hospital, Edegem, Belgium; Neurology, Translational Neurosciences, Born Bunge Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Nathalie Cools
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Center for Cell Therapy and Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium
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Van Dijck C, Tsoumanis A, Rotsaert A, Vuylsteke B, Van den Bossche D, Paeleman E, De Baetselier I, Brosius I, Laumen J, Buyze J, Wouters K, Lynen L, Van Esbroeck M, Herssens N, Abdellati S, Declercq S, Reyniers T, Van Herrewege Y, Florence E, Kenyon C. Antibacterial mouthwash to prevent sexually transmitted infections in men who have sex with men taking HIV pre-exposure prophylaxis (PReGo): a randomised, placebo-controlled, crossover trial. Lancet Infect Dis 2021; 21:657-667. [PMID: 33676596 DOI: 10.1016/s1473-3099(20)30778-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bacterial sexually transmitted infections (STIs) are highly prevalent among men who have sex with men who use HIV pre-exposure prophylaxis (PrEP), which leads to antimicrobial consumption linked to the emergence of antimicrobial resistance. We aimed to assess use of an antiseptic mouthwash as an antibiotic sparing approach to prevent STIs. METHODS We invited people using PrEP who had an STI in the past 24 months to participate in this single-centre, randomised, double-blind, placebo-controlled, AB/BA crossover superiority trial at the Institute of Tropical Medicine in Antwerp, Belgium. Using block randomisation (block size eight), participants were assigned (1:1) to first receive Listerine Cool Mint or a placebo mouthwash. They were required to use the study mouthwashes daily and before and after sex for 3 months each and to ask their sexual partners to use the mouthwash before and after sex. Participants were screened every 3 months for syphilis, chlamydia, and gonorrhoea at the oropharynx, anorectum, and urethra. The primary outcome was combined incidence of these STIs during each 3-month period, assessed in the intention-to-treat population, which included all participants who completed at least the first 3-month period. Safety was assessed as a secondary outcome. This trial is registered with Clinicaltrials.gov, NCT03881007. FINDINGS Between April 2, 2019, and March 13, 2020, 343 participants were enrolled: 172 in the Listerine followed by placebo (Listerine-placebo) group and 171 in the placebo followed by Listerine (placebo-Listerine) group. The trial was terminated prematurely because of the COVID-19 pandemic. 151 participants completed the entire study, and 89 completed only the first 3-month period. 31 participants withdrew consent, ten were lost to follow-up, and one acquired HIV. In the Listerine-placebo group, the STI incidence rate was 140·4 per 100 person-years during the Listerine period, and 102·6 per 100 person-years during the placebo period. In the placebo-Listerine arm, the STI incidence rate was 133·9 per 100 person-years during the placebo period, and 147·5 per 100 person-years during the Listerine period. We did not find that Listerine significantly reduced STI incidence (IRR 1·17, 95% CI 0·84-1·64). Numbers of adverse events were not significantly higher than at baseline and were similar while using Listerine and placebo. Four serious adverse events (one HIV-infection, one severe depression, one Ludwig's angina, and one testicular carcinoma) were not considered to be related to use of mouthwash. INTERPRETATION Our findings do not support the use of Listerine Cool Mint as a way to prevent STI acquisition among high-risk populations. FUNDING Belgian Research Foundation - Flanders (FWO 121·00).
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Affiliation(s)
- Christophe Van Dijck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Medical Microbiology, University of Antwerp, Belgium
| | - Achilleas Tsoumanis
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Medical Sciences, University of Antwerp, Belgium
| | - Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Elke Paeleman
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Isabel Brosius
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jolein Laumen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jozefien Buyze
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Wouters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lutgarde Lynen
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Natacha Herssens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Said Abdellati
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Steven Declercq
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Yven Van Herrewege
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eric Florence
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa.
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Reyniers T, Nöstlinger C, Vuylsteke B, De Baetselier I, Wouters K, Laga M. The Impact of PrEP on the Sex Lives of MSM at High Risk for HIV Infection: Results of a Belgian Cohort. AIDS Behav 2021; 25:532-541. [PMID: 32857317 DOI: 10.1007/s10461-020-03010-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
There is a need for an in-depth understanding of the impact of PrEP on users' sexual health and behaviour, beyond the focus on 'risk'. This mixed-method study was part of a Belgian PrEP demonstration project following 200 men who have sex with men (MSM) for at least 18 months. Taking a grounded-theory approach, 22 participants were interviewed and their transcripts analysed. The preliminary analysis guided the analysis of the questionnaire data. Overall, PrEP improved sexual health. Participants felt better protected against HIV, which enabled them to change their sexual behaviour. The reduction in condom use was moderated by interviewees' attitudes towards the risk for other STIs. Other changes included having more anal sex and experimentation with new sexual behaviours. While PrEP empowers MSM in taking care of their sexual health, comprehensive sexual health counselling is crucial to provide care for users who feel less in control over their sexual health.
