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Maksimovic Z, Curcic A, Ljubisavljevic R, Simovic I, Banjanac A, Aleksandrovic D, Tanasijevic J, Petkovic D, Misic M, Mihajlovic Z, Mitrovic S, Vukasinovic J, Kosic D, Dugalic M, Maljevac E, Bihorac D, Sekler D, Nikolic S, Opacic S, Ivanovic Z. P237 Analysis of factors with impact on short stay surgery for patients operated for breast cancer during COVID 19 pandemic. Breast 2023. [PMCID: PMC10013699 DOI: 10.1016/s0960-9776(23)00355-7] [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: 03/16/2023] Open
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Gillard L, Pouchot J, Cohen-Aubart F, Koné-Paut I, Mouterde G, Michaud M, Reumaux H, Savey L, Belot A, Fautrel B, Mitrovic S. JAK inhibitors in difficult-to-treat adult-onset Still's disease and systemic-onset juvenile idiopathic arthritis. Rheumatology (Oxford) 2022; 62:1594-1604. [PMID: 35920788 DOI: 10.1093/rheumatology/keac440] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Excessive and inappropriate production of pro-inflammatory cytokines plays a key role in Still's disease. JAK inhibitor (JAKi) agents mainly block pro-inflammatory cytokine pathways, notably IL-6 and IFN. The objective was to assess the efficacy and safety of JAKi agents in difficult-to-treat systemic juvenile idiopathic arthritis (SJIA) or adult-onset Still's disease (AOSD). METHODS This retrospective study was based on a national survey conducted in the departments of rheumatology, paediatric rheumatology and internal medicine of French hospitals regarding SJIA and AOSD patients who received JAKi agents. The data were collected with a standardised questionnaire and analysed at different times (treatment initiation, months 1, 3, and 6 and the end of follow-up). RESULTS Nine patients (7 adults) were included. All patients showed inadequate response to corticosteroids or conventional synthetic or biologic disease-modifying anti-rheumatic drugs. Baricitinib was used in 5 patients, ruxolitinib in 2, tofacitinib in 2, and upadacitinib in 1. A JAKi was used combined with corticosteroids in all but 2 patients. A JAKi was associated with anakinra and corticosteroids in one patient, and with methotrexate, anakinra and corticosteroids in another. The median follow-up was 16 [1-33] months. Two cases out 9 showed complete remission, 3/9 partial response and 4/9 treatment failure. At the last visit, corticosteroids could be decreased but not stopped. Tolerance of the JAKi was acceptable (no severe adverse events). CONCLUSION JAKi agents may be a therapeutic option for some patients with difficult-to-treat Still's disease, especially those with partial response to medium- or high-dose corticosteroids or biologics.
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Affiliation(s)
- Louise Gillard
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, AP-HP, France
| | - Jacques Pouchot
- Service de Médecine Interne, Hôpital Européen Georges Pompidou, Université Paris Cité, AP-HP, Paris, France
| | - Fleur Cohen-Aubart
- Service de Médecine Interne 2, Hôpital Pitié-Salpêtrière, Sorbonne Université, AP-HP, Paris, France
| | - Isabelle Koné-Paut
- Service de Rhumatologie Pédiatrique, Hôpital de Bicêtre, Université de Paris Saclay, AP-HP, Le Kremlin-Bicêtre, France.,Centre de Référence des Maladies Autoinflammatoires et des Amyloses (CéRéMAIA), Paris, France
| | - Gaël Mouterde
- Service de Rhumatologie, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Martin Michaud
- Service de Médecine Interne, Clinique Ambroise Paré, Toulouse, France
| | - Héloïse Reumaux
- Service de Rhumatologie Pédiatrique, Hôpital Jeanne de Flandres, Université de Lille, CHU de Lille, Lille, France
| | - Lea Savey
- Service de Médecine Interne, Hôpital Tenon, Sorbonne Université, AP-HP, Paris, France
| | - Alexandre Belot
- Centre International de Recherche en Infectiologie, Inserm, U1111, Université Claude Bernard, Lyon 1, Centre National de la Recherche Scientifique, UMR5308, ENS de Lyon, Lyon, France.,Centre de référence pour les maladies rhumatologiques et inflammatoires pédiatriques (RAISE), Hopital Femme Mère Enfant, Lyon, France.,Service de Néphrologie, Rhumatologie et Néphrologie Pédiatriques, Unité de rhumatologie, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Bruno Fautrel
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, AP-HP, France.,Centre de Référence des Maladies Autoinflammatoires et des Amyloses (CéRéMAIA), Paris, France.,Institut d'Epidémiologie et de Santé Publique Pierre Louis, UMR S1136, Equipe PEPITES, Paris, France
| | - Stéphane Mitrovic
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, AP-HP, France.,Centre de Référence des Maladies Autoinflammatoires et des Amyloses (CéRéMAIA), Paris, France.,Département de Médecine Interne, Unité de Rhumatologie, Institut Mutualiste Montsouris, Paris, France
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Mitrovic S, Hassold N, Kamissoko A, Rosine N, Mathian A, Mercy G, Pertuiset E, Nocturne G, Fautrel B, Koné-Paut I. Erratum to: Adult-onset Still's disease or systemic-onset juvenile idiopathic arthritis and spondyloarthritis: overlapping syndrome or phenotype shift? Rheumatology (Oxford) 2021; 61:882. [PMID: 34850847 DOI: 10.1093/rheumatology/keab831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Stéphane Mitrovic
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université - APHP
- Centre d'Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R Network
- Département de Médecine Interne, Unité de Rhumatologie, Institut Mutualiste Montsouris
| | - Nolan Hassold
- Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Saclay, INSERM, Paris
- Service de Rhumatologie, Hôpital de Bicêtre, APHP, Université de Paris Sud-Saclay, Le Kremlin-Bicêtre
- Service de Rhumatologie Pédiatrique, and CEREMAIA, Hôpital de Bicêtre, APHP, Université de Paris Sud-Saclay, Le Kremlin-Bicêtre
| | - Aly Kamissoko
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université - APHP
- Service de Rhumatologie, Hôpital National Ignace Deen, Conakry, Guinée
| | - Nicolas Rosine
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université - APHP
| | - Alexis Mathian
- Service de Médecine Interne 2, Hôpital Universitaire Pitié-Salpêtrière
| | - Guillaume Mercy
- Service de Radiologie, Hôpital Pitié-Salpêtrière, APHP, Paris
| | | | - Gaëtane Nocturne
- Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Saclay, INSERM, Paris
- Service de Rhumatologie, Hôpital de Bicêtre, APHP, Université de Paris Sud-Saclay, Le Kremlin-Bicêtre
| | - Bruno Fautrel
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université - APHP
- Centre d'Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R Network
- Institut d'Epidémiologie et de Santé Publique Pierre Louis, UMR S 1136, Equipe PEPITES, Paris, France
| | - Isabelle Koné-Paut
- Centre d'Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R Network
- Service de Rhumatologie Pédiatrique, and CEREMAIA, Hôpital de Bicêtre, APHP, Université de Paris Sud-Saclay, Le Kremlin-Bicêtre
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Davergne T, Tekaya R, Sellam J, Tournadre A, Mitrovic S, Ruyssen-Witrand A, Hudry C, Dadoun S, Avouac J, Fautrel B, Gossec L. Influence of perceived barriers and facilitators for physical activity on physical activity levels in patients with rheumatoid arthritis or spondyloarthritis: a cross-sectional study of 150 patients. BMC Musculoskelet Disord 2021; 22:915. [PMID: 34717606 PMCID: PMC8556961 DOI: 10.1186/s12891-021-04792-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/15/2021] [Indexed: 12/20/2022] Open
Abstract
Background Barriers and facilitators to physical activity in inflammatory arthritis can be assessed through the Inflammatory arthritis FAcilitators and Barriers (IFAB) questionnaire. The objective was to measure the correlation between IFAB and self-reported physical activity levels. Methods This was an international, multicentric, cross-sectional study in 2019–20. Consecutive spondyloarthritis (axSpA), rheumatoid arthritis (RA) or psoriatic arthritis (PsA) patients completed the 10-item IFAB, which ranges from − 70 to 70 with lower scores indicating more barriers. Physical activity was measured by the IPAQ-S questionnaire, steps per day collected by smartphone, and psychological readiness to change by stages of behaviour change. Spearman correlations and multivariable linear regression were calculated. Results Of 245 patients included, 150 were analysed: 69 (46%) axSpA, 63 (42%) RA, 18 (12%) PsA. Mean age was 48.6 years (standard deviation, SD 17.1), mean disease duration 11.7 (10.1) years and 60% were women. Barriers to physical activity were moderate: mean IFAB, 6 (SD 19.2); 39 (26%) patients scored less than − 5, corresponding to significant barriers. The mean physical activity was 2837 (SD 2668, median 1784) MET-minutes per week. The IPAQ-S questionnaire was correlated with the IFAB (rho 0.28, p < 0.001), as well as the stage of behaviour change (rho 0.35, p < 0.001) though not with steps per day. Multivariable analyses were confirmatory. Conclusion Perceived barriers and facilitators to physical activity were correlated with physical activity, indicating that targeting patients with high barriers and low facilitators to physical activity could be an effective option to improve physical activity levels. Trial registration ClinicalTrial NCT04426747. Registered 11 June 2020 - Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04792-7.
