Can Implementing New Services Organization Models to Better Meet the Needs of Young People Bring About Practice Changes? Analysis of an Experiment in Québec

The research question addressed in this article is: Can implementing new services organization models to better meet the needs of young people bring about practice changes? More precisely, we examine the effects of a new model called Aire Ouverte (AO) which is implemented gradually across Quebec since 2019. This new model involves public sector and community organizations. To grasp practices' change, we use cultural historical activity theory (CHAT) and employ a qualitative approach. Beyond a precise description of work activities, we gained an inside view of how the actors involved represented their practice and context. Our results show that practice changes seen by actors are in line with the object of the intervention, that is, responding rapidly to the expressed needs of young people. The development of new tools, flexible functioning, strengthening of interprofessional and intersectoral collaboration, involvement of young people in decision-making, all should contribute to improving response to their needs. This being said, a critical look at practice changes reveals a challenge in aligning the design and objective of AO with the needs of some young people. We noted also a poor alignment of effective collaborative practices between levels of care and the practices sought from intersectoral collaboration.

Exceptional association of Budd-Chiari syndrome with pheochromocytoma

We are reporting a case revealed by an abdomino-thoracic painful syndrome associated with multi-organ failure. A 61-year-old hypertensive woman was hospitalized for the management of hypertensive emergency associating acute coronary syndrome and abdominal pain. A thoraco-abdomino-pelvic CT-scan showed a right adrenal mass associated with hepatic vein thrombosis. After medical preparation, an adrenalectomy was performed by way of open surgery; the study of the surgical specimen found a pheochromocytoma score PASS 4. The follow-up was marked by the normalization of blood pressure and biological abnormalities.

Assessment of Antioxidant and Antibacterial Activities of Cystoseira Mediterranea and Padina Pavonica from Algerian North-East for A Potential Use as a Food Preservative

The aim of this work was to evaluate the antioxidant and antibacterial activities of two marine algae, Cystoseira mediterranea and Padina pavonica, extracts. Total phenols (TPC), carotenoids, and phlorotannins contents of the extracts obtained by four extraction solvents were determined and compared. The highest TPC content was observed for aqueous extract of C. mediterranea with 37.09±0.46 mg GAE/g DE followed by ethanol extract of P. pavonica (24.28 ±0.99 mg GAE/g DE), which showed the highest phlorotannins content (1.18±0.18 mg PE/g DE), while its methanol extract held carotenoids content of 66.96 ±4.78 μg g–1 DE. Ethanol extract of C. mediterranea exhibited the best antioxidant activity with an EC50 of 58.3 ±1.16 μg ml . The antibacterial activity screening against MRSA and E. coli showed that ethanol extract of C. mediterranea towards a Methicillin resistant Staphyloccocus aureus (20.33±0.28 mm) and E. coli (15.66±0.57 mm) was more efficient with MICs about 80 mg ml–1 and 20 mg ml–1, respectively. Ethanol extract of C. mediterranea seems to have the highest potential for use in food industries.

Subdural Hematoma Complicating Ventriculoperitoneal Shunts: An Algerian Centers Experience

Introduction Subdural hematoma can occur as a complication of a ventriculoperitoneal shunt (VPS), and it should be considered in any patient who present a shunt dysfunction or who does not show the expected recovery after revision of a shunt. Computed tomography (CT) scan is a quick and easy way of detecting subdural hematoma.

Materials and Methods We conduct a retrospective study of 17 patients. All of them are admitted for a subdural hematoma on a VPS. The diagnosis in 13 cases is made by CT scan; three cases by brain MRI.

Results We operated 16 patients and the evacuation of the hematoma with revision of the shunt was performed; we used an adjustable shunt for three patients and endoscopic third ventriculostomy in one case. The operative outcomes were favorable in 12 patients; there were 4 recurrences, 2 of which required evacuation of the hematoma through a bone flap.

Conclusion The subdural hematoma is a complication observed during the surgical treatment of the hydrocephalus and can be a serious issue. We suggest that a brain CT scan should be routinely performed in symptomatic patients with VPS.