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Affiliation(s)
- Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
| | - Christiana Nöstlinger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Irith De Baetselier
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Kristien Wouters
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium
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Lodeweyckx N, Wouters K, Ledeganck KJ, Trouet D. Biopsy or Biomarker? Children With Minimal Change Disease Have a Distinct Profile of Urinary Epidermal Growth Factor. Front Pediatr 2021; 9:727954. [PMID: 34900856 PMCID: PMC8657767 DOI: 10.3389/fped.2021.727954] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/05/2021] [Indexed: 02/02/2023] Open
Abstract
Background: In this study, the profile of urinary EGF excretion (uEGF/uCreat) was mapped in children presenting with prolonged proteinuria or with nephrotic syndrome refractory to or dependent of steroids. We investigated whether uEGF/uCreat could be linked to the underlying biopsy result, taking into account its response to immunosuppressive medication and to ACE inhibition, as well as genetic predisposition. Methods: Ninety-eight pediatric patients with initial presentation of nephrotic syndrome or prolonged proteinuria were included in this study, along with 49 healthy controls and 20 pediatric Alport patients. All patients had a normal kidney function and were normotensive during the course of the study, whether or not under ACE inhibition. In repeated urine samples, uEGF was measured and concentration was normalized by urine creatinine. In order to compare diagnosis on kidney biopsy, genetic predisposition and response of uEGF/uCreat to immunosuppression and to ACE inhibition, uEGF/uCreat is studied in a linear mixed effects model. Results: Patients with Minimal Change Disease (MCD) showed a significantly different profile of uEGF/uCreat in comparison to healthy children, as well as compared to patients with Focal Segmental Glomerulosclerosis (FSGS) or another glomerulopathy on kidney biopsy. The response of uEGF/uCreat to ACE inhibition was absent in minimal change disease and contrasted with an impressive beneficial effect of ACE inhibition on uEGF/uCreat in FSGS and other proteinuric glomerulopathies. Absence of a genetic predisposition was also associated with a significantly lower uEGF/uCreat. Conclusions: Despite preserved kidney function, children with a proteinuric or nephrotic glomerular disease on kidney biopsy show a significantly lower uEGF/uCreat, indicative of early tubulo-interstitial damage, which appears reversible under ACE inhibition in any underlying glomerulopathy except in minimal change disease. In view of the distinct profile of uEGF/uCreat in minimal change disease compared to other glomerulopathies, and the link between genetic predisposition and uEGF/uCreat, our study suggests that uEGF/uCreat can be a helpful tool to decide on the need for a renal biopsy in order to differentiate minimal change disease from other proteinuric glomerular diseases.
