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Haeusler KG, Eichner FA, Heuschmann PU, Fiebach JB, Engelhorn T, Callans D, De Potter T, Debruyne P, Scherr D, Hindricks G, Al-Khalidi HR, Mont L, Kim WY, Piccini JP, Schotten U, Themistoclakis S, Di Biase L, Kirchhof P. Detection of brain lesions after catheter ablation depends on imaging criteria: insights from AXAFA-AFNET 5 trial. Europace 2023; 25:euad323. [PMID: 37897713 PMCID: PMC10963060 DOI: 10.1093/europace/euad323] [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: 08/29/2023] [Revised: 09/30/2023] [Accepted: 10/05/2023] [Indexed: 10/30/2023] Open
Abstract
AIMS Left atrial catheter ablation is well established in patients with symptomatic atrial fibrillation (AF) but associated with risk of embolism to the brain. The present analysis aims to assess the impact of diffusion-weighted imaging (DWI) slice thickness on the rate of magnetic resonance imaging (MRI)-detected ischaemic brain lesions after ablation. METHODS AND RESULTS AXAFA-AFNET 5 trial (NCT02227550) participants underwent MRI using high-resolution (hr) DWI (slice thickness: 2.5-3 mm) and standard DWI (slice thickness: 5-6 mm) within 3-48 h after ablation. In 321 patients with analysable brain MRI (mean age 64 years, 33% female, median CHA2DS2-VASc 2), hrDWI detected at least one acute brain lesion in 84 (26.2%) patients and standard DWI in 60 (18.7%; P < 0.01) patients. High-resolution diffusion-weighted imaging detected more lesions compared to standard DWI (165 vs. 104; P < 0.01). The degree of agreement for lesion confirmation using hrDWI vs. standard DWI was substantial (κ = 0769). Comparing the proportion of DWI-detected lesions, lesion distribution, and total lesion volume per patient, there was no difference in the cohort of participants undergoing MRI at 1.5 T (n = 52) vs. 3 T (n = 269). CONCLUSION The pre-specified AXAFA-AFNET 5 sub-analysis revealed significantly increased rates of MRI-detected acute brain lesions using hrDWI instead of standard DWI in AF patients undergoing ablation. In comparison to DWI slice thickness, MRI field strength had a no significant impact in the trial. Comparing the varying rates of ablation-related MRI-detected brain lesions across previous studies has to consider these technical parameters. Future studies should use hrDWI, as feasibility was demonstrated in the multicentre AXAFA-AFNET 5 trial.
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Affiliation(s)
- Karl Georg Haeusler
- Atrial Fibrillation NETwork association (AFNET), Mendelstr. 11, 48149 Münster, Germany
- Department of Neurology, Universitätsklinikum Würzburg Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Felizitas A Eichner
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
- Institute of Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Engelhorn
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - David Callans
- Hospital of the University of Pennsylvania, Philadelphia, USA
| | | | | | - Daniel Scherr
- Division of Cardiology, Medical University Graz, Austria
| | | | - Hussein R Al-Khalidi
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Won Yong Kim
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan P Piccini
- Duke Clinical Research Institute (DCRI), Durham, NC, USA
- Division of Cardiology Duke University Medical Center, Duke University, Durham NC, USA
| | - Ulrich Schotten
- Atrial Fibrillation NETwork association (AFNET), Mendelstr. 11, 48149 Münster, Germany
- Departments of Cardiology and Physiology, University Maastricht, Maastricht, The Netherlands
| | | | - Luigi Di Biase
- Albert Einstein College of Medicine at Montefiore Hospital, New York, NY, USA
- Texas Cardiac Arrhythmia Institute at St.David’s Medical Center, Austin, TX, USA
| | - Paulus Kirchhof
- Atrial Fibrillation NETwork association (AFNET), Mendelstr. 11, 48149 Münster, Germany
- University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK
- Department of Cardiology, University Heart and Vascular Center UKE Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research, Partner site Hamburg/Kiel/Lübeck, Germany
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Brignole M, Aksu T, Calò L, Debruyne P, Deharo JC, Fanciulli A, Fedorowski A, Kulakowski P, Morillo C, Moya A, Olshansky B, Piotrowski R, Stec S, Wichterle D. Clinical controversy: methodology and indications of cardioneuroablation for reflex syncope. Europace 2023; 25:euad033. [PMID: 37021351 PMCID: PMC10227654 DOI: 10.1093/europace/euad033] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/05/2022] [Indexed: 04/07/2023] Open
Affiliation(s)
- Michele Brignole
- IRCCS Istituto Auxologico Italiano, Faint & Fall Programme, Ospedale San Luca, Piazzale Brescia 2, 20149 Milano, Italy
| | - Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, 34755 Ataşehir/İstanbul, Turkey
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, 00169 Roma, Italy
| | | | - Jean Claude Deharo
- Assistance Publique − Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, France and Aix Marseille Université, C2VN, 13005 Marseille, France
| | - Alessandra Fanciulli
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Artur Fedorowski
- Department of Cardiology, Karolinska University Hospital, 17177 Stockholm, Sweden
- Department of Medicine, Karolinska Institute, 17177 Stockholm, Sweden
- Department of Clinical Sciences, Lund University, 20502 Malmö, Sweden
| | - Piotr Kulakowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, 04-073 Warsaw, Poland
| | - Carlos Morillo
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, T2N 1N4 Calgary, AB, Canada
| | - Angel Moya
- Department of Cardiology, Hospital Universitari Dexeus, 08028 Barcelona, Spain
| | - Brian Olshansky
- Division of Cardiology, University of Iowa Hospitals, 52242 Iowa City, IA, USA
| | - Roman Piotrowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, 04-073 Warsaw, Poland
| | - Sebastian Stec
- Division of Electrophysiology, Cardioneuroablation, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, 38-500 Sanok, Poland
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), 11336 Prague, Czechia
- Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University, 11336 Prague, Czechia
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Debruyne P, Rossenbacker T, Janssens L, Collienne C, Ector J, Haemers P, le Polain de Waroux JB, Bazelmans C, Boussy T, Wijns W. Durable Physiological Changes and Decreased Syncope Burden 12 Months After Unifocal Right-Sided Ablation Under Computed Tomographic Guidance in Patients With Neurally Mediated Syncope or Functional Sinus Node Dysfunction. Circ Arrhythm Electrophysiol 2021; 14:e009747. [PMID: 33999698 PMCID: PMC8208097 DOI: 10.1161/circep.120.009747] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Philippe Debruyne
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium (P.D., T.R., L.J.)
| | - Tom Rossenbacker
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium (P.D., T.R., L.J.)
| | - Luc Janssens
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium (P.D., T.R., L.J.)
| | - Christine Collienne
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Woluwe, Belgium (C.C.)
| | - Joris Ector
- Department of Cardiology, University of Leuven, Belgium (J.E., P.H.)
| | - Peter Haemers
- Department of Cardiology, University of Leuven, Belgium (J.E., P.H.)
| | | | | | - Tim Boussy
- Department of Cardiology, AZ Groeninge, Kortrijk, Belgium (T.B.)