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Affiliation(s)
- Thomas Davergne
- Sorbonne Université, INSERM UMR-S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Rawdha Tekaya
- Rheumatology Department, University of Tunis El Manar, Charles Nicolle Hospital, Tunis, Tunisie
| | - Jérémie Sellam
- Rheumatology Department, Sorbonne Université, INSERM URMS_938, APHP, Saint-Antoine Hospital, Paris, France
| | - Anne Tournadre
- Rheumatology Department, University of Clermont, Auvergne, Clermont Ferrand Hospital, Clermont-Ferrand, France
| | - Stéphane Mitrovic
- Internal Medicine Department, Institut Mutualiste Montsouris, Paris, France
| | - Adeline Ruyssen-Witrand
- Rheumatology Department, Toulouse University Hospital, Clinical Investigation Centre CIC1436, INSERM and Paul Sabatier University Toulouse III, Toulouse, France
| | | | - Sabrina Dadoun
- CeSOA, MGEN, Paris, France.,Clinique Geoffroy Saint Hilaire, Ramsay, Paris 5, France
| | - Jérôme Avouac
- Rheumatology Department, Université de Paris, Cochin Hospital, Paris, France
| | - Bruno Fautrel
- Sorbonne Université, INSERM UMR-S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.,Rheumatology Department, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Laure Gossec
- Sorbonne Université, INSERM UMR-S 1136, Institut Pierre Louis d'Épidémiologie et de Santé Publique, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.,Rheumatology Department, Pitié Salpêtrière Hospital, APHP, Paris, France
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Mitrovic S, Hassold N, Kamissoko A, Rosine N, Mathian A, Mercy G, Pertuiset E, Nocturne G, Fautrel B, Koné-Paut I. Adult-onset Still's disease or systemic-onset juvenile idiopathic arthritis and spondyloarthritis: overlapping syndrome or phenotype shift? Rheumatology (Oxford) 2021; 61:2535-2547. [PMID: 34559214 DOI: 10.1093/rheumatology/keab726] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/16/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Systemic-onset juvenile idiopathic arthritis (SJIA) and adult-onset Still's disease (AOSD) are the same sporadic systemic auto-inflammatory disease. Spondyloarthritis (SpA) is a group of inflammatory non-autoimmune disorders. We report the observations of eight patients with SJIA/AOSD who also presented features of SpA during their disease evolution and estimate the prevalence of SpA in SJIA/AOSD. METHODS This was a retrospective national survey of the departments of paediatric and adult rheumatology and internal medicine. To be included, SJIA patients had to fulfil the ILAR criteria, AOSD patients the Yamaguchi or Fautrel criteria, and all patients the ASAS classification criteria for axial or peripheral SpA, ESSG criteria for spondyloarthropathy or CASPAR criteria for psoriatic arthritis. The data were collected with a standardized form. RESULTS Eight patients (five adults) were identified in one paediatric and two adult departments. In all but one patient, SpA manifestations occurred several years after SJIA/AOSD onset (mean delay 6.2 ± 3.8 years). Two patients had peripheral and three axial SpA, and four later exhibited psoriatic arthritis and one SAPHO syndrome. The prevalence of SpA in an adult cohort of 76 patients with AOSD was 6.58% (95% CI [2.17-14.69]), greater than the prevalence of SpA in the French general population (0.3%, 95%CI [0.17-0.46]). The prevalence of SpA in an SJIA cohort of 30 patients was 10% (95%CI [2.11-26.53]), more than that reported in the general population of industrialized countries, estimated at 0.016% to 0.15%. CONCLUSION Whilst the temporal disassociation between SpA and AOSD in most cases might suggest a coincidental finding, our work raises the possibility of an SpA AOSD spectrum overlap that needs further study.