European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group Experience with Advanced/Metastatic Epithelioid Sarcoma Patients Treated in Prospective Trials: Clinical Profile and Response to Systemic Therapy

AIMS

Epithelioid sarcoma is a soft tissue sarcoma associated with a high rate of local recurrence after wide resection and high incidence of distant metastasis. Little is known about the clinical course and response to systemic treatments in epithelioid sarcoma patients. We carried out a retrospective analysis of clinical data from epithelioid sarcoma patients to provide a reference for the design of future epithelioid sarcoma-specific studies.

PATIENTS AND METHODS

Data from patients with epithelioid sarcoma entered in prospective multi-sarcoma phase II/III trials were pooled: EORTC trial 62012 (doxorubicin versus doxorubicin/ifosfamide), 62043 (pazopanib), 62072 (pazopanib versus placebo) and 62091 (doxorubicin versus trabectedin). Patients had either a local or a centrally confirmed diagnosis of epithelioid sarcoma, had inoperable/metastatic disease at study entry and were eligible for the according trial. Response was assessed according to RECIST 1.1. Progression-free survival (PFS) and overall survival were calculated from date of entry.

RESULTS

Among 976 patients with advanced sarcomas, 27 epithelioid sarcoma patients (2.8%) were eligible for the analysis (17 men, median age at diagnosis 50 years, range 19-72). Eighteen (66.7%) received chemotherapy as first-line treatment (five doxorubicin, eight doxorubicin/ifosfamide, two pazopanib, three trabectedin) and nine (33.3%) received pazopanib as second line or later. The primary tumour was located in the lower extremity (n = 8; 29.6%), upper extremity (n = 5; 18.5%), retro/intra-abdominal (n = 4; 14.8%) and in other locations (n = 10; 37.0%). At entry, metastases were mainly found in lung (n = 17; 63%), lymph nodes (n = 9; 33.3%), bone (n = 8; 29.6%) and soft tissue (n = 7; 25.9%). The best response for first-line patients was four partial responses (22.2%), 10 stable disease (55.6%) and four progressive disease (22.2%). In subsequent lines, pazopanib achieved one partial response (11.1%), four stable disease (44.4%) and four progressive disease (44.4%). All patients but one progressed on treatment. The median PFS and overall survival were 3.8 (95% confidence interval 2.2-4.8) and 10.8 months (95% confidence interval 8.1-21.3), respectively. Five patients were still alive at the time of the according trial analysis.

CONCLUSION

With all limitations of such a rare disease and small data set, objective response and survival outcomes are similar in epithelioid sarcoma to non-selected sarcoma populations. The clinical testing of novel systemic treatments for epithelioid sarcoma remains an unmet medical need and a high priority.

Abstract PD3-09: Pertuzumab and trastuzumab with or without metronomic chemotherapy for older patients with HER2- positive metastatic breast cancer: Results from the EORTC 75111- 10114 ETF/BCG randomized phase II study