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group (W.W.)
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Smirnov V, Marks C, Debruyne P, Riquet A, Defoort-Dhellemmes S. Ataxie spino-cérébelleuse : quand le fond d’œil fait le diagnostic. J Fr Ophtalmol 2020; 43:676-677. [DOI: 10.1016/j.jfo.2019.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/18/2019] [Indexed: 11/28/2022]
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Debruyne P, Rossenbacker T, Collienne C, Roosen J, Ector B, Janssens L, Charlier F, Vankelecom B, Dewilde W, Wijns W. Unifocal Right-Sided Ablation Treatment for Neurally Mediated Syncope and Functional Sinus Node Dysfunction Under Computed Tomographic Guidance. Circ Arrhythm Electrophysiol 2019; 11:e006604. [PMID: 30354289 DOI: 10.1161/circep.118.006604] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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] [Indexed: 11/16/2022]
Abstract
Background Biatrial, extensive, and complex ablation strategies have been published for the treatment of neurally mediated syncope, sinus node dysfunction, and functional atrioventricular block. We have developed a less extensive and more specific approach compared with previously published cardioneuroablation strategies, called cardio-neuromodulation. It is based on tailored vagolysis of the sinoatrial node through partial ablation of the anterior right-ganglionated plexus, preferentially through a right-sided approach. Methods Patients with syncope were enrolled between December 2016 and December 2017. They were assigned to group A if they had a positive head-up tilt test and to group B if they presented with a pause ≥3 seconds. The area to target during cardio-neuromodulation was designed offline on a computed tomographic scan. Slow heart rates and pauses were compared during 24-hour rhythm registration at baseline, at 1-month follow-up, and 6-month follow-up. Syncope burden was assessed before the procedure and at 3- and 6-month follow-up. Results Twenty patients underwent cardio-neuromodulation through a right-sided approach (12 in group A, 8 in group B). The first application of radiofrequency energy led to a P-P interval shortening >120 ms in all 20 patients. After a mean±SD ablation time of 7±4 minutes and mean ablated surface area of 11±6 mm2, the P-P interval shortened by 219±160 ms ( P<0.001). The number of beats <50/min during 24-hour rhythm registration was reduced by a median of 100% at 6-month follow-up ( P<0.001). Syncope burden was reduced by 95% at 6-month follow-up ( P<0.001). Conclusions These data indicate that cardio-neuromodulation, through a right-sided and computed tomographic-guided procedure, is safe, fast, and highly reproducible in preventing inappropriate functional sinus bradycardia and syncope recurrence.
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Affiliation(s)
- Philippe Debruyne
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium (P.D., T.R., J.R., B.E., L.J., F.C., B.V., W.D.)
| | - Tom Rossenbacker
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium (P.D., T.R., J.R., B.E., L.J., F.C., B.V., W.D.)
| | - Christine Collienne
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Woluwe, Belgium (C.C.)
| | - John Roosen
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium (P.D., T.R., J.R., B.E., L.J., F.C., B.V., W.D.)
| | - Bavo Ector
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium (P.D., T.R., J.R., B.E., L.J., F.C., B.V., W.D.)
| | - Luc Janssens
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium (P.D., T.R., J.R., B.E., L.J., F.C., B.V., W.D.)
| | - Filip Charlier
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium (P.D., T.R., J.R., B.E., L.J., F.C., B.V., W.D.)
| | - Bart Vankelecom
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium (P.D., T.R., J.R., B.E., L.J., F.C., B.V., W.D.)
| | - Willem Dewilde
- Department of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium (P.D., T.R., J.R., B.E., L.J., F.C., B.V., W.D.)
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group (W.W.)
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Kefer J, Aminian A, Vermeersch P, de Potter T, Stammen F, Benit E, Budts W, Missault L, Drieghe B, Buysschaert I, Cornelis K, Herzet JM, Guedes A, Debbas N, Rivero M, Lempereur M, Lochy S, Casado-Arroyo R, Laruelle C, Debruyne P, Ledent T. Transcatheter left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: results from the Belgian registry. EUROINTERVENTION 2019; 13:1603-1611. [PMID: 28966159 DOI: 10.4244/eij-d-17-00076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study aimed to assess the safety and efficacy at midterm follow-up of left atrial appendage occlusion (LAAO) using different devices, in real life in Belgium. METHODS AND RESULTS Between June 2009 and November 2016, 457 consecutive patients (63% male, 75±12 yrs, CHA2DS2-VASc 4±0.6, HAS-BLED 3.5±0.7) undergoing LAAO were included. Technical success was 97.1%. There were 19 periprocedural major adverse events (4.1%) including three deaths (0.6%), nine tamponades (1.9%), four major bleedings (0.8%) and two device embolisations (0.4%). Among patients successfully implanted having a complete follow-up (672 patient-years, median follow-up 370 days), the actual annual stroke rate was 1.2%, lower than the expected stroke risk of 4% (70% reduction). The observed bleeding rate was 2%, while the calculated risk was 3.7% (46% reduction). Kaplan-Meier analysis showed a similar overall survival (93±2% and 87±3% versus 91±3% and 87±4%; p=0.35) and event-free survival (92±2% and 84±3% versus 88±3% and 80±5%; p=0.17) at one and two years, for the ACP/Amulet versus the WATCHMAN groups of patients, respectively. CONCLUSIONS The data from the Belgian left atrial appendage occlusion registry suggest that the procedure is effective and relatively safe in a real-world setting, using either the WATCHMAN or the ACP/Amulet device.