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Affiliation(s)
- Stéphane Mitrovic
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Paris, FranceSorbonne Université - APHP.,Centre d'Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R network, Paris, France.,Département de Médecine Interne, Unité de Rhumatologie, Institut Mutualiste Montsouris, Paris, France
| | - Nolan Hassold
- Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Saclay, INSERM, Paris, France.,Service de Rhumatologie, Hôpital de Bicêtre, APHP, université de Paris sud-Saclay, Le Kremlin-Bicêtre, France.,Service de rhumatologie pédiatrique, and CEREMAIA, Hôpital de Bicêtre, APHP, université de Paris sud-Saclay, Le Kremlin-Bicêtre, France
| | - Aly Kamissoko
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Paris, FranceSorbonne Université - APHP.,Service de Rhumatologie, Hôpital National Ignace Deen, Conakry, Guinée
| | - Nicolas Rosine
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Paris, FranceSorbonne Université - APHP
| | - Alexis Mathian
- Service de Médecine Interne 2, Hôpital Universitaire Pitié-Salpêtrière, AP-HP, Paris, France
| | - Guillaume Mercy
- Service de Radiologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Edouard Pertuiset
- Centre hospitalier René Dubos, Service de rhumatologie, Pontoise, France
| | - Gaëtane Nocturne
- Center for Immunology of Viral Infections and Autoimmune Diseases, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, Université Paris Saclay, INSERM, Paris, France.,Service de Rhumatologie, Hôpital de Bicêtre, APHP, université de Paris sud-Saclay, Le Kremlin-Bicêtre, France
| | - Bruno Fautrel
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Paris, FranceSorbonne Université - APHP.,Centre d'Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R network, Paris, France.,Institut d'Epidémiologie, et de Santé Publique Pierre Louis, UMR S 1136, Equipe PEPITES, Paris, France
| | - Isabelle Koné-Paut
- Centre d'Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R network, Paris, France.,Service de rhumatologie pédiatrique, and CEREMAIA, Hôpital de Bicêtre, APHP, université de Paris sud-Saclay, Le Kremlin-Bicêtre, France
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Mitrovic S, Fautrel B. Clinical Phenotypes of Adult-Onset Still's Disease: New Insights from Pathophysiology and Literature Findings. J Clin Med 2021; 10:jcm10122633. [PMID: 34203779 PMCID: PMC8232697 DOI: 10.3390/jcm10122633] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 06/10/2021] [Indexed: 01/02/2023] Open
Abstract
Adult-onset Still's disease (AOSD) is a non-familial, polygenic systemic autoinflammatory disorder. It is traditionally characterized by four cardinal manifestations-spiking fever, an evanescent salmon-pink maculopapular rash, arthralgia or arthritis and a white-blood-cell count (WBC) ≥ 10,000/mm3, mainly neutrophilic polymorphonuclear cells (PMNs)-but many other manifestations and complications can be associated, making clinical expression very heterogeneous and diagnosis sometimes difficult. The AOSD course can be diverse and is currently impossible to predict. Several clinical phenotypes have been described, either on the basis of the evolution of symptoms over time (monocyclic, polycyclic and chronic evolution) or according to dominant clinical evolution (systemic and arthritis subtypes). However, these patterns are mainly based on case series and not on robust epidemiological studies. Furthermore, they have mainly been established a long time ago, before the era of the biological treatments. Thus, based on our personal experience and on recent advances in the understanding of disease pathogenesis, it appears interesting to reshuffle AOSD phenotypes, emphasizing the continuum between AOSD profiles and other systemic autoinflammatory disorders, eventually proposing a research agenda.
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Affiliation(s)
- Stéphane Mitrovic
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université—APHP, 75013 Paris, France;
- Centre d’Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R Network, 75013 Paris, France
- Département de Médecine Interne, Institut Mutualiste Montsouris, 75014 Paris, France
| | - Bruno Fautrel
- Service de Rhumatologie, Hôpital Pitié-Salpêtrière, Sorbonne Université—APHP, 75013 Paris, France;
- Centre d’Etude et de Référence sur les Maladies AutoInflammatoires et les Amyloses (CEREMAIA), FAI2R Network, 75013 Paris, France
- Institut d’Epidémiologie et de Santé Publique Pierre Louis, UMR S 1136, Equipe PEPITES, 75013 Paris, France
- Correspondence:
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Mitrovic S, Boucly A, Lazaro E, Schleinitz N, Bloch-Queyrat C, Christides C, Pouchot J, Humbert M, Montani D, Savale L, Jaïs X, Sitbon O, Fautrel B. OP0094 PULMONARY ARTERIAL HYPERTENSION IN ADULT-ONSET STILL’S DISEASE: A CASE SERIES OF 13 PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Pulmonary Arterial Hypertension (PAH) is a rare but potentially fatal complication of Adult-Onset Still’s Disease (AOSD) (1). To date, only isolated observations have been published.Objectives:To establish the largest case series of AOSD patients with PAH, and to describe their clinical profile, evolution and response to treatments.Methods:Cases were retrospectively identified from the French PAH network database and from an online call of the “Club Rhumatismes et Inflammation” (http://www.cri-net.com). To be included, all patients had to fulfil the Yamaguchi or Fautrel’s criteria for AOSD and PAH had to be confirmed by right heart catheterization. The data were collected using a standardized questionnaire.Results:Thirteen patients were identified. All were female, the mean age at PAH diagnosis was 32± 12 years, 2 (15%) patients were Caucasian, 6 (46%) from Sub-Saharan Africa, 1 (8%) from Asia and 4 (31%) from West Indies. Only 2 (15%) patients were smokers. All patients had a systemic onset of AOSD, 12 had a polycyclic and 1 a chronic articular evolution, and the mean delay between AOSD and PAH diagnosis was 2.9 (range 1.7 -5.4) years. At PAH diagnosis, patients were receiving the following treatments: 13 (100%) corticosteroids (median dose 12 mg [interquartile range (IQR) 9-18]), 3 (23%) methotrexate, 8 (61%) interleukin (IL)-1 inhibitors (exposure median duration 6.7 months [IQR 3.6-8.5]), none IL-6 inhibitors, 2 (15%) TNF inhibitors. Six (46%) patients developed PAH during an AOSD flare. PAH was severe at diagnosis: 2 (15%), 7 (54%) and 4 (31%) patients were in NYHA functional class II, III and IV, respectively, with a median 6-minute walk distance of 289 m [IQR 0-448], a mean pulmonary arterial pressure of 41 ± 12 mmHg, a mean pulmonary arterial occlusion pressure of 6 ± 3 mmHg, a mean cardiac output of 3.9 ± 1.2 L/min, a mean cardiac index of 2.5 ± 0.9 L/min/m2 and a median pulmonary vascular resistance of 7 Wood Units [IQR 6-11]. The treatment prescribed after PAH diagnosis is detailed in the table. The median follow-up was 34 months [IQR 7-42]. Five patients (38.5 %) died. Figure 1 shows the overall survival. The haemodynamic response to PAH treatment seemed to be dissociated from the prognosis since several patients have died while their haemodynamic had improved or almost normalised.Conclusion:PAH is a rare but potentially severe complication of AOSD, leading to death in 38.5% of our cases series. AOSD remission should be physicians’ objective, since PAH seems to occur when the underlying disease is not controlled.References:[1]Feist E, Mitrovic S, Fautrel B. Mechanisms, biomarkers and targets for adult-onset Still’s disease. Nat Rev Rheumatol. 2018;1:603-618.Table 1.Therapeutic managementTreatmentn (%)Inotropic therapy5 (38%)HTAP treatment10 (77%)•0Monotherapy3•oInitial oral dual combination therapy3•nDual combination therapy including intravenous (IV) prostacyclin1•uUpfront triple combination therapy including IV prostacyclin3High-dose corticosteroids9 (69%)Interleukin 1 inhibitors initiation2 (15%)Interleukin 6 inhibitors initiation5 (38%)Acknowledgements:The authors want to thank the Club Rhumatismes et Inflammation for the diffusion of the online call.Disclosure of Interests:None declared