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Affiliation(s)
- Niels Lodeweyckx
- Department of Pediatric Nephrology, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Clinical Trial Center (CTC), Clinical Research Center (CRC) Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Kristien J Ledeganck
- Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Edegem, Belgium
| | - Dominique Trouet
- Department of Pediatric Nephrology, Antwerp University Hospital, Edegem, Belgium.,Laboratory of Experimental Medicine and Pediatrics and Member of the Infla-Med Centre of Excellence, University of Antwerp, Edegem, Belgium
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Van Eyck A, Eerens S, Trouet D, Lauwers E, Wouters K, De Winter BY, van der Lee JH, Van Hoeck K, Ledeganck KJ. Body composition monitoring in children and adolescents: reproducibility and reference values. Eur J Pediatr 2021; 180:1721-1732. [PMID: 33481106 PMCID: PMC8105252 DOI: 10.1007/s00431-021-03936-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/09/2020] [Revised: 01/04/2021] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Abstract
There is an increasing need for suitable tools to evaluate body composition in paediatrics. The Body Composition Monitor (BCM) shows promise as a method, but reference values in children are lacking. Twenty children were included and measured twice by 4 different raters to asses inter- and intra-rater reproducibility of the BCM. Reliability was assessed using the Bland-Altman method and by calculating intraclass correlation coefficients (ICCs). The intra-rater ICCs were high (≥ 0.97) for all parameters measured by BCM as were the inter-rater ICCs for all parameters (≥ 0.98) except for overhydration (0.76). Consequently, a study was set up in which BCM measurements were performed in 2058 healthy children aged 3-18.5 years. The age- and gender-specific percentile values and reference curves for body composition (BMI, waist circumference, fat mass and lean tissue mass) and fluid status (extracellular and intracellular water and total body water) relative to age were produced using the GAMLSS method for growth curves.Conclusion: A high reproducibility of BCM measurements was found for fat mass, lean tissue mass, extracellular water and total body water. Reference values for these BCM parameters were calculated in over 2000 children and adolescents aged 3 to 18 years. What is Known • The 4-compartment model is regarded as the 'gold standard' of body composition methods, but is inappropriate for regular follow-up or screening of large groups, because of associated limitations. • Body Composition Monitor® is an inexpensive field method that has the potential to be an adequate monitoring tool. What is New • Good reproducibility of BCM measurements in children provides evidence to use the device in longitudinal follow-up, multicentre and comparative studies. • Paediatric reference values relative to age and sex for the various compartments of the body are provided.
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Affiliation(s)
- Annelies Van Eyck
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Wilrijk, Belgium ,Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Sofie Eerens
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Dominique Trouet
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Wilrijk, Belgium ,Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Eline Lauwers
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Wilrijk, Belgium
| | - Kristien Wouters
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, Edegem, Belgium ,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Benedicte Y. De Winter
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Wilrijk, Belgium ,Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
| | - Johanna H. van der Lee
- Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Pediatric Clinical Research Office, AMC, Amsterdam, The Netherlands
| | - Koen Van Hoeck
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Kristien J. Ledeganck
- Laboratory of Experimental Medicine and Pediatrics and member of the Infla-Med Centre of Excellence, University of Antwerp, Wilrijk, Belgium ,University of Antwerp, Universiteitsplein 1, T3.34, 2610 Antwerp, Belgium
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Roex G, Timmers M, Wouters K, Campillo-Davo D, Flumens D, Schroyens W, Chu Y, Berneman ZN, Lion E, Luo F, Anguille S. Safety and clinical efficacy of BCMA CAR-T-cell therapy in multiple myeloma. J Hematol Oncol 2020; 13:164. [PMID: 33272302 PMCID: PMC7713173 DOI: 10.1186/s13045-020-01001-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
Background B-cell maturation antigen (BCMA)-targeted chimeric antigen receptor (CAR)-T-cell therapy is an emerging treatment option for multiple myeloma. The aim of this systematic review and meta-analysis was to determine its safety and clinical activity and to identify factors influencing these outcomes. Methods We performed a database search using the terms “BCMA,” “CAR,” and “multiple myeloma” for clinical studies published between 01/01/2015 and 01/01/2020. The methodology is further detailed in PROSPERO (CRD42020125332). Results Twenty-three different CAR-T-cell products have been used so far in 640 patients. Cytokine release syndrome was observed in 80.3% (69.0–88.2); 10.5% (6.8–16.0) had neurotoxicity. A higher neurotoxicity rate was reported in studies that included more heavily pretreated patients: 19.1% (13.3–26.7; I2 = 45%) versus 2.8% (1.3–6.1; I2 = 0%) (p < 0.0001). The pooled overall response rate was 80.5% (73.5–85.9); complete responses (CR) were observed in 44.8% (35.3–54.6). A pooled CR rate of 71.9% (62.8–79.6; I2 = 0%) was noted in studies using alpaca/llama-based constructs, whereas it was only 18.0% (6.5–41.1; I2 = 67%) in studies that used retroviral vectors for CAR transduction. Median progression-free survival (PFS) was 12.2 (11.4–17.4) months, which compared favorably to the expected PFS of 1.9 (1.5–3.7) months (HR 0.14; p < 0.0001). Conclusions Although considerable toxicity was observed, BCMA-targeted CAR-T-cell therapy is highly efficacious even in advanced multiple myeloma. Subgroup analysis confirmed the anticipated inter-study heterogeneity and identified potential factors contributing to safety and efficacy. The results of this meta-analysis may assist the future design of CAR-T-cell studies and lead to optimized BCMA CAR-T-cell products.