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Affiliation(s)
- Joelle Kefer
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Debruyne P. Letter by Debruyne regarding article "Selective ablation of atrial ganglionated plexus attenuates vasovagal reflex in a canine model". Pacing Clin Electrophysiol 2019; 42:390. [PMID: 30609071 DOI: 10.1111/pace.13597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/18/2018] [Indexed: 11/28/2022]
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Maeremans J, Kayaert P, Bataille Y, Bennett J, Ungureanu C, Haine S, Vandendriessche T, Sonck J, Scott B, Coussement P, Dendooven D, Pereira B, Frambach P, Janssens L, Debruyne P, Van Mieghem C, Barbato E, Cornelis K, Stammen F, De Vroey F, Vercauteren S, Drieghe B, Aminian A, Debrauwere J, Carlier S, Coosemans M, Van Reet B, Vandergoten P, Dens JA. Assessing the landscape of percutaneous coronary chronic total occlusion treatment in Belgium and Luxembourg: the Belgian Working Group on Chronic Total Occlusions (BWGCTO) registry. Acta Cardiol 2018; 73:427-436. [PMID: 29183248 DOI: 10.1080/00015385.2017.1408891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: Important developments in materials, devices, and techniques have improved outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI), and resulted in a growing interest in CTO-PCI. The Belgian Working Group on Chronic Total Occlusions (BWGCTO) working group aims to assess the evolution within the CTO-PCI landscape over the next years. Methods: From May 2016 onwards, patients undergoing CTO-PCI were included in the BWGCTO registry by 15 centres in Belgium and Luxemburg. Baseline, angiographic, and procedural data were collected. Here, we report on the one-year in-hospital outcomes. Results: Over the course of one year, 411 procedures in 388 patients were included with a mean age of 64 ± 11 years. The majority were male (81%). Relatively complex CTOs were treated (Japanese CTO score =2.2 ± 1.2) with a high procedure success rate (82%). Patient- and lesion-wise success rates were 83 and 85%, respectively. Major adverse in-hospital events were acceptably low (3.4%). Antegrade wire escalation technique was applied most frequently (82%). On the other hand, antegrade dissection and re-entry and retrograde strategies were more frequently applied in higher volume centres and successful for lesions with higher complexity. Conclusion: Satisfactory procedural outcomes and a low rate of adverse events were obtained in a complex CTO population, treated by operators with variable experience levels. Antegrade wire escalation was the preferred strategy, regardless of operator volume.
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Affiliation(s)
- Joren Maeremans
- Faculty of Medicine and Life Sciences, Universiteit Hasselt , Hasselt , Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg , Genk , Belgium
| | - Peter Kayaert
- Department of Cardiology, Universitair Ziekenhuis Brussel , Brussels , Belgium
- Department of Cardiology, Universitair Ziekenhuis Gent , Ghent , Belgium
| | - Yoann Bataille
- Department of Cardiology, CHR de la Citadelle , Liège , Belgium
| | - Johan Bennett
- Department of Cardiovascular Medicine, Universitair Ziekenhuis Leuven , Leuven , Belgium
| | - Claudiu Ungureanu
- Department of Cardiology, Hôpital de Jolimont , Haine-Saint-Paul , Belgium
| | - Steven Haine
- Department of Cardiology, Universitair Ziekenhuis Antwerpen , Edegem , Belgium
| | - Tom Vandendriessche
- Department of Cardiology, Universitair Ziekenhuis Antwerpen , Edegem , Belgium
| | - Jeroen Sonck
- Department of Cardiology, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Benjamin Scott
- Department of Cardiology, Hartcentrum ZNA , Antwerpen , Belgium
| | | | | | - Bruno Pereira
- Department of Cardiology, INCCI Haerz Zenter , Luxembourg , Luxembourg
| | - Peter Frambach
- Department of Cardiology, INCCI Haerz Zenter , Luxembourg , Luxembourg
| | - Luc Janssens
- Department of Cardiology, Imelda Ziekenhuis , Bonheiden , Belgium
| | | | - Carlos Van Mieghem
- Department of Cardiology, Onze-Lieve-Vrouw Ziekenhuis Aalst , Aalst , Belgium
| | - Emanuele Barbato
- Department of Cardiology, Onze-Lieve-Vrouw Ziekenhuis Aalst , Aalst , Belgium
| | | | | | - Frederic De Vroey
- Department of Cardiology, Grand Hôpital de Charleroi , Charleroi , Belgium
| | | | - Benny Drieghe
- Department of Cardiology, Universitair Ziekenhuis Gent , Ghent , Belgium
| | - Adel Aminian
- Department of Cardiology, CHU Charleroi , Charleroi , Belgium
| | | | | | - Mark Coosemans
- Department of Cardiology, AZ Turnhout , Turnhout , Belgium
| | - Bert Van Reet
- Department of Cardiology, AZ Turnhout , Turnhout , Belgium
| | | | - Jo Andre Dens
- Faculty of Medicine and Life Sciences, Universiteit Hasselt , Hasselt , Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg , Genk , Belgium
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Friedlander M, Rau J, Lee C, Meier W, Lesoin A, Kim JW, Poveda A, Buck M, Scambia G, Shimada M, Hilpert F, King M, Debruyne P, Bologna A, Malander S, Monk B, Petru E, Calvert P, Herzog T, Barrett C, du Bois A. Quality of life in patients with advanced epithelial ovarian cancer (EOC) randomized to maintenance pazopanib or placebo after first-line chemotherapy in the AGO-OVAR 16 trial. Measuring what matters—patient-centered end points in trials of maintenance therapy. Ann Oncol 2018; 29:737-743. [DOI: 10.1093/annonc/mdx796] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cool L, Missiaen J, Debruyne P, Geldhof K, Lefebvre T, Desmedt M, Foulon V, Pottel H, Vandijck D, Van Eygen K. Oncological Home-Hospitalization: Prospective randomized trial to evaluate its implications for patient and society. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx388.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Debruyne P, Haemers P. Dual intraventricular response after cardiac resynchronization. HeartRhythm Case Rep 2017. [PMID: 28649504 PMCID: PMC5469316 DOI: 10.1016/j.hrcr.2017.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Philippe Debruyne
