Diffuse skin findings secondary to lymph node tularemia in a patient with chronic rheumatoid arthritis on methotrexate

Tularemia has many atypical presentations which can represent a diagnostic challenge. The history is essential in the investigation of this disease. Bite-induced primary skin lesions should be distinguished from the infrequent immune-mediated secondary skin lesions. Herein, we present an atypical pseudovesicular rash secondary to Francisella tularensis.

An update on the applications and characteristics of magnetic iron oxide nanoparticles for drug delivery

INTRODUCTION

In the field of drug delivery, controlling the release of therapeutic substances at localized targets has become a primary focus of medical research, especially in the field of cancer treatment. Magnetic nanoparticles are one of the most promising drug carriers thanks to their biocompatibility and (super)paramagnetic properties. These properties allow for the combination between imaging modalities and specific release of drugs at target sites using either local stimulus (i.e. pH, conjugation of biomarkers, …) or external stimulus (i.e. external magnetic field).

AREAS COVERED

This review provides an update on recent advances with the development of targeted drug delivery systems based on magnetic nanoparticles (MNPs). This overview focuses on active targeting strategies and systems combining both imaging and therapeutic modalities (i.e. theranostics). If most of the examples concern the particular case of cancer therapy, the possibility of using MNPs for other medical applications is also discussed.

EXPERT OPINION

The development of clinically relevant drug delivery systems based on magnetic nanoparticles is driven by advantages stemming from their remarkable properties (i.e. easy preparation, facile chemical functionalization, biocompatibility, low toxicity and superior magnetic responsiveness). This literature review shows that drug carriers based on magnetic nanoparticles can be efficiently used for the controlled release of drug at targeted locations mediated by various stimuli. Advances in the field should lead to the implementation of such systems into clinical trials, especially systems enabling drug tracking in the body.

Effects of disease-modifying therapy on peripheral leukocytes in patients with multiple sclerosis

Modern disease-modifying therapies (DMTs) in multiple sclerosis (MS) have variable modes of action and selectively suppress or modulate the immune system. In this review, we summarize the predicted and intended as well as unwanted adverse effects on leukocytes in peripheral blood as a result of treatment with DMTs for MS. We link changes in laboratory tests to the possible therapeutic risks that include secondary autoimmunity, infections, and impaired response to vaccinations. Profound knowledge of the intended effects on leukocyte counts, in particular lymphocytes, explained by the mode of action, and adverse effects which may require additional laboratory and clinical vigilance or even drug discontinuation, is needed when prescribing DMTs to treat patients with MS.

Les opioïdes : de la douleur à l’addiction ?

La crise des opioïdes actuelle aux États-Unis et sa médiatisation soulèvent la question de l’utilisation adéquate de ces antalgiques dans notre pratique quotidienne. En quatre vignettes cliniques, nous évoquons le travail conjoint des équipes d’addictologie et d’algologie pour prendre en charge au mieux les patients sous opioïdes en oncologie. Nous présentons les meilleurs moyens de diagnostiquer, prévenir et prendre en charge les écueils de ces traitements : la dépendance aux opioïdes de prescription et le mésusage des opioïdes de prescription, voire l’addiction aux opioïdes. Une des clés de cette prise en charge est la multidisciplinarité, centrale dans la réunion de concertation pluridisciplinaire.

Regorafenib after failure of gemcitabine and platinum-based chemotherapy for locally advanced/metastatic biliary tumors: REACHIN, a randomized, double-blind, phase II trial

BACKGROUND

There is a high unmet clinical need for treatments of advanced/metastatic biliary tract cancers after progression on first-line chemotherapy. Regorafenib has demonstrated efficacy in some gastrointestinal tumors that progress on standard therapies.

PATIENTS AND METHODS

REACHIN was a multicenter, double-blind, placebo-controlled, randomized phase II study designed to evaluate the safety and efficacy of regorafenib in patients with nonresectable/metastatic biliary tract cancer that progressed after gemcitabine/platinum chemotherapy. Patients were randomly assigned 1 : 1 to best supportive care plus either regorafenib 160 mg once daily 3 weeks on/1 week off or placebo until progression or unacceptable toxicity. No crossover was allowed. The primary objective was progression-free survival (PFS). Secondary objectives were response rate, overall survival, and translational analysis.