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Affiliation(s)
- Gils Roex
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Marijke Timmers
- Division of Hematology and Center for Cell Therapy & Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Clinical Trial Center, Antwerp University Hospital, Edegem, Belgium
| | - Diana Campillo-Davo
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Donovan Flumens
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wilfried Schroyens
- Division of Hematology and Center for Cell Therapy & Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Yiwei Chu
- Biotherapy Research Center, Fudan University, Shanghai, China
| | - Zwi N Berneman
- Division of Hematology and Center for Cell Therapy & Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Eva Lion
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Feifei Luo
- Biotherapy Research Center, Fudan University, Shanghai, China.,Department of Digestive Diseases, Huashan Hospital of Fudan University, Shanghai, China
| | - Sébastien Anguille
- Laboratory of Experimental Hematology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. .,Division of Hematology and Center for Cell Therapy & Regenerative Medicine, Antwerp University Hospital, Edegem, Belgium.
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Op de Beeck S, Dieltjens M, Verbruggen AE, Vroegop AV, Wouters K, Hamans E, Willemen M, Verbraecken J, De Backer WA, Van de Heyning PH, Braem MJ, Vanderveken OM. Phenotypic Labelling Using Drug-Induced Sleep Endoscopy Improves Patient Selection for Mandibular Advancement Device Outcome: A Prospective Study. J Clin Sleep Med 2020; 15:1089-1099. [PMID: 31482830 DOI: 10.5664/jcsm.7796] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Mandibular advancement device (MAD) outcome varies between patients. We hypothesized that upper airway collapse sites, patterns, and degrees assessed during baseline drug-induced sleep endoscopy (DISE) affect MAD outcome. METHODS One hundred patients with obstructive sleep apnea (OSA) were included and underwent baseline type 1 polysomnography. MAD was fitted intraorally at fixed 75% maximal protrusion. A total of 72 patients completed 3-month follow-up polysomnography and baseline DISE. Response was defined as apnea-hypopnea index (AHI) reduction ≥ 50%, deterioration as AHI increases during MAD treatment compared to baseline. RESULTS Adjusting for baseline AHI and body mass index, patients with tongue base collapse showed 3.69 higher odds (1.27-10.73; P = .0128) for response. Complete concentric collapse at the level of the palate (5.32 [1.21-23.28]; P = .0234) and complete laterolateral oropharyngeal collapse (6.62 [1.14-38.34]; P = .0330) related to deterioration. Results for tongue base collapse and complete concentric collapse at the level of the palate were confirmed in the moderate to severe OSA subgroup. Applying these results to this selected subgroup increased response rate with 54% and decreased deterioration rate with 53%. These results were confirmed using other response and deterioration definitions. CONCLUSIONS Three baseline DISE phenotypes identified during drug-induced sleep were significantly related to MAD treatment outcome: one beneficial, tongue base collapse, and two adverse, complete concentric collapse at the level of the palate and complete laterolateral oropharyngeal collapse. If confirmed in future prospective studies, these results could guide patient selection for MAD outcome. CLINICAL TRIAL REGISTRATION This prospective clinical trial (PROMAD) was registered on Clinicaltrials.gov with identifier: NCT01532050. CITATION Op de Beeck S, Dieltjens M, Verbruggen AE, Vroegop AV, Wouters K, Hamans E, Willemen M, Verbraecken J, De Backer WA, Van de Heyning PH, Braem MJ, Vanderveken OM. Phenotypic labelling using drug-induced sleep endoscopy improves patient selection for mandibular advancement device outcome: a prospective study. J Clin Sleep Med. 2019;15(8):1089-1099.
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Affiliation(s)
- Sara Op de Beeck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Annelies E Verbruggen
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Anneclaire V Vroegop
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Kristien Wouters
- Clinical Trial Centre (CTC), CRC Antwerp, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Evert Hamans
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Marc Willemen
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Johan Verbraecken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium; Department of Pulmonology, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Wilfried A De Backer
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Paul H Van de Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Marc J Braem
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium; Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
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42
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Abstract
Screening for STIs in men who have sex with men receiving HIV pre-exposure prophylaxis resulted in high consumption of macrolides, extended spectrum cephalosporins, fluoroquinolones and tetracyclines. The consumption of macrolides was 52 times as high as that reported for community-level consumption in certain European countries.