- Address reprint requests and correspondence: Dr Philippe Debruyne, Imeldaziekenhuis, Imeldalaan 9, 2820 Bonheiden, Belgium.Imeldaziekenhuis2820 BonheidenImeldalaan 9Belgium
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Affiliation(s)
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland; Saolta University Healthcare Group, Galway, Ireland
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Debruyne P. "Cardio-Neuromodulation" With a Multielectrode Irrigated Catheter: A Potential New Approach for Patients With Cardio-Inhibitory Syncope. J Cardiovasc Electrophysiol 2016; 27:1110-3. [PMID: 27307200 DOI: 10.1111/jce.13031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 04/23/2016] [Revised: 06/02/2016] [Accepted: 06/07/2016] [Indexed: 12/16/2022]
Abstract
Syncope is frequently neurally mediated and can seriously affect quality of life. Different ablation strategies have been successfully performed. These approaches have not gained wide acceptance and are quite extensive and complex, exposing patients to significant risks. This article reports the case of a 16-year-old girl who was severely affected by frequent and prolonged episodes of syncope and was treated by tailored ablation of the anterior right ganglionated plexus with a multielectrode irrigated catheter. She had fainted >30 times in the 5 years preceding treatment, experiencing approximately 10 severe episodes of syncope in the previous 12 months. After 3 minutes of ablation, the P-P interval was reduced by >400 milliseconds. Syncope disappeared and the patient has remained completely asymptomatic over a follow-up of 22 months. The "reset" basal P-P interval has remained unchanged (follow-up electrocardiogram at 16 months). At 6 months, there was no residual heart rate activity <50 bpm. On 24-hour rhythm registration, P-P intervals ≥1,000 milliseconds (corresponding to a heart rate of ≤60 bpm) were reduced by >16,000 beats. We believe that this case report is original for several reasons: the unusual clinical presentation; the unique structure targeted; the very limited ablation, implying much lower risks for the patient; the anatomical approach; and the different endpoint. This new "cardio-neuromodulation" approach could be useful for the treatment of patients with neurally mediated syncope.
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Verma A, Debruyne P, Nardi S, Deneke T, DeGreef Y, Spitzer S, Balzer JO, Boersma L. Evaluation and Reduction of Asymptomatic Cerebral Embolism in Ablation of Atrial Fibrillation, But High Prevalence of Chronic Silent Infarction. Circ Arrhythm Electrophysiol 2013; 6:835-42. [DOI: 10.1161/circep.113.000612] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Atul Verma
- From the Southlake Regional Health Center, Newmarket, Ontario, Canada (A.V.); Imelda Ziekenhuis, Bonheiden, Belgium (P.D.); Pineta Grande Hospital, Castel Volturno, Italy (S.N.); Herz- und Gefäß-Klinik, Bad Neustadt/Saale, Germany (T.D.); AZ Middelheim, Antwerp, Belgium (Y.D.); Praxisklinik Herz und Gefäße, Dresden, Germany (S.S.); Catholic Clinic, Mainz, Germany (J.O.B.); and St. Antonius Zeikenhuis, Nieuwegein, the Netherlands (L.B.)
| | - Philippe Debruyne
- From the Southlake Regional Health Center, Newmarket, Ontario, Canada (A.V.); Imelda Ziekenhuis, Bonheiden, Belgium (P.D.); Pineta Grande Hospital, Castel Volturno, Italy (S.N.); Herz- und Gefäß-Klinik, Bad Neustadt/Saale, Germany (T.D.); AZ Middelheim, Antwerp, Belgium (Y.D.); Praxisklinik Herz und Gefäße, Dresden, Germany (S.S.); Catholic Clinic, Mainz, Germany (J.O.B.); and St. Antonius Zeikenhuis, Nieuwegein, the Netherlands (L.B.)
| | - Stefano Nardi
- From the Southlake Regional Health Center, Newmarket, Ontario, Canada (A.V.); Imelda Ziekenhuis, Bonheiden, Belgium (P.D.); Pineta Grande Hospital, Castel Volturno, Italy (S.N.); Herz- und Gefäß-Klinik, Bad Neustadt/Saale, Germany (T.D.); AZ Middelheim, Antwerp, Belgium (Y.D.); Praxisklinik Herz und Gefäße, Dresden, Germany (S.S.); Catholic Clinic, Mainz, Germany (J.O.B.); and St. Antonius Zeikenhuis, Nieuwegein, the Netherlands (L.B.)
| | - Thomas Deneke
- From the Southlake Regional Health Center, Newmarket, Ontario, Canada (A.V.); Imelda Ziekenhuis, Bonheiden, Belgium (P.D.); Pineta Grande Hospital, Castel Volturno, Italy (S.N.); Herz- und Gefäß-Klinik, Bad Neustadt/Saale, Germany (T.D.); AZ Middelheim, Antwerp, Belgium (Y.D.); Praxisklinik Herz und Gefäße, Dresden, Germany (S.S.); Catholic Clinic, Mainz, Germany (J.O.B.); and St. Antonius Zeikenhuis, Nieuwegein, the Netherlands (L.B.)
| | - Yves DeGreef
- From the Southlake Regional Health Center, Newmarket, Ontario, Canada (A.V.); Imelda Ziekenhuis, Bonheiden, Belgium (P.D.); Pineta Grande Hospital, Castel Volturno, Italy (S.N.); Herz- und Gefäß-Klinik, Bad Neustadt/Saale, Germany (T.D.); AZ Middelheim, Antwerp, Belgium (Y.D.); Praxisklinik Herz und Gefäße, Dresden, Germany (S.S.); Catholic Clinic, Mainz, Germany (J.O.B.); and St. Antonius Zeikenhuis, Nieuwegein, the Netherlands (L.B.)