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Davergne T, Tekaya R, Deprouw C, Sellam J, Tournadre A, Mitrovic S, Ruyssen-Witrand A, Hudry C, Dadoun S, Avouac J, Fautrel B, Gossec L. POS0274-HPR BARRIERS TO PHYSICAL ACTIVITY COLLECTED BY THE IFAB QUESTIONNAIRE CORRELATE WITH LEVELS OF PHYSICAL ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS OR SPONDYLOARTHRITIS: A CROSS-SECTIONAL STUDY OF 150 PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Physical activity is important for patients with inflammatory arthritis (IA), such as spondyloarthritis (axSpA), rheumatoid arthritis (RA) or psoriatic arthritis (PsA). They are more prone to physical inactivity but derive specific benefits from regular physical activity (1,2). It is not easy to modify physical activity level (3). Barriers and facilitators to physical activity can be assessed through questionnaires (4), however, it is important to demonstrate a link between these explanatory elements and physical activity levels.Objectives:To measure the correlation between barriers and facilitators to physical activity, assessed through a simple questionnaire, and self-reported physical activity levels.Methods:This was an international, multicentric, cross-sectional study performed between October 2019 and June 2020 (ClinicalTrial NCT04426747). Consecutive patients were included if they had definite axSpA, RA or PsA, were aged above 18 and able to walk. Barriers and facilitators to physical activity were measured using the 10-item Inflammatory arthritis Facilitators and barriers questionnaire (IFAB) (5). The IFAB ranges -70 to 70 with lower scores indicating more barriers; scores below -5 correspond to significant barriers. Physical activity was measured by the IPAQ-S questionnaire (6). Exploratory analyses used steps per day collected by smartphone, and psychological readiness to change by stages of behavior change. Statistical analysis used Spearman correlation (rho, p<0.05), Student T test or multivariate analysis using R version 3.5.1. There was no imputation of missing data.Results:Of 245 patients included, 150 had analysable data (69 (46%) axSpA, 63 (42%) RA, 18 (12%) PsA). Mean age was 48.6 years (SD 17.1), mean disease duration 11.7 (10.1) years and 60% were women. The mean score of barriers and facilitators to physical activity was 6.0 (SD 19.2, median 4) (Figure 1). A total of 39 (26%) patients scored less than -5, which could justify a targeted intervention. The mean physical activity was 2837 (SD 2668, median 1784) Metabolic Equivalent of Task min per week. Physical activity was correlated with score of barriers and facilitators to physical activity in linear regression (rho 0.28, p<0.001), as well as the stage of behavior change regarding active lifestyle (rho 0.35, p<0.001). No correlation was observed with steps per day (Table 1)Table 1for abstract: correlation between IFAB questionnaire, each items and level of physical activity with or without extreme valuesItemCorrelation with IPAQ-S min/met/week, rhoCorrelation with stage of behavior change, rhoCorrelation with mean steps per day, rhoTotal IFAB score0.28 ***0.35 ***0.08Item 10.29 ***0.16 *0.16 *Item 20.060.020.05Item 30.080.16 *0.01Item 40.130.09-0.07Item 5-0.090.100.07Item 60.22 **0.25 ***-0.05Item 70.22 **0.20 **0.12Item 80.16 *0.26 ***0.11Item 90.150.33 ***0.11Item 100.090.17 *0.02Social support questions0.140.27 ***-0.03Psychological and knowledge status questions0.22 **0.16 *0.09*=P<0.05, **=p<0.01, ***=p<0.001Conclusion:Perceived barriers and facilitators to physical activity are correlated with physical activity. Targeting patients with high barriers and low facilitators to physical activity could be an effective option to improve physical activity levels.References:[1]O’DWYER T., et al. Rheumatology 2014. Vol. 53, n° 10, pp. 1812-1817.[2]OSTHOFF, A et al. 2018. Vol. 77, n° 9, pp. 1251-1260. DOI 10.1136/annrheumdis-2018-213585.[3]MARLEY, J, et al: BMC Musculoskeletal Disorders. 2017. Vol. 18, pp. 482. DOI 10.1186/s12891-017-1836-2.[4]COSTE, N., et al. 2019. DOI 10.1016/j.rehab.2019.07.009.[5]DAVERGNE, T, et al. Rheumatology International 2020. DOI 10.1007/s00296-020-04692-4.[6]LEE, PH, et al. 2011. Vol. 8, pp. 115. DOI 10.1186/1479-5868-8-115.Figure 1.Distribution of the IFAB score Footnote: Y axis: effectifs, X axis: IFAB score (possibles values from -70 to 70)Acknowledgements:I have no acknowledgements to declare.We thank the following coinvestigators: Sylvie Rozenberg, Beatrice Banneville, Rachida Inaoui, Emmanuelle Dernis, Athan Baillet and Catherine Beauvais, and we thank Hervé Servy for expert CRO adviceDisclosure of Interests:None declared
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Gillard L, Mitrovic S, Reumaux H, Michaud M, Cohen F, Pouchot J, Fautrel B. AB0772 JAK INHIBITORS IN REFRACTORY ADULT AND CHILDHOOD ONSET STILL’S DISEASE. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Excessive and inappropriate production of pro-inflammatory cytokines such as interleukin (IL)-1, IL-6 or IL-18, is a pathogenic cornerstone in adult and childhood onset Still’s disease. Beyond therapies targeting IL-1 or IL-6, Janus kinases (JAK) inhibitors have been proposed for adult-onset Still’s disease (AOSD) patients refractory to or intolerant of treatment with biologicals. Recently, it has been suggested that JAK inhibitors might be efficient in refractory AOSD patients1.Objectives:To assess the efficacy and safety of JAK inhibitors in the treatment of refractory systemic juvenile idiopathic arthritis (sJIA) or AOSD.Methods:This retrospective study was based on a national survey of the departments of rheumatology, paediatric rheumatology and internal medicine in all French hospitals from an online call of the “Club Rhumatismes et Inflammation” (www.cri-net.com). The data were collected using a standardized questionnaire, and analyzed at different time points (treatment initiation, M1, M3, M6 and end of the follow-up). The response to JAK inhibitors was categorized as: complete remission (resolution of all clinical and biologic signs), partial remission (clinical improvement with persistence of a few symptoms) or failure (lack of clinical or biological improvement).Results:6 patients (5 adults and 1 child) were recruited (Table 1). Mean age at treatment start was 39.6 years for the AOSD patient and 6 years for the sJIA patient, and mean disease duration was 5.3 years. The clinical expression was predominantly systemic in 5 five patients and chronic articular in one. Response to corticosteroids, conventional synthetic or biological Disease Modifying Anti-Rheumatic Drugs had been considered inadequate in all patients. Baricitinib was used in 3 patients, ruxolitinib in 2, and tofacitinib in 1. Steroids were concurrently used in all patients, anakinra in one, methotrexate and anakinra in one. At a mean (SD) follow-up of 9.5 months, partial response was observed in 4 (66.7%) cases (patients with ruxolitinib, tofacitinib or baricitinib) and failure in 2 (33.3%) (patients with baricitinib). No patient achieved complete remission. At the last visit, steroids could be decreased but not stopped in all patients. Patients with partial response had an average decrease of 72,8% (90% for tofacitinib, 70% for baricitinib, 58.5% for ruxolitinib between the start and the follow-up end date) and non-responder patients were yet able to reduce steroids by 60,5% (Table 1). Tolerance of JAK inhibitors was excellent, however patient 4 experienced an episode of infectious pulmonary disease.Conclusion:JAK inhibitors therapy may be helpful for some patients with refractory Still’s disease. However, no complete response was observed in this short series of cases. There might be a difference of response between the molecules, although the number of patients is too low to draw conclusions. Additional information is thus needed to evaluate more precisely the risk-benefit ratio of this treatment, and a possible difference in efficacy among the different groups of JAK inhibitors.References:[1]Hu Q, Wang M, Jia J, et al. Ann Rheum Dis 2020;0:1–3. doi:10.1136/annrheumdis-2019-216Table 1.Characteristics of the AOSD patientNo.SexAge (year)Main symptomsTreatments before JAKi onsetJAK inhibitorsSteroids at onset (mg/day)Concomitant treatmentResponse at last F-USteroids at the end of F-U (mg/day)F-U (months)1F6Fever, polyarthritis, rashAINS, ANAKI, TOCI, CANAKI, ADA, THALI, INFLIXRUXOLITINIB 5mgx2/day30P1232M28Fever, polyarthritis, rashANAKIBARICITINIB 4mg/day800N1013M32Fever, polyarthritis, rashTOCI+MTX, ANAKI+MTX, CANAKI+MTX, ADA, CICLO, IgIVBARICITINIB 4mg/day16MTX 20 mg/week ANAKINRA 100mg/dayP12194F40Fever, polyarthritis, rashMTX, IMUREL, CICLO, ETANERCEPT, ANAKI+MTX, TOCI+MTX, IgIVRUXOLITINIB 15mgx2/day60ANAKI 200mg/dayP3045F48Fever, polyarthritis, rashTOCI, ANAKI, CICLO, CANAKI, IMURELTOFACITINIB 5mgx2/day500P7.596F50Fever, polyarthralgia, rashANAKIBARICITINIB 4mg/day600N401F-U: Follow-upN: No responseP: Partial responseAcknowledgements:I thank all the coauthors, particularly Stéphane Mitrovic and Bruno Fautrel. Also, a special thank to the CRI.Disclosure of Interests:None declared
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Davergne T, Tekaya R, Deprouw C, Sellam J, Tournadre A, Mitrovic S, Ruyssen-Witrand A, Hudry C, Dadoun S, Avouac J, Fautrel B, Gossec L. To apply the recent EULAR recommendations, more knowledge on adherence patterns to medication and to physical activity is needed. Joint Bone Spine 2021; 88:105137. [PMID: 33484861 DOI: 10.1016/j.jbspin.2021.105137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Thomas Davergne
- Inserm, Institut Pierre-Louis d'épidémiologie et de Santé Publique, Sorbonne Université, 75013 Paris, France.