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Affiliation(s)
- Chris Kenyon
- HIV/STI Unit, Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium.,Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - Irith De Baetselier
- Department of Clinical Sciences, STI Reference Center, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Wouters
- HIV/STI Unit, Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium
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43
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De Baetselier I, Kenyon C, Vanden Berghe W, Smet H, Wouters K, Van den Bossche D, Vuylsteke B, Crucitti T. An alarming high prevalence of resistance-associated mutations to macrolides and fluoroquinolones in Mycoplasma genitalium in Belgium: results from samples collected between 2015 and 2018. Sex Transm Infect 2020; 97:297-303. [PMID: 32769204 DOI: 10.1136/sextrans-2020-054511] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/02/2020] [Accepted: 07/05/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The number of reported cases of multiresistant Mycoplasma genitalium (MG) is increasing globally. The aim of this study was to estimate the prevalence of macrolide and possible fluoroquinolone resistance-associated mutations (RAMs) of MG in Belgium. METHODS The study was performed retrospectively on two sets of MG-positive samples collected in Belgium between 2015 and 2018. The first set of samples originated from routine surveillance activities and the second set came from a cohort of men who have sex with men (MSM) using pre-exposure prophylaxis to prevent HIV transmission. Detection of RAMs to macrolides and fluoroquinolones was performed on all samples using DNA sequencing of the 23S ribosomal RNA gene, the gyrA gene and the parC gene. RESULTS Seventy-one per cent of the MG samples contained a mutation conferring resistance to macrolides or fluoroquinolones (ParC position 83/87). RAMs were more frequently found among men compared with women for fluoroquinolones (23.9% vs 9.1%) and macrolides (78.4% vs 27.3%). Almost 90% of the MG infections among MSM possessed a RAM to macrolides (88.4%). In addition, 18.0% of the samples harboured both macrolides and fluoroquinolone RAMs; 3.0% in women and 24.2% in MSM. Being MSM was associated with macrolide RAMs (OR 15.3), fluoroquinolone RAMs (OR 3.8) and having a possible multiresistant MG infection (OR 7.2). CONCLUSION The study shows an alarmingly high prevalence of MG with RAMs to macrolides and fluoroquinolones in Belgium. These results highlight the need to improve antimicrobial stewardship in Belgium in order to avoid the emergence of untreatable MG.
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Affiliation(s)
- Irith De Baetselier
- Department of Clinical Sciences, STI Reference Laboratory, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Hilde Smet
- Department of Clinical Sciences, STI Reference Laboratory, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Kristien Wouters
- Department of Clinical Sciences, STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dorien Van den Bossche
- Department of Clinical Sciences, STI Reference Laboratory, Institute of Tropical Medicine, Antwerpen, Belgium
| | - Bea Vuylsteke
- Public Health, HIV/STI Unit, Institute of Tropical Medicine, Antwerpen, Belgium
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44
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De Venter M, Elzinga BM, Van Den Eede F, Wouters K, Van Hal GF, Veltman DJ, Sabbe BGC, Penninx BWJH. The associations between childhood trauma and work functioning in adult workers with and without depressive and anxiety disorders. Eur Psychiatry 2020; 63:e76. [PMID: 32669136 PMCID: PMC7443788 DOI: 10.1192/j.eurpsy.2020.70] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND To examine the association between childhood trauma and work functioning, and to elucidate to what extent this association can be accounted for by depression and/or anxiety. METHODS Data of 1,649 working participants were derived from the Netherlands Study of Depression and Anxiety (NESDA, n = 2,981). Childhood trauma (emotional neglect, psychological, physical, and sexual abuse before age 16) was assessed with a structured interview and work functioning, in terms of absenteeism and presenteeism, with the Health and Labor Questionnaire Short Form (SF-HLQ) and the World Health Organization Disability Assessment Schedule II (WHODAS-II), respectively. Depressive and/or anxiety disorders were assessed with the Composite Interview Diagnostic Instrument (CIDI). Mediation analyses were conducted. RESULTS At baseline, 44.8% reported to have experienced childhood trauma. Workers with the highest childhood trauma level showed significantly (p < 0.001) more absenteeism as well as more presenteeism. Mediation analyses revealed that indirect effects between the childhood trauma index and both work indices were significantly mediated by current depressive disorder (p = 0.023 and p < 0.001, respectively) and current comorbid depression-anxiety (p = 0.020 and p < 0.001, respectively), with the latter accounting for the largest effects (PM = 0.23 and PM = 0.29, respectively). No significant mediating role in this relationship was found for current anxiety disorder and remitted depressive and/or anxiety disorder. CONCLUSIONS Persons with childhood trauma have significantly reduced work functioning in terms of absenteeism and presenteeism. This seems to be largely accounted for by current depressive disorders and current comorbid depression-anxiety.