RESULTS

Sixty-six patients with intrahepatic (n = 42), perihilar (n = 6), or extrahepatic (n = 9) cholangiocarcinoma, or gallbladder carcinoma (n = 9) were randomized, 33 to each treatment group (33 per group). At a median follow-up of 24 months, all patients had progressed and six patients were alive. Median treatment duration was 11.0 weeks [95% confidence interval (CI): 6.0-15.9] in the regorafenib group and 6.3 weeks (95% CI: 3.9-7.0) in the placebo group (P = 0.002). Fourteen of 33 patients (42%) in the regorafenib group had a dose reduction. Stable disease rates were 74% (95% CI: 59-90) in the regorafenib group and 34% with placebo (95% CI: 18-51; P = 0.002). Median PFS in the regorafenib group was 3.0 months (95% CI: 2.3-4.9) and 1.5 months (95% CI: 1.2-2.0) in the placebo group (hazard ratio 0.49; 95% CI: 0.29-0.81; P = 0.004) and median overall survival was 5.3 months (95% CI: 2.7-10.5) and 5.1 months (95% CI: 3.0-6.4), respectively (P = 0.28). There were no unexpected/new safety signals.

CONCLUSION

Regorafenib significantly improved PFS and tumor control in patients with previously treated metastatic/unresectable biliary tract cancer in the second- or third-line setting.

CLINICAL TRIAL REGISTRATION

The trial is registered in the European Clinical Trials Register database (EudraCT 2012-005626-30) and at ClinicalTrials.gov (NCT02162914).

P1539Aortic pulse wave velocity measured by an oscillometric device independently predicts all-cause mortality in a cohort of 4146 subjects

Objectives

Assessment of carotid-femoral pulse wave velocity by applanation tonometry independently predicts all-cause and cardiovascular mortality. However, there has been a need for a simpler, user-independent measurement with a validated device, that is applicable even in the primary care setting.

Methods and subjects

4146 subjects (49% men) aged 35–75 years were measured in multiple centers in Hungary. Subjects visited the outpatient department of these centers on their own initiative. The measurement of aortic pulse wave velocity (PWVao) with Arteriograph was performed in addition to taking past medical history, physical examination and laboratory tests. The mean follow-up time of the study was 5.5 years. The number of events (all cause mortality) were provided by the Hungarian National Health Insurance Fund. Cox regression analyses were used to identify predictive factors for this endpoint.

Results

The mean age of the study population was 53 years, brachial systolic and diastolic blood pressure were 137±20 and 82±11 mmHg, and heart rate was 70±10 1/min. The mean value of SCORE was 3 in this large cohort. 410 subjects had a registered cerebro-or cardiovascular event before the measurement, the number of smokers was 656 (16%), 1974 subjects were treated with at least one anti-hypertensive drug (48%), while the number of subjects on lipid-lowering, antidiabetic or antiplatelet medication were 807 (19%), 352 (8%) and 398 (17%), respectively. There were 116 fatal events during a mean follow-up of 5.5 years. According to the Cox regression, PWVao is a significant and independent predictor of all cause-mortality and in univariate analysis, a 1.0 m/s increase in PWVao was associated with HR 1.7 [1.47–1.98; p<0.001], for this endpoint.

Conclusion

Aortic pulse wave velocity measured by an invasively validated, simple, oscillometric device predicted all-cause mortality in a large cohort of relatively young subjects of the general population that may improve risk stratification even in the everyday clinical practice or primary care setting.

P1553Differential association between vascular and chronological age with cardiovascular outcomes

Background/Introduction

Increased pulse wave velocity (PWV), is a reliable marker of early vascular aging (EVA). However, the identification of individuals whose arteries are abnormally healthy in comparison to their age and cardiovascular (CV) risk profile might be of interest, to discover novel pathways of cardioprotection and provide preventive strategies for successful vascular aging.