| | - Stefan Spitzer
- From the Southlake Regional Health Center, Newmarket, Ontario, Canada (A.V.); Imelda Ziekenhuis, Bonheiden, Belgium (P.D.); Pineta Grande Hospital, Castel Volturno, Italy (S.N.); Herz- und Gefäß-Klinik, Bad Neustadt/Saale, Germany (T.D.); AZ Middelheim, Antwerp, Belgium (Y.D.); Praxisklinik Herz und Gefäße, Dresden, Germany (S.S.); Catholic Clinic, Mainz, Germany (J.O.B.); and St. Antonius Zeikenhuis, Nieuwegein, the Netherlands (L.B.)
| | - Jörn O. Balzer
- From the Southlake Regional Health Center, Newmarket, Ontario, Canada (A.V.); Imelda Ziekenhuis, Bonheiden, Belgium (P.D.); Pineta Grande Hospital, Castel Volturno, Italy (S.N.); Herz- und Gefäß-Klinik, Bad Neustadt/Saale, Germany (T.D.); AZ Middelheim, Antwerp, Belgium (Y.D.); Praxisklinik Herz und Gefäße, Dresden, Germany (S.S.); Catholic Clinic, Mainz, Germany (J.O.B.); and St. Antonius Zeikenhuis, Nieuwegein, the Netherlands (L.B.)
| | - Lucas Boersma
- From the Southlake Regional Health Center, Newmarket, Ontario, Canada (A.V.); Imelda Ziekenhuis, Bonheiden, Belgium (P.D.); Pineta Grande Hospital, Castel Volturno, Italy (S.N.); Herz- und Gefäß-Klinik, Bad Neustadt/Saale, Germany (T.D.); AZ Middelheim, Antwerp, Belgium (Y.D.); Praxisklinik Herz und Gefäße, Dresden, Germany (S.S.); Catholic Clinic, Mainz, Germany (J.O.B.); and St. Antonius Zeikenhuis, Nieuwegein, the Netherlands (L.B.)
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Beuselinck B, Wolter P, Karadimou A, Elaidi R, Dumez H, Rogiers A, Van Cann T, Willems L, Body JJ, Berkers J, Van Poppel H, Lerut E, Debruyne P, Paridaens R, Schöffski P. Concomitant oral tyrosine kinase inhibitors and bisphosphonates in advanced renal cell carcinoma with bone metastases. Br J Cancer 2013; 107:1665-71. [PMID: 23132391 PMCID: PMC3493858 DOI: 10.1038/bjc.2012.385] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [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: 02/05/2023] Open
Abstract
BACKGROUND The presence of bone metastases in patients with metastatic renal cell carcinoma treated with oral tyrosine kinase inhibitors (TKIs) is associated with poorer outcome as compared with patients without bone involvement. Concomitant bisphosphonates could probably improve outcomes but also induce osteonecrosis of the jaw (ONJ). METHODS Retrospective study on all the renal cell carcinoma patients with bone metastases treated with sunitinib or sorafenib between November 2005 and June 2012 at the University Hospitals Leuven and AZ Groeninge in Kortrijk. RESULTS Seventy-six patients were included in the outcome analysis: 49 treated with concomitant bisphosphonates, 27 with TKI alone. Both groups were well balanced in terms of prognostic and predictive markers. Response rate (38% vs 16% partial responses, P=0.028), median progression-free survival (7.0 vs 4.0 months, P=0.0011) and median overall survival (17.0 vs 7.0 months, P=0.022) were significantly better in patients receiving bisphosphonates. The incidence of ONJ was 10% in patients treated with TKI and bisphosphonates. CONCLUSION Concomitant use of bisphosphonates and TKI in renal cell carcinoma patients with bone involvement probably improves treatment efficacy, to be confirmed by prospective studies, but is associated with a high incidence of ONJ.
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Affiliation(s)
- B Beuselinck
- Department of General Medical Oncology, University Hospitals Leuven, Leuven Cancer Institute, KU Leuven, Herestraat 49, Herestraat 49, B-3000 Leuven, Belgium.
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Outteryck O, Zephir H, Defoort S, Bouyon M, Debruyne P, Bouacha I, Ferriby D, Lacour A, Labalette P, de Seze J, Vermersch P. Optical coherence tomography in clinically isolated syndrome: no evidence of subclinical retinal axonal loss. ACTA ACUST UNITED AC 2009; 66:1373-7. [PMID: 19901169 DOI: 10.1001/archneurol.2009.265] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Optical coherence tomography has emerged as a new tool for quantifying axonal loss in multiple sclerosis (MS). A reduction in retinal nerve fiber layer (RNFL) thickness is correlated with Expanded Disability Status Scale score and brain atrophy. OBJECTIVE To investigate RNFL and macular volume measurements using optical coherence tomography in the clinically isolated syndrome population. DESIGN Prospective case series. Settings Neurologic clinics at the university hospitals of Lille and Strasbourg (France). PARTICIPANTS Fifty-six consecutive patients with clinically isolated syndrome (18 with optic neuritis and 38 without optic neuritis) and 32 control subjects. MAIN OUTCOME MEASURES Macular volume and RNFL thickness. RESULTS Mean (SD) overall RNFL thickness (98.98 [10.26] microm) and macular volume (6.86 [0.32] microm(3)) in the clinically isolated syndrome population were not significantly different compared with the controls (98.71 [9.08] mum and 6.92 [0.38] microm(3), respectively). No link was noted between atrophy of the RNFL or macula and conversion to MS at 6 months. CONCLUSIONS Optical coherence tomography does not reveal retinal axonal loss at the earliest clinical stage of MS and does not predict conversion to MS at 6 months.
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Affiliation(s)
- Olivier Outteryck
- Department of Neurology, Université Lille Nord de France, Lille, France.