Introduction: Pertuzumab (P) is approved as first line therapy for HER2-positive (HER2+) metastatic breast cancer (MBC) combined with trastuzumab (T) and docetaxel. However older patients are at higher risk of chemotherapy-induced toxicity raising high interest in a less toxic backbone such as metronomic chemotherapy and in chemo-free dual HER2 blockade (TP). Patients and Methods: This phase II selection study randomized (1:1) patients with HER2+ MBC, aged 70+ or frail 60+, to first line chemotherapy with metronomic oral cyclophosphamide 50 mg/day + TP (TPM) or TP alone. Prior endocrine therapy and up to 1 line of anti-HER2 therapy (without chemotherapy) for MBC were allowed.T-DM1 was offered in case of progression. Randomization was stratified according to hormonal receptors, previous anti-HER2 treatment and geriatric assessment. Primary endpoint was progression-free survival (PFS) rate at 6 months seeking a difference of ≥ 10% between the two arms. Results: Between July 2013 and May 2016, 39 and 41 patients were randomized to TP and TPM arm respectively: median age 76.7 years, hormone receptor positivity 69%, prior adjuvant T 11%, prior metastatic T (with endocrine therapy) 3%, visceral involvement 93.7%, potential frailty profile according to geriatric screening G8 (≤14) 71% and/or to short physical performance battery (<10) 81%, Charlson comorbidity score > 0 in 40%. With 20.7 months of median follow-up, 6-month and median PFS were 46.2% (95% CI 30.2-60.7) and 5.6 months (95% CI 3.6-16.8) versus 73.4% (95% CI 56.6-84.6) and 12.7 months (95% CI 6.7-24.8) for TP and TPM, respectively. Four patients in TPM and 2 in TP developed brain metastases only as progression event. OS and breast cancer specific survival were comparable between the two arms; 9/29 deaths were not breast cancer-related. Response rate was 44% in TP arm and 53% in TPM arm. In 29 patients who received T-DM1 second line, 6-month PFS, median PFS and response rate were 49.5% (95% CI 29.2-66.9), 5 months (95% CI 2.5-12.5) and 13.5%. In patients who discontinued TP(M), 37, 9 and 14 stopped because of progression, toxicity or other reasons, respectively. During TPM treatment, 1 patient died of heart failure and 1 developed grade 3 heart failure; 1 patient in each arm developed a ≥ 10% asymptomatic left ventricular ejection fraction decrease below 50%. Diarrhea any grade and grade ≥ 3 were observed in 56% and 8% versus 71% and 12% patients in TP and TPM arms, respectively. No grade 3 or febrile neutropenia was reported. There was no relevant difference in functional evolution between both groups. In the whole population, several geriatric items were of prognostic value by multivariate analysis: e.g. for OS, G8 >14 vs ≤ 14 HR=0.12 (95% CI 0.03-0.55, p 0.006). In 29 patients receiving T-DM1, grade 3 toxicity was rare: fatigue (2 patients), thrombocytopenia and epistaxis (1 patient). Conclusions: Metronomic chemotherapy-based dual blockade (TPM) seems to be superior to dual blockade alone (TP) in an elderly/frail HER2+ MBC population, with an attractive safety profile. TPM, followed by T-DM1 after progression, may delay or supersede taxane chemotherapy in this population.

Citation Format: Wildiers H, Tryfonidis K, dal Lago L, Vuylsteke P, Curigliano G, Waters S, Brouwers B, Aalders K, Meulemans B, Litiere S, Touati N, Cardoso F, Brain E. Pertuzumab and trastuzumab with or without metronomic chemotherapy for older patients with HER2- positive metastatic breast cancer: Results from the EORTC 75111- 10114 ETF/BCG randomized phase II study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD3-09.

Luminescence properties of ZnGa2O4:Cr3+,Bi3+ nanophosphors for thermometry applications

Luminescence properties of chromium(iii) and bismuth(iii) co-doped ZnGa₂O₄ nanoparticles are investigated for thermometry applications.

Abstract P6-09-13: The association between pCR status after neoadjuvant chemotherapy and sites of first distant relapse after surgery: A substudy of the EORTC 10094/BIG-1-00 trial

Background

Chemotherapy in eligible patients is increasingly applied in the neoadjuvant setting, as it offers the possibility for 'in vivo' monitoring of the activity to the administered treatment, prevention of early micrometastatic spread and often allows less invasive surgery in patients that would otherwise have needed a mastectomy. The achievement of a pathologic complete response (pCR) after neoadjuvant chemotherapy is a prognosticator for better outcome. However, less is known about the patterns of distant relapse between patients that did and did not achieve pCR. We assessed the differences in sites of first distant relapse after pCR versus non-pCR after neoadjuvant chemotherapy in patients enrolled in the EORTC 10094/BIG-1-00 “p53” trial.

Methods

The analyzed population consisted of patients enrolled in the “p53” trial that received ≥1 cycle of chemotherapy before surgery and who have been diagnosed with a distant relapse. pCR was defined as no evidence of residual invasive cancer (or very few scattered tumor cells) in the primary tumor and axillary lymph nodes with or without residual ductal carcinoma in situ (DCIS). Intrinsic subtype classification was performed using the 2011 St Gallen consensus. The first site of distant relapse was collected for all patients and was classified as soft tissue, visceral, skeletal or CNS. As primary analysis, the associations between achievement of pCR and sites of distant relapse were investigated in 4 multivariate logistic regression models, one for each site, adjusting for intrinsic subtype and preceding local recurrence (yes/no). Adjusted P-values are reported (Benjamini-Hochberg correction). Secondary analyses include: associations between site of first distant relapse and pCR by subtype, description of concomitant sites of relapse.