Purpose

1) to provide a novel calculation for vascular age and examine his determinants; 2) to test the hypothesis that individuals with the largest difference between chronological and vascular age (C-V age) show a lower rate of CV events than their counterparts, and may thus be defined as the supernormal vascular aging group (SUPERNOVA).

Methods

Vascular age was defined as predicted age based on classical CV risk factors and PWV. The best fitting model for vascular age was investigated in the multicenter, European, cross-sectional Reference Values for Arterial stiffness Collaboration Database (n=11406). Continuous variables were modelled as smoothing splines. Thereafter, the risk of fatal and non-fatal CV events associated with C-V age was examined in the longitudinal cohort of the Malmo Diet and Cancer Study (n=2663) using Cox proprotional hazard regression models. C-V age was examined as a continuous variable (natural splines) and as a 3 levels categorical variables based on the best grouping of the deciles of C-V age and corresponding to the EVA (<3.0 years), normal vascular aging (3.0 to 8.8 years) and SUPERNOVA (>8.8 years) respectively.

Results

In the Reference Values Cohort (age range 17–85 years, 52.4% men, 38.1% hypertensives, 3.9% diabetics, average PWV 7.8 m/s), the most significant predictor of vascular age (full model r2 0.598) was PWV. In the Malmo Diet and Cancer Study Cohort (age 61–89 years, 63.6% men, 64.0% hypertensives, 12.9% diabetics, PWV 11.5 m/s), during follow-up (6.6 years on average), 286 individuals developed a first cardiovascular event. In the Cox survival analysis, C-V age was significantly and inversely associated with CV events. Compare to normal vascular aging, participants with SUPERNOVA had lower risk for CV events [HR 0.51 (0.34–0.76)] whereas those with EVA had a higher risk [HR 2.71 (1.80–4.09)]. Instead, there was no significant association with all-cause mortality.

Conclusions

The use of PWV and CV risk factors may be useful to define early and supernormal vascular aging in particular, and to assess its clinical relevance towards the risk of cardiovascular disease and death.

Dendron based antifouling, MRI and magnetic hyperthermia properties of different shaped iron oxide nanoparticles

Owing to the great potential of iron oxide nanoparticles (NPs) for nanomedicine, large efforts have been made to better control their magnetic properties, especially their magnetic anisotropy to provide NPs able to combine imaging by MRI and therapy by magnetic hyperthermia. In that context, the design of anisotropic NPs appears as a very promising and efficient strategy. Furthermore, their bioactive coating also remains a challenge as it should provide colloidal stability, biocompatibility, furtivity along with good water diffusion for MRI. By taking advantage of our controlled synthesis method of iron oxide NPs with different shapes (cubic, spherical, octopod and nanoplate), we demonstrate here that the dendron coating, shown previously to be very suitable for 10 nm sized iron oxide, also provided very good colloidal, MRI and antifouling properties to the anisotropic shaped NPs. These antifouling properties, demonstrated through several experiments and characterizations, are very promising to achieve specific targeting of disease tissues without affecting healthy organs. On the other hand, the magnetic hyperthermia properties were shown to depend on the saturation magnetization and the ability of NPs to self-align, confirming the need of a balance between crystalline and dipolar magnetic anisotropies.

Update on liver transplantation for cholangiocarcinoma : a review of the recent literature

Cholangiocarcinoma (CC) represent 3% of all gastrointestinal tumours and can be classified anatomically in 3 types: intrahepatic (ICC), perihilar (PCC) and distal (DCC) cholangiocarcinomas. Resection is the treatment of choice but is only achieved in a few cases (<20%) because of invasion of the biliary tract and/or vascular structures. The outcome of advanced CC is poor with an overall survival (OS) of maximum 15 months with chemotherapy. In the 1990s, CC was regarded as a contraindication for liver transplantation (LT). LT has recently been proposed as potentially curative option for ICC and PCC. Careful patient selection has changed OS. This article provides an update on current status of LT for patients with unresectable CC.