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Affiliation(s)
- Maud De Venter
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Bernet M Elzinga
- Department of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Filip Van Den Eede
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium.,University Department of Psychiatry, Campus Antwerp University Hospital (UZA), Antwerp, Belgium
| | - Kristien Wouters
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital (UZA), University of Antwerp, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Guido F Van Hal
- Social Epidemiology and Health Policy, Department Epidemiology and Social Medicine, University of Antwerp (UA), Antwerp, Belgium
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Bernard G C Sabbe
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam Neuroscience and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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45
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Van Heerden J, Geel J, Hendricks M, Wouters K, Büchner A, Naidu G, Hadley GP, Du Plessis J, Van Emmenes B, Van Zyl A, Vermeulen J, Kruger M. The evaluation of induction chemotherapy regimens for high-risk neuroblastoma in South African children . Pediatr Hematol Oncol 2020; 37:300-313. [PMID: 32075464 DOI: 10.1080/08880018.2020.1717698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Achieving remission after induction therapy in high-risk neuroblastoma (HR-NB) is of significant prognostic importance. This study investigated remission after induction-chemotherapy using three standard neuroblastoma protocols in the South African (SA) setting. Retrospective data of 261 patients with HR-NB diagnosed between January 2000 and December 2016, who completed induction chemotherapy with standard treatment protocols were evaluated. The treatment protocols were either OPEC/OJEC or the St Jude NB84 protocol (NB84) or rapid COJEC (rCOJEC). The postinduction metastatic complete remission (mCR) rate, 2-year overall survival (OS) and 2-year event free survival (EFS) were determined as comparative denominators. The majority (48.3%; n = 126) received OPEC/OJEC, while 70 patients received (26.8%) rCOJEC and 65 (24.9%) NB84. Treatment with NB84 had the best mCR rate (36.9%), followed by OPEC/OJEC (32.5%) and rCOJEC (21.4%). The 2-year OS of treatment with NB84 was 41% compared to OPEC/OJEC (35%) and rCOJEC (24%) (p = 0.010). The 2-year EFS of treatment with NB84 was 37% compared to OPEC/OJEC (35%) and rCOJEC (18%) (p = 0.008). OPEC/OJEC had the least treatment-related deaths (1.6%) compared to rCOJEC (7.1%) and NB84 (7.5%) (p = 0.037). On multivariate analysis LDH (p = 0.023), ferritin (p = 0.002) and INSS stage (p = 0.006) were identified as significant prognostic factors for OS. The induction chemotherapy was not significant for OS (p = 0.18), but significant for EFS (p = 0.08) Treatment with NB84 achieved better mCR, OS and EFS, while OPEC/OJEC had the least treatment-related deaths. In resource-constrained settings, OPEC/OJEC is advised as induction chemotherapy in HR-NB due to less toxicity as reflected in less treatment-related deaths.
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Affiliation(s)
- Jaques Van Heerden
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Jennifer Geel
- Faculty of Health Sciences, Division of Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Marc Hendricks
- Haematology Oncology Service, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Kristien Wouters
- Clinical Trial Center, CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Ané Büchner
- Paediatric Haematology and Oncology, Department of Paediatrics, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Gita Naidu
- Faculty of Health Sciences, Division of Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, University of the Witwatersrand, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - G P Hadley
- Department of Paediatric Surgery, Faculty of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Jan Du Plessis
- Department of Paediatrics, Faculty of Health Sciences, University of the Free State, Division of Paediatric Haematology and Oncology, Universitas Hospital, Bloemfontein, South Africa
| | - Barry Van Emmenes
- Division of Paediatric Haematology and Oncology, Department of Paediatrics, Frere Hospital, East London, South Africa
| | - Anel Van Zyl
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Johani Vermeulen
- Paediatric Haematology Oncology, Department of Paediatrics and Child Health, Port Elizabeth Provincial Hospital, Walter Sisulu University, Port Elizabeth, South Africa
| | - Mariana Kruger
- Paediatric Haematology and Oncology, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
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46
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Neckebroeck B, Verkempinck S, Vaes G, Wouters K, Magnée J, Hendrickx M, Van Loey A. Advanced insight into the emulsifying and emulsion stabilizing capacity of carrot pectin subdomains. Food Hydrocoll 2020. [DOI: 10.1016/j.foodhyd.2019.105594] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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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47
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Dieltjens M, Braem MJ, Op de Beeck S, Vroegop AVMT, Kazemeini E, Van de Perck E, Beyers J, Kastoer C, Wouters K, Willemen M, Verbraecken JA, Vanderveken OM. Correction to: Remotely controlled mandibular positioning of oral appliance therapy during polysomnography and drug-induced sleep endoscopy compared with conventional subjective titration in patients with obstructive sleep apnea: protocol for a randomized crossover trial. Trials 2020; 21:339. [PMID: 32303248 PMCID: PMC7165368 DOI: 10.1186/s13063-020-04313-2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Following publication of the original article [1], the authors reported that Fig. 1 had not been corrected based on the reviewer's comments. The correct Fig. 1 is presented below.