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Arndt C, Rebollo O, Séguinet S, Debruyne P, Caputo G. Quantification of metamorphopsia in patients with epiretinal membranes before and after surgery. Graefes Arch Clin Exp Ophthalmol 2007; 245:1123-9. [PMID: 17219116 DOI: 10.1007/s00417-006-0505-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 11/15/2006] [Accepted: 11/16/2006] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To evaluate quantification of metamorphopsia before and after the removal of unilateral epiretinal membrane (ERM). METHODS One hundred and four consecutive patients with unilateral ERM scheduled for membrane peeling were prospectively enrolled. A complete ophthalmologic examination was performed. Metamorphopsia was evaluated, with standard Amsler grids and a laser grid generated with a scanning laser ophthalmoscope (SLO). The SLO procedure determined the area of distortion and was performed twice at a 30-minute interval to evaluate its reproducibility. The result was considered to be reliable when the area of distortion was identical in both SLO test sessions. One year after surgery, a complete ophthalmologic examination was performed. Metamorphopsia was again quantified with the SLO procedure. RESULTS Before surgery, a reliable quantification of metamorphopsia (defined as area of distortion) could be performed in 98 patients (94%). Among these patients, 85 completed the follow-up of 12 months after surgery. Of these 85 patients, visual distortions had been detected preoperatively in 48 patients (56%). One year after surgery, visual distortions were detected in only 11 patients (13%). In 48 patients with preoperative distortions, the decrease of the area of distortion correlated with the change in visual acuity (r = -0.460, p = 0.011). CONCLUSIONS SLO-based evaluation of metamorphopsia made it possible to provide a fast and reliable method for preoperative and post-operative quantification of visual distortion in patients undergoing ERM removal.
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Affiliation(s)
- Carl Arndt
- Ophtalmologie, Hopital Gui de Chauliac, CHU de Montpellier, 80 avenue Augustin Fliche, 34295 Montpellier 05, France.
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Demey W, Wildiers H, Maleux G, Clement P, Heye S, Debruyne P, Van Oosterom A, Paridaens R. Intrahepatic mitomycin C as treatment of breast cancer hepatic metastasis. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.10690] [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: 11/20/2022] Open
Abstract
10690 Background: Because of increasing survival due to improving systemic treatment, liver metastasis represents a major and increasing cause of death in women with metastatic breast cancer. Regional treatment is an attractive option in the treatment of liver metastases. We reviewed the tolerability and efficacy of intrahepatic administration of mitomycin C (MMC) performed in our institution. Patients with only or predominant liver metastasis were eligible, independent of previous chemotherapy for metastatic breast cancer. Methods: In a unicentric protocol we reviewed retrospectively all patients (n = 11) who received intrahepatic MMC for liver metastasis of breast cancer between January 2000 and July 2005 in the University Hospital Leuven. MMC was administered as a bolus of 6 mg in 50 ml saline directly into the right and left hepatic arteries by transcatheter technique. The procedure was performed by an interventional radiologist. Patients were hospitalised for 24 hours. In patients with severe liver function disturbances or more than six administrations of MMC a dose reduction was applied. Results: All treated patients were reviewed. The median age was 52 years (range, 36–61). Most patients were heavily pre-treated with a median of 4 systemic chemotherapy regimens (range, 1–5). Treatment was well tolerated, no grade 3 or 4 adverse events were reported. Only one patient had persistent thrombocytopenia for which interruption of treatment was required. One patient had fatigue. There were no procedure-related complications. Six patients received only 1 or 2 administrations because of rapid disease progression within the first two months. Among the remainders, 4 patients had 6 and 1 had 11administrations. When evaluatde by RECIST criteria one patient had a complete remisson, two patients had a partial remission and 2 patients remained stable for at least 6 months. Conclusions: In this retrospective analysis intrahepatic administration of MMC was well tolerated and provided clincal benefit (respons or at least disease stabilization for 6 months) in 45% of heavily pre-treated patients. This treatment represents a valid therapeutic option for patients with predominant liver metastases of breast cancer after failure of standard systemic treatment. No significant financial relationships to disclose.
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Affiliation(s)
- W. Demey
- U. Z. Gasthuisberg, Brussels, Belgium; UZ Gasthuisberg, Leuven, Belgium
| | - H. Wildiers
- U. Z. Gasthuisberg, Brussels, Belgium; UZ Gasthuisberg, Leuven, Belgium
| | - G. Maleux
- U. Z. Gasthuisberg, Brussels, Belgium; UZ Gasthuisberg, Leuven, Belgium
| | - P. Clement
- U. Z. Gasthuisberg, Brussels, Belgium; UZ Gasthuisberg, Leuven, Belgium
| | - S. Heye
- U. Z. Gasthuisberg, Brussels, Belgium; UZ Gasthuisberg, Leuven, Belgium
| | - P. Debruyne
- U. Z. Gasthuisberg, Brussels, Belgium; UZ Gasthuisberg, Leuven, Belgium
| | - A. Van Oosterom
- U. Z. Gasthuisberg, Brussels, Belgium; UZ Gasthuisberg, Leuven, Belgium
| | - R. Paridaens
- U. Z. Gasthuisberg, Brussels, Belgium; UZ Gasthuisberg, Leuven, Belgium
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Debruyne P. Bile acids stimulate expression of intestinal differentiation markers in gastroesophageal junction (GEJ) adenocarcinoma cells. Clin Pharmacol Ther 2004. [DOI: 10.1016/j.clpt.2003.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The anatomic variability of the cardiac veins limits the feasibility of cardiac resynchronization therapy. This report describes another way to position the pacemaker electrode in sharply angulated coronary sinus branches.
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Pocard M, Debruyne P, Bras-Gonçalves R, Mareel M, Dutrillaux B, Poupon MF. Single alteration of p53 or E-cadherin genes can alter the surgical resection benefit in an experimental model of colon cancer. Dis Colon Rectum 2001; 44:1106-12. [PMID: 11535849 DOI: 10.1007/bf02234630] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE p53 and E-cadherin mutations are associated with a high risk of metastatic potential and local recurrence after colorectal surgery. LoVo, a human colon cancer cell line expressing a wild-type p53 and a normal E-cadherin, was studied. Clone LoVo-XC17 was obtained from LoVo cells transfected with a vector bearing a p53 273his mutation. Clone LoVo-92R4 was obtained from LoVo by culture cells with an E-cadherin down-regulation. LoVo, LoVo-XC17, and LoVo-92R4 were studied for in vivo behavior in a surgical intracolonic graft model. METHODS Ten nude mice were used per cell line. A colonic tumor was obtained by tumor implantation into the cecal wall. The cecal tumor was resected at Day 15; at this time the volumes of the different tumors were similar. RESULTS Surgical resection of the LoVo tumor led to 100 percent disease-free animals at one month. Surgical resection of mice grafted with the LoVo-XC17 line did not cure any mice (0/10; P = 0.001). Mice had local recurrences (10/10), mesenteric lymph node metastases (9/10), liver metastases (2/10), and peritoneal carcinomatosis (8/10). Surgical resection of LoVo-92R4 tumors led to cures in 30 percent (3/10), whereas 70 percent had isolated mesenteric lymph node metastases (7/10; P = 0.003). CONCLUSION In this model surgical tumor resection was consistently effective for colonic tumors with functional p53 and E-cadherin, it was consistently ineffective with tumors displaying a mutated p53, and it was partially effective with E-cadherin-deficient tumors. This study shows that the alteration of a single gene can be associated with a profound alteration of surgical resection benefit.