Results

The study included 383 (21%) eligible patients out of the 1856 randomized for the 'p53' trial, of whom 28 (7%) had achieved pCR and 355 (93%) did not. Median follow-up was 5.4 years. Achievement of pCR was associated with a trend towards a decreased presentation with skeletal metastases (21% (pCR) vs 50% (non-pCR), OR=0.32, adj-p=0.071, see Table) and we observed an increase in the proportion of patients with CNS tissue as first site of distant relapse (21% vs 9%, OR=2.39, adj-p=0.183). The trend for skeletal metastases was seen in all subtypes except for Luminal A. Patients with pCR were more likely to present with only one relapse location category when compared to non-pCR (86% vs 69%).

Association between site of first distant relapse and pCRSite of first distant relapseNon-pCR N=355pCR N=28Total N=383Median of time from surgery till first distant relapsepCR: Yes vs NoCategoryN(%)N(%)N(%)MonthsOR (95% CI)Adj. p-valueSoft tissue43 (12.1)4 (14.3)47 (12.3)250.94 (0.30, 2.95)0.909Visceral183 (51.5)14 (50.0)197 (51.4)220.80 (0.36, 1.74)0.756Skeletal179 (50.4)6 (21.4)185 (48.3)280.32 (0.12, 0.82)0.071CNS32 (9.0)6 (21.4)38 (9.9)162.39 (0.87, 6.58)0.183

Conclusion

In this group of patients treated with neoadjuvant chemotherapy, patients that achieved a pCR were less likely to present with skeletal metastases as first site of distant relapse, even after adjustment for intrinsic subtype.

Citation Format: Touati N, Aalders K, Slaets L, Tryfonidis K, Cameron DA, Bonnefoi H. The association between pCR status after neoadjuvant chemotherapy and sites of first distant relapse after surgery: A substudy of the EORTC 10094/BIG-1-00 trial [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-13.

Pazopanib in advanced vascular sarcomas: an EORTC Soft Tissue and Bone Sarcoma Group (STBSG) retrospective analysis

BACKGROUND

Pazopanib is a multitargeted tyrosine kinase inhibitor approved for the treatment of patients with selective subtypes of advanced soft tissue sarcoma (STS) who have previously received standard chemotherapy including anthracyclines. Data on the efficacy in vascular sarcomas are limited. The main objective of this study was to investigate the activity of pazopanib in vascular sarcomas.

PATIENTS AND METHODS

A retrospective study of patients with advanced vascular sarcomas, including angiosarcoma (AS), epithelioid hemangioendothelioma (HE) and intimal sarcoma (IS) treated with pazopanib in real life practice at EORTC centers as well as patients treated within the EORTC phase II and III clinical trials (62043/62072) was performed. Patient and tumor characteristics were collected. Response was assessed according to RECIST 1.1. and survival analysis was performed.

RESULTS

Fifty-two patients were identified, 40 (76.9%), 10 (19.2%) and two (3.8%) with AS, HE and IS, respectively. The response rate was eight (20%), two (20%) and two (100%) in the AS, HE and IS subtypes, respectively. There was no significant difference in response rate between cutaneous and non-cutaneous AS and similarly between radiation-associated and non-radiation-associated AS. Median progression-free survival (PFS) and median overall survival (OS; from commencing pazopanib) were three months (95% CI 2.1-4.4) and 9.9 months (95% CI 6.5-11.3) in AS, respectively.

CONCLUSION

The activity of pazopanib in AS is comparable to its reported activity in other STS subtypes. In this study, the activity of pazopanib was similar in cutaneous/non-cutaneous and in radiation/non-radiation-associated AS. In addition, pazopanib showed promising activity in HE and IS, worthy of further evaluation.

[Neurologic manifestations of sarcoidosis: A study of 18 cases]

INTRODUCTION

Sarcoidosis is a multisystemic granulomatous disease of unknown aetiology. Neurologic manifestations are found in 5 to 10% of cases.