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Affiliation(s)
- Marijke Dieltjens
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium. .,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium. .,Department of Special Dentistry Care, Antwerp University Hospital, Edegem, Antwerp, Belgium.
| | - Marc J Braem
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Special Dentistry Care, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Sara Op de Beeck
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Anneclaire V M T Vroegop
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Elahe Kazemeini
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Eli Van de Perck
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Jolien Beyers
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Chloé Kastoer
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Kristien Wouters
- Clinical Trial Center, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Marc Willemen
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Johan A Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Antwerp, Belgium.,Department of Pulmonology, Antwerp, University Hospital, Edegem, Antwerp, Belgium.,Laboratory of Experimental Medicine and Pediatrics (LEMP), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Olivier M Vanderveken
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Antwerp, Belgium
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48
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Nöstlinger C, Reyniers T, Smekens T, Apers H, Laga M, Wouters K, Vuylsteke B. Drug use, depression and sexual risk behaviour: a syndemic among early pre-exposure prophylaxis (PrEP) adopters in Belgium? AIDS Care 2020; 32:57-64. [PMID: 32160759 DOI: 10.1080/09540121.2020.1739218] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Little is known about how interacting psychosocial problems may influence sexual behaviour among men having sex with men taking Pre-exposure prophylaxis (PrEP). This study assessed (1) the prevalence of depression, recreational drug-use and sexual risk behaviour; (2) changes in these psychosocial conditions over time; and (3) the interaction of drug use and depression with sexual risk behaviour. We analysed data of the Belgian Be-PrEP-ared cohort study (N = 200). We assessed depression using the PHQ-9, recreational drug use and receptive condomless anal intercourse (rCAI) with anonymous partners. Frequencies of psychosocial problems were compared at baseline, 9 and 18 months follow-up (FU). Bivariate associations between depression and drug-use behaviour, and their interaction with rCAI with anonymous sexual partners using was examined using linear regression. Receptive CAI increased from 41% at baseline to 53% at M18 (p = 0.038). At baseline, we found an interaction effect of poly-drug use and depression, potentiating rCAI with anonymous partners. Participants reporting poly-drug use associated with depression were significant more likely to report this type of sexual risk behaviour than those who did not report this association (p = 0.030). The high level of intertwined psychosocial problems call for multi-level interventions for those PrEP users experiencing a syndemic burden.
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Affiliation(s)
| | - Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tom Smekens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Hanne Apers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kristien Wouters
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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49
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Reyniers T, Vuylsteke B, Pirotte B, Hoornenborg E, Bil JP, Wouters K, Laga M, Nöstlinger C. Physicians' preparedness for pre-exposure prophylaxis: results of an online survey in Belgium. Sex Health 2019; 15:606-611. [PMID: 30384876 DOI: 10.1071/sh18072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/27/2018] [Indexed: 12/21/2022]
Abstract
Background Physicians have a crucial role in the implementation and scale up of pre-exposure prophylaxis (PrEP). The objective of this study is to examine Belgian physicians' PrEP knowledge, concerns, acceptance and their willingness to prescribe PrEP. METHODS A cross-sectional online survey was conducted between March and June 2016. Dissemination targeted Belgian primary care physicians (PCPs) and HIV specialists. Sociodemographic characteristics, experience with HIV and PrEP, self-assessed PrEP knowledge, concerns about PrEP, and PrEP acceptance were stratified according to professional background. Associations with willingness to prescribe PrEP were examined using univariable and multivariable binary logistic regression analyses. RESULTS In total, 333 completed surveys were included in the analysis. Sixty-two physicians (18.6%) scored their knowledge of PrEP to be good, 263 (79.0%) had an accepting attitude towards PrEP and 198 (59.5%) were willing to prescribe PrEP if approved in Belgium. HIV specialists consistently reported having better knowledge of PrEP, less concerns and a more accepting attitude towards PrEP than PCPs. In multivariable logistic regression analysis, higher PrEP knowledge (OR 2.4; 95%CI: 1.0-5.7) and higher PrEP acceptance (OR: 3.8; 95%CI: 2.1-6.8) remained significantly associated with the willingness to prescribe PrEP. CONCLUSIONS HIV specialists are better prepared to provide PrEP than PCPs in Belgium. Interventions to improve PrEP knowledge and acceptance among all providers are needed. The role of PCPs could be very important in optimising the rollout of PrEP, but additional training and guidelines will be needed.