| | - Rawdha Tekaya
- Rheumatology department, Hôpital Charles-Nicolle, University of Tunis El-Manar Tunis, Tunis, Tunisia
| | - Camille Deprouw
- Rheumatology department, Saint-Antoine hospital, Paris, France
| | - Jeremie Sellam
- Rheumatology department, Saint-Antoine hospital, Paris, France
| | - Anne Tournadre
- Rheumatology department, Clermont-Ferrand hospital, University of Clermont, Auvergne, France
| | - Stéphane Mitrovic
- Internal Medicine Department, Institut Mutualiste Montsouris, Paris, France
| | | | | | - Sabrina Dadoun
- CeSOA, MGEN, Paris, France; Clinique Geoffroy Saint-Hilaire, Ramsay, Paris 5, France
| | - Jérôme Avouac
- Rheumatology department, université de Paris, Cochin hospital, Paris, France
| | - Bruno Fautrel
- Inserm, Institut Pierre-Louis d'épidémiologie et de Santé Publique, Sorbonne Université, 75013 Paris, France; Rheumatology department, Pitié Salpêtrière hospital, AP-HP, Paris, France
| | - Laure Gossec
- Inserm, Institut Pierre-Louis d'épidémiologie et de Santé Publique, Sorbonne Université, 75013 Paris, France; Rheumatology department, Pitié Salpêtrière hospital, AP-HP, Paris, France
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Hagège B, Tan E, Gayraud M, Fautrel B, Gossec L, Mitrovic S. Remission and low disease activity in psoriatic arthritis publications: a systematic literature review with meta-analysis. Rheumatology (Oxford) 2021; 59:1818-1825. [PMID: 32118267 DOI: 10.1093/rheumatology/keaa030] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/10/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Remission (REM) or low disease activity (LDA) is the treatment target in psoriatic arthritis (PsA). The objective of this study was to assess the reporting and prevalence of REM/LDA in published studies of PsA. METHODS This was a systematic literature review of all clinical papers published in PubMed, EMBASE or Cochrane database in English between 2012 and 2019 in the field of PsA. Data were collected regarding reporting of REM/LDA by very low disease activity/minimal disease activity (VLDA/MDA), Disease Activity index for Psoriatic Arthritis (DAPSA), or Disease Activity Score 28 joints (DAS28). The pooled rates of REM and LDA by each definition were calculated by random effect meta-analysis. RESULTS In all, 258 publications (corresponding to 114 651 patients), of which 81 (31%) were randomized controlled trials, were analysed: patients' mean age was 49.4 ( 4.4) years; with a mean disease duration of 8.5 ( 3.8) years. REM/LDA was reported in 91/258 (35.3%) publications. VLDA/MDA was used in 61/91 (67.0%) studies, DAPSA in 27/91 (29.6%) and DAS28 in 28/91 (30.7%), with 40/91 (43.9%) papers reporting several of these definitions. The pooled prevalence (lower-upper limits) of REM was 13.1% (10.9-15.4), 23.1% (16.8-30.1) and 42.1% (33.9-50.4) using VLDA, DAPSA-REM and DAS28, respectively. For LDA the pooled prevalence was 36.3% (32.3-40.5), 52.8% (41.8-63.6) and 60.4% (52.5-68.0) using MDA, DAPSA-LDA and DAS28, respectively. CONCLUSION REM/LDA status was reported in only1/3 of recent studies on PsA, with important variations in the frequency of these outcomes according to the definition used: 13.1-42.1% for REM, and 36.3-60.4% for LDA. This highlights the need for consensus.
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Affiliation(s)
- Benjamin Hagège
- Internal Medicine Department, Institut Mutualiste MontsourisParis, France
| | - Elina Tan
- Internal Medicine Department, Institut Mutualiste MontsourisParis, France
| | - Martine Gayraud
- Internal Medicine Department, Institut Mutualiste MontsourisParis, France
| | - Bruno Fautrel
- Rheumatology Department, Pitié Salpêtrière Hospital, Sorbonne Université-AP-HP, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR S1136, Paris, France
| | - Laure Gossec
- Rheumatology Department, Pitié Salpêtrière Hospital, Sorbonne Université-AP-HP, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR S1136, Paris, France
| | - Stéphane Mitrovic
- Internal Medicine Department, Institut Mutualiste MontsourisParis, France.,Rheumatology Department, Pitié Salpêtrière Hospital, Sorbonne Université-AP-HP, Paris, France.,INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR S1136, Paris, France
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Simovic S, Jeremic J, Davidovic G, Srejovic I, Mitrovic S, Zivkovic V, Ravic M, Miloradovic V, Nikolic M, Vucic R, Andjic M, Rankovic M, Draginic N, Jakovljevic V. P561Acute effects of dronedarone and amiodarone on functional, morphological and oxidative stress parameters in isolated rat heart with hypertension. Europace 2020. [DOI: 10.1093/europace/euaa162.379] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Amiodarone represents the most widely used antiarrhythmic drug, even though it has been shown that it has negative inotropic and lusitropic effect in healthy hears. On the other hand, dronedarone reduces the risk of recurrent atrial fibrillation, but with increased early mortality related to the worsening of heart failure. However, the mechanisms responsible for these fatal outcomes remain unclear and require further examinations.
Purpose
To investigate acute, direct effects of Dronedarone and Amiodarone on cardiac contractility, coronary flow and oxidative stress parameters in isolated rat heart with hypertension.