Prevalence, management and ethnobotanical investigation of hypertension in two Guinean urban districts

ETHNOPHARMACOLOGICAL RELEVANCE

Hypertension is an important public health challenge in low- and middle-income countries, and in many African countries including Guinea medicinal plants are still widely used for its treatment.

MATERIALS AND METHODS

The objective of this study was to determine the prevalence of hypertension in two Guinean urban districts (Pounthioun and Dowsare), to describe its management and to collect information on traditional herbal remedies. A total of 316 participants entered the study, 28.2% (89/316) men and 71.8% (227/316) women. Of these, 181 were from Dowsare (50 men and 131 women) and 135 from Pounthioun (39 men and 96 women). The mean age of subjects was 40.8 ± 14.0 years (range18 - 88years), while the majority of subjects (63.3% or 200/316) were 45-74 years old.

RESULTS

The overall prevalence of hypertension was 44.9% (142/316): 46.4% (84/181) from Dowsare and 43.0% (58/135) from Pounthioun. Ethnobotanical investigations among hypertensive patients led to the collection of 15 plant species, among which Hymenocardia acida leaves and Uapaca togoensis stem bark were the most cited. Phytochemical investigation of these two plant species led to the isolation and identification of isovitexin and isoorientin from H. acida, and betulinic acid and lupeol from U. togoensis.

CONCLUSION

The presence of these constituents in Hymenocardia acida leaves and Uapaca togoensis stem bark may at least in part support their traditional use against hypertension in Guinea.

VSION as high field MRI T1 contrast agent: evidence of their potential as positive contrast agent for magnetic resonance angiography

Because of their outstanding magnetic properties, iron oxide nanoparticles have already been the subject of numerous studies in the biomedical field, in particular as a negative contrast agent for T₂-weighted nuclear magnetic resonance imaging, or as therapeutic agents in hyperthermia experiments. Recent studies have shown that below a given particle size (i.e. 5 nm), iron oxide may be used to provide a significant positive (brightening) effect on T₁-weighted MRI. In such an application, not only the size of the crystal, but also the control of the coating process is essential to ensure optimal properties, especially at a very high field (> 3 T). In this work, we focused on the development of very small iron oxide nanoparticles as a potential platform for high field T₁ magnetic resonance angiography (MRA) applications. The feasibility has been evaluated in vivo at 9.4 T, demonstrating the usefulness of the developed system for MRA applications.

Evaluation of the Active Targeting of Melanin Granules after Intravenous Injection of Dendronized Nanoparticles

The biodistribution of dendronized iron oxides, NPs10@D1_DOTAGA and melanin-targeting NPs10@D1_ICF_DOTAGA, was studied in vivo using magnetic resonance imaging (MRI) and planar scintigraphy through [¹⁷⁷Lu]Lu-radiolabeling. MRI experiments showed high contrast power of both dendronized nanoparticles (DPs) and hepatobiliary and urinary excretions. Little tumor uptake could be highlighted after intravenous injection probably as a consequence of the negatively charged DOTAGA-derivatized shell, which reduces the diffusion across the cells' membrane. Planar scintigraphy images demonstrated a moderate specific tumor uptake of melanoma-targeted [¹⁷⁷Lu]Lu-NPs10@D1_ICF_DOTAGA at 2 h post-intravenous injection (pi), and the highest tumor uptake of the control probe [¹⁷⁷Lu]Lu-NPs10@D1_DOTAGA at 30 min pi, probably due to the enhanced permeability and retention effect. In addition, ex vivo confocal microscopy studies showed a high specific targeting of human melanoma samples impregnated with NPs10@D1_ICF_Alexa647_ DOTAGA.

Reinvestigation of the mechanism of polymerization of β-butyrolactone from 1,5,7-triazabicyclo[4.4.0]dec-5-ene

The questionable mechanism initially proposed to explain how 1,5,7-triazabicyclo[4.4.0]dec-5-ene (TBD) allows us to ring-open β-lactones, such as β-butyrolactone (BL), is reinvestigated here.