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Affiliation(s)
- Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Benoit Pirotte
- Department of Infectious Diseases, Centre Hospitalier Régional (CHR) de Liège, Boulevard du Douzième de Ligne 1, 4000 Liège, Belgium
| | - Elske Hoornenborg
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands
| | - Janneke P Bil
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands
| | - Kristien Wouters
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Christiana Nöstlinger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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50
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Dieltjens M, Braem MJ, Op de Beeck S, Vroegop AVMT, Kazemeini E, Van de Perck E, Beyers J, Kastoer C, Wouters K, Willemen M, Verbraecken JA, Vanderveken OM. Remotely controlled mandibular positioning of oral appliance therapy during polysomnography and drug-induced sleep endoscopy compared with conventional subjective titration in patients with obstructive sleep apnea: protocol for a randomized crossover trial. Trials 2019; 20:615. [PMID: 31665059 PMCID: PMC6820920 DOI: 10.1186/s13063-019-3698-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 09/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The amount of mandibular protrusion is a key factor in optimizing the efficacy of mandibular advancement device (MAD) therapy in an individual patient diagnosed with obstructive sleep apnea. This process is called titration and is generally based on resolution of subjective symptoms like snoring and/or daytime sleepiness as a function of protrusion. An objective approach uses a remotely controlled mandibular positioner (RCMP) during a full-night polysomnography (PSG), in analogy with continuous positive airway pressure (CPAP) titration. More recently, the feasibility of RCMP use during drug-induced sleep endoscopy (DISE) titration was reported. METHODS This randomized crossover trial will compare DISE-assisted titration to PSG-guided titration, as well as with the conventional subjective titration method. The primary outcome is the actual mandibular protrusive position found to be the most optimal for each tested titration procedure. Furthermore, the therapeutic efficacy will be compared among the different titration modalities using level 1 sleep studies. DISCUSSION Currently, the optimal titration of MAD therapy is most often based on 'trial and error'. The conventional method relies on subjective improvement in symptoms, although this may not provide the most accurate indicator for efficient titration. Therefore, relying on objective criteria in the titration process should be advantageous. In analogy with CPAP, titration of the most optimal mandibular protrusion could be performed using RCMP during an overnight titration PSG. Recently, it was shown that titration under direct visualization of upper airway patency and collapsibility is feasible using the RCMP during DISE. However, no clinical results for such a procedure are as yet available. This study is the first to compare the most optimal mandibular protrusive position according to three titration procedures, as well as to compare the therapeutic efficacy of these titration methods. TRIAL REGISTRATION ClinicalTrials.gov, NCT03716648 . Registered on 23 October 2018.
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Affiliation(s)
- Marijke Dieltjens
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium. .,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium. .,Department of Special Dentistry Care, Antwerp University Hospital, Edegem, Antwerp, Belgium.
| | - Marc J Braem
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Special Dentistry Care, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Sara Op de Beeck
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Anneclaire V M T Vroegop
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Elahe Kazemeini
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Eli Van de Perck
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Jolien Beyers
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Chloé Kastoer
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Kristien Wouters
- Clinical Trial Center, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Marc Willemen
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Johan A Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Antwerp, Belgium.,Department of Pulmonology, Antwerp University Hospital, Edegem, Antwerp, Belgium.,Laboratory of Experimental Medicine and Pediatrics (LEMP), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium
| | - Olivier M Vanderveken
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium.,Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Antwerp, Belgium
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