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Affiliation(s)
- M Pocard
- Cytogénétique Moléculaire et Oncologie, Institut Curie, Paris, France
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27
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Christen T, Verin V, Bochaton-Piallat M, Popowski Y, Ramaekers F, Debruyne P, Camenzind E, van Eys G, Gabbiani G. Mechanisms of neointima formation and remodeling in the porcine coronary artery. Circulation 2001; 103:882-8. [PMID: 11171799 DOI: 10.1161/01.cir.103.6.882] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND To characterize the cells responsible for neointima formation after porcine coronary artery wall injury, we studied the expression of smooth muscle cell (SMC) differentiation markers in 2 models: (1) self-expanding stent implantation resulting in no or little interruption of internal elastic lamina and (2) percutaneous transluminal coronary angioplasty (PTCA) resulting in complete medial rupture and exposure of adventitia to blood components. METHODS AND RESULTS The expression of alpha-smooth muscle (SM) actin, SM myosin heavy chain isoforms 1 and 2, desmin, and smoothelin was investigated by means of immunohistochemistry and Western blots in tissues of the arterial wall collected at different time points and in cell populations cultured from these tissues. The expression of smoothelin, a marker of late SMC differentiation, was used to discriminate between SMCs and myofibroblasts. Both stent- and PTCA-induced neointimal tissues and their cultured cell populations expressed all 4 markers. The adventitial tissue underlying PTCA-induced lesions temporarily expressed alpha-SM actin, desmin, and SM myosin heavy chain isoforms, but not smoothelin. When placed in culture, adventitial cells expressed only alpha-SM actin. CONCLUSIONS Our results suggest that SMCs are the main components of coronary artery neointima after both self-expanding stent implantation and PTCA. The adventitial reaction observed after PTCA evolves with a chronology independent of that of neointima formation and probably corresponds to a myofibroblastic reaction.
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MESH Headings
- Actins/metabolism
- Angioplasty, Balloon, Coronary
- Animals
- Blotting, Western
- Cell Differentiation
- Cells, Cultured
- Coronary Vessels/injuries
- Coronary Vessels/physiology
- Coronary Vessels/ultrastructure
- Cytoskeletal Proteins/metabolism
- Desmin/metabolism
- Electrophoresis, Polyacrylamide Gel
- Endothelium, Vascular/ultrastructure
- Immunohistochemistry
- Models, Animal
- Muscle Proteins/metabolism
- Muscle, Smooth, Vascular/injuries
- Muscle, Smooth, Vascular/physiology
- Muscle, Smooth, Vascular/ultrastructure
- Myosin Heavy Chains/metabolism
- Staining and Labeling
- Stents
- Swine
- Time Factors
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Affiliation(s)
- T Christen
- Department of Pathology, University of Geneva, Divisions of Cardiology, University Hospital Geneva, Geneva, Switzerland
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Arndt CF, Séguinet S, Debruyne P, Defoort-Dhellemmes S, Hache JC. [Quantitive evaluation of metamorphopsia in macular disease]. J Fr Ophtalmol 2000; 23:679-82. [PMID: 10992062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
INTRODUCTION Visual acuity loss and scotoma are not the only functional consequence of macular disease. Frequently, patients also complain of metamorphopsia. Such visual distortion should be taken into account when evaluating the potential benefit of surgical procedures in macular disease. The Amsler grid does not allow any quantified analysis. In addition, a precise confrontation of the macular lesion with its functional consequences is not possible by this test. We present a new method for analyzing metamorphopsia in macular disease. METHODS Opto-acustic modulation controlled laser emission allowed to generate a retinal image of 256 squares with an angular size of 1 degrees each. The subject was instructed to fixate the center of the grid and to push a handheld button every time he perceived abnormalities within the presented pattern. At the end of the procedure, the responses were represented on graph superimposed on the fundus image. 15 eyes of 15 successive patients complaining of metamorphopsia were included in this preliminary study. Informed consent was obtained prior to inclusion. All patients reported abnormalities on standard Amsler testing. The test-retest reliability was evaluated by repeating the same procedure between 2 hours and 7 days after the first procedure. RESULTS The evaluation of 3 patients did not provide reliable information on metamorphopsia because of instable fixation. In 12 patients, a coherent response was obtained. In 9 eyes, the result was unchanged when repeating the procedure, concerning both the number of abnormal elements and their spatial distribution. CONCLUSION The preliminary results appear to be encouraging, indicating a good reproducibility of the results of this method. They should be confirmed on a larger scale. Further work is necessary to evaluate the interest of this method in assessing functional results of macular surgery.