PATIENTS AND METHODS

We conducted a retrospective study over 6-year period including 18 patients diagnosed with neurosarcoidosis in the Neurologic department of the Military Hospital of Instruction of Tunis. Clinical, radiological, therapeutic features and outcome were studied.

RESULTS

The mean age was 43.44 years. Neurologic signs were the first symptom in 10 cases. Peripheral nervous system impairment was often found. Meningitis was noted in 8 cases. Biological tests are not contributive for the diagnosis. The brain magnetic resonance imaging was pathologic in 10 cases. Corticosteroids were administrated in the majority of cases. Eight patients did not show any sign of improvement. Ten cases improved with treatment.

DISCUSSION AND CONCLUSION

Diagnosis of neurosarcoidosis is difficult because of its clinical and radiological polymorphism. It is based on a clinical history suggestive of neurosarcoidosis, laboratory, imaging and histological studies.

Cysteine-grafted nonwoven geotextile: a new and efficient material for heavy metals sorption--Part B

The development of a new material designed to trap heavy metals from sediments or wastewater, based on a polypropylene non-woven covalently grafted with cysteine, has been reported in a previous paper (Part A). The non-woven was first functionalized with acrylic acid (AA) which is used as spacer, and then cysteine was immobilized on the substrate through covalent coupling in order to obtain the so-called PP-g-AA-cysteine. Some preliminary heavy metals adsorption tests gave interesting results: at 20 °C for 24 h and in a 1000 mg/L heavy metals solution, PP-g-AA-cysteine adsorbs 95 mg Cu/g PP (CuSO4 solution), 104 mg Cu/g PP (Cu(NO3)2 solution), 135 mg Pb/g PP (Pb(NO3)2 solution) and 21 mg Cr/g PP (Cr(NO3)3 solution). In this second part of the work, heavy metals sorption tests were carried out with Cu (II), Pb (II), and Cr (III) separately, in order to determine the sorption capacity of this new sorbent as a function of (i) the heavy metals concentration in the solution, (ii) the contact time with the solution, (iii) the pH and (iv) the ionic strength of the solution containing heavy metals. Moreover, the sorption capacity of PP-g-AA-Cysteine was studied using a polluted solution consisting of a mixture of these different heavy metals. An Electron Paramagnetic Resonance study was finally carried out in order to determine the coordination geometry in the environment of the copper trapped by the PP-g-AA-cysteine.

Développement et application d’une vignette clinique pour apprécier la qualité des soins en oncology

BACKGROUND

In conjunction with a study focusing on the implementation and effect of an integrated care network for cancer patients in the Monteregie region in Quebec, the vignette research strategy was adopted to assess the quality of care provided by the interdisciplinary teams working with this clientele. This research strategy has only recently been used to assess professional practices. This article adopts a resolutely methodological angle in order to describe a rigorous, innovative, transferable experience from the standpoint of the elaboration of a vignette.

METHODS

We adopted a six-step approach to elaborate the vignette. This vignette includes the description of collaboration with clinicians. The approach assured us of attaining high content validity from the standpoint of facets of its relevance, completeness and intelligibility to respondents. Our clinical vignette describes a sequence of events stemming from the care coordination of a 58-year-old man suffering from rectal cancer. Data were collected through group interviews with the interdisciplinary teams (n=5) under study. The professionals present were asked to describe their usual practices with respect to the events described in the vignette. We adopted two data analysis strategies: (i) a comparison of practices revealed through the interviews with anticipated responses in light of the guidelines of the "Programme québécois de lutte contre le cancer"; and (ii) an analysis according to facets of the quality of care.

RESULTS

Team professional practices seem to evolve towards the care package valued by the "Programme québécois de lutte contre le cancer". Differences were also observed between the teams from the standpoint of the continuity of care.

CONCLUSION

Our study shows that it is possible to develop a vignette that enables us to understand professional practices in an interdisciplinary context provided that a rigorous approach is adopted. This approach, which can be transferred to the study of similar phenomena, makes it possible to document the care offered and contribute to the renewal of professional practices.