Methods
The present study was carried out on 18 isolated hearts of spontaneously hypertensive Wistar Kyoto male rats (6 weeks old, bodyweight 200 ± 10 g). After isolation, all hearts were retrogradely perfused according to Langendorff technique with a gradually increment of coronary perfusion pressure (CPP from 40 to 120 cm H2O) and randomly divided into 3 groups: Control (n = 6), Amiodarone (n = 6, isolated hearts perfused with Amiodarone in dose of 3 umol), Dronedarone (n = 6, isolated hearts perfused with Dronedarone in dose of 1.8 umol). During ex vivo protocol continuously were registered cardiac contractility parameters and coronary flow, while from collected coronary venous effluent markers of oxidative stress were measured. All hearts were then fixated and stained with Hematoxylin/eosin.
Results
Dronedarone severely depressed the function of all cardiodynamic parameters of the heart compared with Amiodarone or Control while Amiodarone intensified the function of the isolated rat heart with hypertension compared to Control (dp/dt max mmHg/s at coronary perfusion pressure 120cmH2O Dronedarone vs. Amiodarone vs. Control 579.733 ± 202.27 vs. 3063.65 ± 467.93 vs. 2682.88 ± 368.75; p < 0.001. dp/dt min mmHg/s 120cmH2O -352.13 ± 204.65 vs. 1960 ± 242.21 vs. -1858.83 ± 118.23; p < 0.001. SLVP mmHg at CPP 120cmH20 27.8 ± 3.46 vs. 98.95 ± 11.78 vs. 71.45 ± 7.56; p < 0.001. DLVP mmHg at CPP 120cmH2O 6.32 ± 0.49 vs. 4.83 ± 0.54 vs. 0.85 ± 0.35; p < 0.001). Acute administration of Dronedarone decreased the level of NO2- and increased the level of H2O2 , while Amiodarone heightens O2- levels (O2- nmol/min g wt at coronary perfusion pressure 120cmH2O Dronedarone vs. Amiodarone vs. Control 28.62 ± 2.54 vs. 77.3 ± 8.86 vs. 31.72 ± 4.56; p < 0.001. H2O2 nmol/min g wt at CPP 120cmH2O 92.56 ± 11.65 vs. 48.63 ± 10.11 vs. 42.84 ± 84; p < 0.001. NO2- nmol/min g wt at CPP 120cmH2O 38.61 ± 4.94 vs. 82.28 ± 5.76 vs. 64.71 ± 3.51; p < 0.001). Pathohistological, structural changes were observed in both, experimental groups.
Conclusions
Acute administration of Dronedarone depresses cardiac function in isolated, working rat heart with hypertension, with decreasing the NO2- levels, increasing the level of H2O2 and enhanced structural changes when compared to Amiodarone.
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Affiliation(s)
- S Simovic
- University of Kragujevac Faculty of Medicine, Department of Internal Medicine, Kragujevac, Serbia
| | - J Jeremic
- University of Kragujevac Faculty of Medicine, Department of Pharmacy, Kragujevac, Serbia
| | - G Davidovic
- University of Kragujevac Faculty of Medicine, Department of Internal Medicine, Kragujevac, Serbia
| | - I Srejovic
- University of Kragujevac Faculty of Medicine, Department of Physiology, Kragujevac, Serbia
| | - S Mitrovic
- University of Kragujevac Faculty of Medicine, Department of Pathology, Kragujevac, Serbia
| | - V Zivkovic
- University of Kragujevac Faculty of Medicine, Department of Physiology, Kragujevac, Serbia
| | - M Ravic
- University of Kragujevac Faculty of Medicine, Department of Pharmacy, Kragujevac, Serbia
| | - V Miloradovic
- University of Kragujevac Faculty of Medicine, Department of Internal Medicine, Kragujevac, Serbia
| | - M Nikolic
- Clinical Center Kragujevac, Clinic of Cardiology, Kragujevac, Serbia
| | - R Vucic
- University of Kragujevac Faculty of Medicine, Department of Internal Medicine, Kragujevac, Serbia
| | - M Andjic
- University of Kragujevac Faculty of Medicine, Department of Pharmacy, Kragujevac, Serbia
| | - M Rankovic
- University of Kragujevac Faculty of Medicine, Department of Pharmacy, Kragujevac, Serbia
| | - N Draginic
- University of Kragujevac Faculty of Medicine, Department of Pharmacy, Kragujevac, Serbia
| | - V Jakovljevic
- University of Kragujevac Faculty of Medicine, Department of Physiology, Kragujevac, Serbia
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Gossec L, Guyard F, Leroy D, Lafargue T, Seiler M, Jacquemin C, Molto A, Sellam J, Foltz V, Gandjbakhch F, Hudry C, Mitrovic S, Fautrel B, Servy H. Detection of Flares by Decrease in Physical Activity, Collected Using Wearable Activity Trackers in Rheumatoid Arthritis or Axial Spondyloarthritis: An Application of Machine Learning Analyses in Rheumatology. Arthritis Care Res (Hoboken) 2020; 71:1336-1343. [PMID: 30242992 DOI: 10.1002/acr.23768] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/18/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Flares in rheumatoid arthritis (RA) and axial spondyloarthritis (SpA) may influence physical activity. The aim of this study was to assess longitudinally the association between patient-reported flares and activity-tracker-provided steps per minute, using machine learning. METHODS This prospective observational study (ActConnect) included patients with definite RA or axial SpA. For a 3-month time period, physical activity was assessed continuously by number of steps/minute, using a consumer grade activity tracker, and flares were self-assessed weekly. Machine-learning techniques were applied to the data set. After intrapatient normalization of the physical activity data, multiclass Bayesian methods were used to calculate sensitivities, specificities, and predictive values of the machine-generated models of physical activity in order to predict patient-reported flares. RESULTS Overall, 155 patients (1,339 weekly flare assessments and 224,952 hours of physical activity assessments) were analyzed. The mean ± SD age for patients with RA (n = 82) was 48.9 ± 12.6 years and was 41.2 ± 10.3 years for those with axial SpA (n = 73). The mean ± SD disease duration was 10.5 ± 8.8 years for patients with RA and 10.8 ± 9.1 years for those with axial SpA. Fourteen patients with RA (17.1%) and 41 patients with axial SpA (56.2%) were male. Disease was well-controlled (Disease Activity Score in 28 joints mean ± SD 2.2 ± 1.2; Bath Ankylosing Spondylitis Disease Activity Index score mean ± SD 3.1 ± 2.0), but flares were frequent (22.7% of all weekly assessments). The model generated by machine learning performed well against patient-reported flares (mean sensitivity 96% [95% confidence interval (95% CI) 94-97%], mean specificity 97% [95% CI 96-97%], mean positive predictive value 91% [95% CI 88-96%], and negative predictive value 99% [95% CI 98-100%]). Sensitivity analyses were confirmatory. CONCLUSION Although these pilot findings will have to be confirmed, the correct detection of flares by machine-learning processing of activity tracker data provides a framework for future studies of remote-control monitoring of disease activity, with great precision and minimal patient burden.