Characterization of Gd loaded chitosan-TPP nanohydrogels by a multi-technique approach combining dynamic light scattering (DLS), asymetrical flow-field-flow-fractionation (AF4) and atomic force microscopy (AFM) and design of positive contrast agents for molecular resonance imaging (MRI)

Chitosan CS-tripolyphosphate TPP/hyaluronic acid HA nanohydrogels loaded with gadolinium chelates (GdDOTA ⊂ CS-TPP/HA NGs) synthesized by ionic gelation were designed for lymph node (LN) MRI. In order to be efficiently drained to LNs, nanogels (NGs) needed to exhibit a diameter ϕ < 100 nm. For that, formulation parameters were tuned, using (i) CS of two different molecular weights (51 and 37 kDa) and (ii) variable CS/TPP ratio (2 < CS/TPP < 8). Characterization of NG size distribution by dynamic light scattering (DLS) and asymetrical flow-field-flow-fractionation (AF4) showed discrepancies since DLS diameters were consistently above 200 nm while AF4 showed individual nano-objects with ϕ < 100 nm. Such a difference could be correlated to the presence of aggregates inherent to ionic gelation. This point was clarified by atomic force microscopy (AFM) in liquid mode which highlighted the main presence of individual nano-objects in nanosuspensions. Thus, combination of DLS, AF4 and AFM provided a more precise characterization of GdDOTA ⊂ CS-TPP/HA nanohydrogels which, in turn, allowed to select formulations leading to NGs of suitable mean sizes showing good MRI efficiency and negligible toxicity.

How a grafting anchor tailors the cellular uptake and in vivo fate of dendronized iron oxide nanoparticles

Superparamagnetic iron oxide nanoparticles synthesized by thermal decomposition have been grafted with two dendrons bearing respectively a monophosphonic anchor (D2) or a biphosphonic tweezer (D2-2P) at their focal point.

Minor changes in the macrocyclic ligands but major consequences on the efficiency of gold nanoparticles designed for radiosensitization

Many studies have been devoted to adapting the design of gold nanoparticles to efficiently exploit their promising capability to enhance the effects of radiotherapy. In particular, the addition of magnetic resonance imaging modality constitutes an attractive strategy for enhancing the selectivity of radiotherapy since it allows the determination of the most suited delay between the injection of nanoparticles and irradiation. This requires the functionalization of the gold core by an organic shell composed of thiolated gadolinium chelates. The risk of nephrogenic systemic fibrosis induced by the release of gadolinium ions should encourage the use of macrocyclic chelators which form highly stable and inert complexes with gadolinium ions. In this context, three types of gold nanoparticles (Au@DTDOTA, Au@TADOTA and Au@TADOTAGA) combining MRI, nuclear imaging and radiosensitization have been developed with different macrocyclic ligands anchored onto the gold cores. Despite similarities in size and organic shell composition, the distribution of gadolinium chelate-coated gold nanoparticles (Au@TADOTA-Gd and Au@TADOTAGA-Gd) in the tumor zone is clearly different. As a result, the intravenous injection of Au@TADOTAGA-Gd prior to the irradiation of 9L gliosarcoma bearing rats leads to the highest increase in lifespan whereas the radiophysical effects of Au@TADOTAGA-Gd and Au@TADOTA-Gd are very similar.

Pulmonary arterial hypertension in adult onset Still's disease: a case report of a severe complication

Background

Adult onset of Still’s disease (AOSD) is a rare systemic inflammatory disease. Cardiorespiratory complications are mainly represented by pleural and pericardial disorders and are less frequent than cutaneous and articular complaints. Pulmonary arterial hypertension (PAH) occurring in AOSD is rarely described in literature.

Case presentation

We present the case of a young patient who developed severe PAH 2 years after diagnosis of AOSD. This is a rare and severe complication which is probably underestimated.

Conclusions

PAH in AOSD can be lethal, and unfortunately its occurrence is unpredictable. Echocardiographic screening of AOSD patients should be evaluated in further trials. Currently, the most suitable treatment is still unknown.