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Affiliation(s)
- C F Arndt
- Exploration Fonctionnelle de la Vision, CHRU Lille, Cedex, France
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de Seze J, Arndt CF, Stojkovic T, Lebrun T, Debruyne P, Hache JC, Vermersch P. Multiple sclerosis with normal neuro-ophthalmological work-up: results of focal stimulations induced by a scanning laser ophthalmoscope. Acta Neurol Scand 2000; 101:311-4. [PMID: 10987319 DOI: 10.1034/j.1600-0404.2000.90283a.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 11/23/2022]
Abstract
OBJECTIVE Visual evoked potentials (VEPs) are a very useful tool in diagnosis of multiple sclerosis (MS). Nevertheless, in some cases of the disease, VEPs are normal. The aim of this study was to evaluate the diagnostic value of focal checkerboard reversal stimulation based on opto-acoustic modulation generated by a scanning laser ophthalmoscope (SLO) in patients whose standard neuro-ophthalmological work-up was normal. METHODS We prospectively studied 185 MS patients. In this cohort we found 30 patients with definite MS and normal neuroophthalmological work-up and we studied the diagnostic yield of focal visual stimulation in these patients. We performed focal SLO-elicited VEPs with two different spatial distributions: a central 8 x 8 degrees square field and a central 8 x 8 degrees exclusion square. The results were analysed in terms of age of the patient, course of the disease, and disability evaluated on the Expanded Disability Status Scale (EDSS). RESULTS Mean latencies of focal VEPs were increased in MS patients compared to controls. In MS, focal stimulation allowed dysfunction of the visual system to be detected in 50% of patients who have been classified as normal according to conventional VEPs. VEP abnormalities were found to be correlated with the EDSS score (P<0.001) and the course of the disease (P<0.05). CONCLUSION We have demonstrated the value of focal VEPs in MS diagnosis using SLO-based techniques. Further prospective work in patients with possible and probable MS should enable an evaluation of the sensitivity and specificity of this method in the early diagnosis of MS.
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Affiliation(s)
- J de Seze
- Department of Neuro-ophthalmology, Hôpital Roger Salengro, CHRU de Lille, France
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Debruyne P, Vermeulen S, Mareel M. The role of the E-cadherin/catenin complex in gastrointestinal cancer. Acta Gastroenterol Belg 1999; 62:393-402. [PMID: 10692769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Cancer is a genetic disease. The unstable genome of cancer cells causes tumour progression through multiple alterations in suppressor and promoter genes, leading to loss of homeostatic and gain of oncogenic functions. Invasion is the critical step in the acquisition of malignancy. It implicates a continuous molecular conversation of the cancer cells with other cells and with the extracellular matrix in which adhesion molecules are crucial. One of these, E-cadherin, is discussed in the present review. E-cadherin is a transmembrane glycoprotein that forms a complex with cytoplasmic proteins, termed catenins because they link E-cadherin to the actin cytoskeleton. E-cadherin/catenin-mediated intercellular adhesion and communication is mainly homophylic homotypic. There is compelling evidence from experiments in vitro as well as in vivo to accept that the E-cadherin/catenin complex acts as an invasion suppressor. The mechanism of this action is not only through cell-cell adhesion but also through transduction of signals to the cell's motility system. In the replication error positive human colon cancer cell line HCT-8, the alpha E-catenin gene CTNNA1 is an invasion suppressor gene. Here, the transition from the non-invasive to the invasive state was prevented by introduction into the unstable non-invasive cells of either an extra CTNNA1 or a wild type hMSH6 mismatch repair gene. beta-catenin also participates at a complex which comprises the adenomatous polyposis cancer protein APC. In colorectal cancer, mutation of either APC or beta-catenin is oncogenic. Downregulation of the E-cadherin/catenin complex may occur in several ways amongst which are gene mutations, methylation of 5'CpG dinucleotides within the promotor region of E-cadherin, tyrosine phosphorylation of beta-catenin, cell surface expression of proteoglycans sterically hindering E-cadherin and proteolytic release of fragments from the extracellular part of E-cadherin. Upregulation of the E-cadherin/catenin complex has been realized with a series of agents, some of which can be used therapeutically. In most human gastrointestinal cancers the E-cadherin/catenin or related complexes are disturbed and this underscores their pivotal role in the progression of these tumours. Mutations of the E-cadherin gene, including germline mutations, occur in diffuse gastric carcinoma, CpG methylation around the promotor region of E-cadherin in hepatocellular carcinomas and mutations of the APC tumour suppressor gene or in the beta-catenin oncogene in most colorectal cancers. The literature agrees about the disturbance of immunohistochemical patterns of E-cadherin and catenin expression in gastrointestinal cancers. Conflicting opinions do, however, exist about the prognostic value of such immunohistochemical aberrations. We doubt that immunohistochemistry of E-cadherin or catenins add prognostic value to the already used histological grading systems. In our opinion the major benefit from understanding of the E-cadherin/catenin-mediated pathways of invasion will be the development of new anti-invasive treatment strategies.
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Affiliation(s)
- P Debruyne
- Department of Radiotherapy and Nuclear Medicine, University Hospital Gent, Belgium
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Goethals P, Debruyne P, Saffarian M. Drug-induced Brugada syndrome. Acta Cardiol 1998; 53:157-60. [PMID: 9793569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Survivors of sudden death without structural heart disease and a normal coronary angiogram are often diagnosed with idiopathic ventricular fibrillation (VF). The criteria for idiopathic VF have been reviewed elsewhere. However, a careful analysis of the electrocardiogram (ECG) is essential in the differential diagnosis of unexplained sudden cardiac death. We report two patients with unexplained VF, intermittent right bundle-branch block (RBBB) and ST-segment elevation in the precordial leads V1-V3. This syndrome is named after Brugada who first described a clinical series. This paper stresses the dynamic changes and the spontaneous normalization of the ECG. Class I drugs can unmask this peculiar ECG-pattern and can sometimes precipitate an arrhythmia if they are given chronically. Patients with the diagnosis of idiopathic VF should be screened for intermittent RBBB and ST-segment elevation. Because the syndrome is mostly familial and inherited as an autosomal dominant trait, diagnosis of this entity in a patient has an implication for the screening of family members.
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Affiliation(s)
- P Goethals
- Department of Cardiology, Algemeen Ziekenhuis Sint-Jan, Brussels, Belgium
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Lehmann D, Lang W, Debruyne P. [Controlled EEG alpha feedback training in normals and headache patients (author's transl)]. Arch Psychiatr Nervenkr (1970) 1976; 221:331-43. [PMID: 952600 DOI: 10.1007/bf00365610] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Headache patients and healthy controls underwent alpha-EEG feedback training in 12 sessions. The present study does not support the literature which reports alpha increase by feedback training. The study included a patient group receiving feedback, a patient control group receiving pseudofeedback, and a volunteer group receiving feedback. Increase of alpha EEG was observed under feedback and pseudofeedback. However, there was always more alpha during baseline times than during training times. Alpha increase over time is suggested to be a habituation effect. Headache pain decreased with training (within the boundaries of a placebo effect), and there was no difference in headache decrease between feedback and pseudofeedback patients.
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