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Affiliation(s)
- Laure Gossec
- Sorbonne Université and Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | | | | | | | | | | | - Anna Molto
- Cochin Hospital, AP-HP, INSERM U1153, PRES Sorbonne Paris-Cité, Paris Descartes University, Paris, France
| | - Jérémie Sellam
- Sorbonne Université, INSERM UMRS 938, Paris, France, St. Antoine Hospital, AP-HP, DHU i2B, Paris, France
| | - Violaine Foltz
- Sorbonne Université and Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | | | | | - Stéphane Mitrovic
- Sorbonne Université and Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Bruno Fautrel
- Sorbonne Université and Pitié Salpêtrière Hospital, AP-HP, Paris, France
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Mitrovic S, Hertig A, Fautrel B. Reply to the Letter: 'Thrombotic microangiopathy in adult-onset Still's disease: the story is just beginning'. Expert Rev Clin Immunol 2019; 15:1125-1126. [PMID: 31623457 DOI: 10.1080/1744666x.2019.1682893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Stéphane Mitrovic
- Department of Rheumatology, AP-HP, Hôpital de La Pitié Salpêtrière, Sorbonne Université, Paris, France.,Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Alexandre Hertig
- Department of Renal Transplantation, AP-HP, Hôpital de La Pitié Salpêtrière, Sorbonne Université, Paris, France
| | - Bruno Fautrel
- Department of Rheumatology, AP-HP, Hôpital de La Pitié Salpêtrière, Sorbonne Université, Paris, France.,Faculté de Médecine et Institut Pierre Louis d'Epidémiologie et Santé publique, Sorbonne Université, Paris, France.,CRI-IMIDIATE, a FCRIN Clinical Research Network, France
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Abstract
Adult-onset Still’s disease (AoSD) is a rare but clinically well-known, polygenic, systemic autoinflammatory disease. Owing to its sporadic appearance in all adult age groups with potentially severe inflammatory onset accompanied by a broad spectrum of disease manifestation and complications, AoSD is an unsolved challenge for clinicians with limited therapeutic options. This Review provides a comprehensive insight into the complex and heterogeneous nature of AoSD, describing biomarkers of the disease and its progression and the cytokine signalling pathways that contribute to disease. The efficacy and safety of biologic therapeutic options are also discussed, and guidance for treatment decisions is provided. Improving the approach to AoSD in the future will require much closer cooperation between paediatric and adult rheumatologists to establish common diagnostic strategies, treatment targets and goals. Adult-onset Still’s disease (AoSD) is not easily diagnosed, and treatment options are limited. This Review provides an overview of the disease and its pathogenesis, clinical trial results, therapeutic options and a plan to diagnose and clinically manage these patients. Similar to systemic-onset juvenile idiopathic arthritis, adult-onset Still’s disease (AoSD) is a rare systemic autoinflammatory disease with potentially severe inflammatory onset accompanied by a broad spectrum of disease manifestation and complications. AoSD should be considered in patients with persistent fever, and the diagnosis is based on the combination of clinical and laboratory findings as well as the exclusion of other inflammatory conditions. Central to the pathogenesis of AoSD is the intense activation of innate immune cells and overproduction of several pro-inflammatory cytokines including IL-1, IL-6 and IL-18. Two IL-1 antagonists have been approved for treatment of AoSD, and growing evidence suggests that other biologic agents are therapeutic options, such as anti-IL-6 and anti-IL-18 therapeutics. As a reliable prediction of response and outcome is not possible, therapeutic decisions have to be made on the basis of clinical, biological or imaging characteristics of disease. A close cooperation between paediatric and adult rheumatologists is required to establish common diagnostic strategies, treatment targets and goals.
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Affiliation(s)
- Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité- Universitätsmedizin, Berlin, Germany.
| | - Stéphane Mitrovic
- Department of Rheumatology, AP-HP, Pitié-Salpêtrière Hospital, AP-HP, Paris, France. .,Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France.
| | - Bruno Fautrel
- Department of Rheumatology, AP-HP, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.,Sorbonne Université, GRC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
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Bonnet I, Bozzi B, Fourniols E, Mitrovic S, Soulier-Escrihuela O, Brossier F, Sougakoff W, Robert J, Jauréguiberry S, Aubry A. Erwinia billingiae as Unusual Cause of Septic Arthritis, France, 2017. Emerg Infect Dis 2019; 25:1587-1589. [PMID: 31310207 PMCID: PMC6649348 DOI: 10.3201/eid2508.181073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In 2017 in France, we treated a patient with knee septic arthritis caused by Erwinia billingiae after trauma involving a palm tree. This rare pathogen could only be identified through 16S rRNA gene sequencing. For bacterial infections after injuries with plants, 16S rRNA gene sequencing might be required for species identification.
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MESH Headings
- Aged
- Humans
- Male
- Anti-Bacterial Agents/therapeutic use
- Arthritis, Infectious/diagnosis
- Arthritis, Infectious/drug therapy
- Arthritis, Infectious/microbiology
- Enterobacteriaceae Infections/diagnosis
- Enterobacteriaceae Infections/epidemiology
- Enterobacteriaceae Infections/microbiology
- Erwinia/classification
- Erwinia/genetics
- Erwinia/isolation & purification
- France
- RNA, Ribosomal, 16S/genetics
- RNA, Ribosomal, 16S/isolation & purification
- Sequence Analysis, DNA
- Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
- Treatment Outcome
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17
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Zhao C, Pan T, Dou T, Liu J, Liu C, Ge Y, Zhang Y, Yu X, Mitrovic S, Lim R. Making global river ecosystem health assessments objective, quantitative and comparable. Sci Total Environ 2019; 667:500-510. [PMID: 30833248 DOI: 10.1016/j.scitotenv.2019.02.379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 06/09/2023]
Abstract
Assessing and comparing global river ecosystem health in an objective and quantitative way remains a major challenge. In this study the widely-used semi-quantitative methods Rapid Biological assessment Protocols (RBPs) was used to determine the health of rivers. The findings were then compared to the results derived from our new UAV (Unmanned aerial vehicles) orthophotographic imagery method. This method quantitatively and objectively assesses river ecosystem health. As a comparison, our method was used to quantitatively measure distance and areas of a range of hydrological and biological attributes thus improving the accuracy of distance- and area-related indices, consequently avoiding subjective errors in these estimations that is fraught in methods like the RBPs. To strengthen the objectivity of the assessment the weights of these indices were objectively determined using the entropy weighting method. This new method was then tested using 9551 UAV orthophotographs taken over six field campaigns. It performed satisfactorily, showing that in our study area the health status of mountain rivers was the best with the highest score of 0.94 out of 1.0. Temporally, the health of the river was better in summer (0.65) compared with that in autumn (0.40). Changes in river ecosystem health were driven by variations in biology and water quality. In contrast the outputs of RBPs, especially in relation to distance and area indices, had ~ 20% uncertainty due to visual errors and subjectivity in estimations by observers. The UAV orthophotographic imaging method proposed in this study can improve the ability to compare the health of rivers across different periods and regions throughout the globe.