Electronic supplementary material

The online version of this article (doi:10.1186/s12890-016-0237-x) contains supplementary material, which is available to authorized users.

Gastric Duplication Cyst with Respiratory Epithelium: a Rare Entity

Gastric duplication cyst is an uncommon entity and management is principally surgical. Diagnosis is often delayed because of the non-specific nature of symptoms. The authors report one case of gastric duplication cyst incidentally diagnosed in a 23-year-old man. He had no specific symptoms but follow up of the unknown retro gastric mass showed an increase in size and cholelithiasis. Magnetic resonance imaging (MRI) was not useful for diagnosis but an endoscopic ultrasound suggested a GIST. The growing size of the mass led to a laparoscopic resection. Histopathology showed a gastric duplication cyst boarded with gastric and respiratory ciliated epithelium. This respiratory differenciation is extremely rare. Our patient is the 25th case reported in the literature. The embryologic origin, diagnosis tools and treatment of those rare cysts are briefly reviewed.

Community-acquired infections due to Staphylococcus argenteus lineage isolates harbouring the Panton-Valentine leucocidin, France, 2014

We describe two cases of human infections caused by Staphylococcus aureus clonal complex (CC) 75, also called Staphylococcus argenteus, harbouring the Panton-Valentine leucocidin (PVL). These two sporadic cases were community-acquired, and identified in France in 2014. Both had an epidemiological link with Mayotte, an overseas department of France located in the Indian Ocean off the south-eastern African coast. This report illustrates that, contrary to previous descriptions, S. argenteus can acquire important virulence factors and be responsible for severe infections.

Protein adsorption can be reversibly switched on and off on mixed PEO/PAA brushes

Adsorption of proteins on surfaces placed in biological fluids is a ubiquitous and mostly irreversible phenomenon, desirable or not, but often uncontrolled. Adsorption of most proteins on poly(ethylene oxide) (PEO) brushes is very limited, while the amount of proteins adsorbed on poly(acrylic acid) (PAA) brushes varies with the pH and ionic strength (I) of the protein solution. Mixed brushes of PEO and PAA are designed here to reversibly adsorb and desorb albumin, lysozyme, collagen and immunoglobulin G, four very different proteins in terms of size, solubility and isoelectric point. Protein adsorption and desorption are monitored using X-ray photoelectron spectroscopy, as well as with quartz crystal microbalance for in situ and real-time measurements. Large amounts of protein are adsorbed and then nearly completely desorbed on mixed PEO/PAA brushes by a simple pH and I trigger. The mixed brushes thus nicely combine the properties of pure PAA and pure PEO brushes. These adsorption/desorption cycles are shown to be repeated with high efficiency. The high-performance smart substrates created here could find applications in domains as diverse as biosensors, drug delivery and nanotransport.

Validation of a dendron concept to tune colloidal stability, MRI relaxivity and bioelimination of functional nanoparticles

A dendritic coating induces colloidal stability of nanoparticles through electrostatic and steric interactions.

A new magnetic resonance imaging contrast agent loaded into poly(lacide-co-glycolide) nanoparticles for long-term detection of tumors

The incorporation of a lipophilic Gd chelate (GdDO3A-C12) in biocompatible PLGA poly(D, L-lactide-co-glycolide) nanoparticles was explored as an approach to increase the relaxivity of contrast agents for magnetic resonance imaging. By nanoprecipitation, it was possible to obtain PEGylated gadolinium nanoparticles (mean diameter of 155 nm) with high Gd loading (1.1 × 10(4) Gd centers per nanoparticle). The corresponding GdDO3AC12 ⊂ NPs nanoparticles exhibited an enhanced relaxivity (up to sixfold greater than DOTAREM® at 40 MHz) because the nanoparticle framework constrained the lipophilic Gd chelate motion and favorably impacted the Gd chelate rotational correlation time. T1-weighted imaging at 3 T on phantoms showed enhanced contrast for the GdDO3AC12 ⊂ NPs. Importantly, Gd chelate leakage was almost nonexistent, which suggested that these GdDO3AC12 ⊂ NPs could be useful for long-term MRI detection.