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Affiliation(s)
- C Zhao
- College of Water Sciences, Beijing Normal University, Beijing Key Laboratory of Urban Hydrological Cycle and Sponge City Technology, Beijing 100875, PR China; ICube, UdS, CNRS (UMR 7357), 300 Bld Sebastien Brant, CS 10413, 67412 Illkirch, France
| | - T Pan
- School of Geography, Beijing Normal University, Beijing 100875, PR China
| | - T Dou
- Jinan Survey Bureau of Hydrology and Water Resources, Jinan 250013, PR China
| | - J Liu
- School of Environmental Science and Engineering, Southern University of Science and Technology, Shenzhen, 518055, PR China
| | - C Liu
- College of Water Sciences, Beijing Normal University, Beijing Key Laboratory of Urban Hydrological Cycle and Sponge City Technology, Beijing 100875, PR China.
| | - Y Ge
- Jinan Survey Bureau of Hydrology and Water Resources, Jinan 250013, PR China
| | - Y Zhang
- School of Geography, Beijing Normal University, Beijing 100875, PR China
| | - X Yu
- School of Geography, Beijing Normal University, Beijing 100875, PR China
| | - S Mitrovic
- School of Life Sciences, Faculty of Science, University of Technology, Sydney, NSW 2007, Australia
| | - R Lim
- School of the Environment, Faculty of Science, University of Technology, Sydney, NSW 2007, Australia
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18
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Spasic M, Ninkovic S, Nedovic J, Mitrovic S, Markovic I, Milosevic B, Inic Z, Goran M, Kocic M, Radovanovic D. A borderline phyllodes breast tumor clinicaly presented as giant exulcerated suspicious malignant tumor. Breast 2019. [DOI: 10.1016/s0960-9776(19)30420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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19
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Mitrovic S, Gouze H, Schaeverbeke T, Gossec L, Fautrel B. Reply to the comment of Alkan Melikoglu ‘Joint manifestations can provide diagnostic clues in Morquio syndrome, a case report’. Joint Bone Spine 2019; 86:123-124. [DOI: 10.1016/j.jbspin.2018.06.016] [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: 06/06/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
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20
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Hilliquin S, Hugues B, Mitrovic S, Gossec L, Fautrel B. Ability of disease-modifying antirheumatic drugs to prevent or delay rheumatoid arthritis onset: a systematic literature review and meta-analysis. Ann Rheum Dis 2018; 77:1099-1106. [PMID: 29884751 DOI: 10.1136/annrheumdis-2017-212612] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Recent advances in knowledge of the pathogenesis of rheumatoid arthritis (RA) has led to promoting very early intervention. OBJECTIVES To assess the efficacy of therapeutic interventions in preventing or delaying RA onset with a systematic literature review (SLR) and meta-analysis (MA). METHODS The SLR aimed to include all reports of randomised controlled trials of disease-modifying antirheumatic drugs or glucocorticoids used in patients presenting genetic and/or environmental risk factors for RA and/or systemic autoimmunity associated with RA, and/or symptoms without clinical arthritis and/or unclassified arthritis and in patients with RA. We searched PubMed, EMBASE and Cochrane databases for English articles published from 2006 to 2016 using the keywords 'undifferentiated arthritis' or 'very early rheumatoid arthritis' with 'therapy' or 'treatment'. Main outcome was RA occurrence, defined as fulfilment of the 1987 ACR criteria. The MA was performed with RevMan with the Mantel-Haenszel method. RESULTS Among 595 abstracts screened, 10 reports of trials were selected. The studies included 1156 patients, with mean symptom duration 16.2±12.6 weeks. The occurrence of RA was available for nine studies, assessing methylprednisolone, methotrexate, a tumour necrosis factor blocker, abatacept or rituximab. In the group arthralgia without arthritis (people at risk of RA), the MA of the two available studies did not show significant reduction in RA occurrence at week 52 or more (pooled OR 0.74, 95% CI 0.37 to 1.49). For people with undifferentiated arthritis, the MA of the seven available studies revealed significant risk reduction with OR 0.73(95% CI 0.56 to 0.97). CONCLUSIONS This MA demonstrates that early therapeutic intervention may significantly reduce the risk of RA onset in this very first phase of the disease.
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Affiliation(s)
- Stéphane Hilliquin
- Rheumatology, UPMC, Institut Pierre Louis d'épidémiologie et Santé publique, GRC 08, Paris, France.,Department of Rhumatologie, AP-HP, GH Pitié Salpêtrière, Paris, France
| | - Benjamin Hugues
- Rheumatology, UPMC, Institut Pierre Louis d'épidémiologie et Santé publique, GRC 08, Paris, France.,Department of Rhumatologie, AP-HP, GH Pitié Salpêtrière, Paris, France
| | - Stéphane Mitrovic
- Rheumatology, UPMC, Institut Pierre Louis d'épidémiologie et Santé publique, GRC 08, Paris, France.,Department of Rhumatologie, AP-HP, GH Pitié Salpêtrière, Paris, France
| | - Laure Gossec
- Rheumatology, UPMC, Institut Pierre Louis d'épidémiologie et Santé publique, GRC 08, Paris, France.,Department of Rhumatologie, AP-HP, GH Pitié Salpêtrière, Paris, France
| | - Bruno Fautrel
- Rheumatology, UPMC, Institut Pierre Louis d'épidémiologie et Santé publique, GRC 08, Paris, France.,Department of Rhumatologie, AP-HP, GH Pitié Salpêtrière, Paris, France
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22
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Abstract
INTRODUCTION Adult-onset Still's disease (AOSD) is a rare systemic auto-inflammatory disorder in which management and treatment have considerably progressed over the past decade. Despite wide use of interleukin (IL)-1 or IL-6 inhibitors, serious complications remain possible. Areas covered: A comprehensive literature search in MEDLINE via Pubmed was performed to review AOSD's severe and sometimes life-threatening complications: reactive hemophagocytic lymphohystiocytosis, coagulation disorders, fulminant hepatitis, cardiac or pulmonary complications and amyloid A amyloidosis. Expert commentary: Early recognition and prompt management is essential to significantly decrease morbi-mortality. The key question is to determine whether the complication is related to the disease itself or related to or favored by (e.g. infection) the ongoing treatment. For all severe AOSD-related complications, high-dose corticosteroids and supportive measures remain the first-line treatment. In case of inadequate response, combination with IL-1 or IL-6 blockers is justified. Cyclosporine A and etoposide remain of interest, especially in case of reactive hemophagocytic lymphohysitocytosis. Plasma exchange may be useful in case of thrombotic microangiopathy. In the near future, new biologic or non-biologic drugs targeting IL-18 or other cytokines or kinases could be of help.
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Affiliation(s)
- Stéphane Mitrovic
- a Department of Rheumatology , Pitié-Salpêtrière Hospital, AP-HP , Paris , France.,b Department of Internal Medicine , Institut Mutualiste Montsouris , Paris , France
| | - Bruno Fautrel
- a Department of Rheumatology , Pitié-Salpêtrière Hospital, AP-HP , Paris , France.,c Sorbonne Université , Faculté de Médecine et Institut Pierre Louis d'Epidémiologie et Santé publique , Paris , France.,d CRI-IMIDIATE, a FCRIN Clinical Research Network network , Paris , France
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23
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Reygaerts T, Mitrovic S, Fautrel B, Gossec L. Effect of biologics on fatigue in psoriatic arthritis: A systematic literature review with meta-analysis. Joint Bone Spine 2018; 85:405-410. [PMID: 29452303 DOI: 10.1016/j.jbspin.2018.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/25/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Fatigue is a significant issue in psoriatic arthritis. The objective was to assess the effect of biological disease modifying antirheumatic drugs and apremilast on fatigue in psoriatic arthritis randomised controlled trials and to compare this effect with the effect in the same trials, on pain, through a systematic literature review and meta-analysis. METHODS A systematic literature review was performed up to January 2017 in PubMed, Embase and Cochrane databases. All randomized controlled trials in psoriatic arthritis of biological disease modifying antirheumatic drugs or apremilast, assessing fatigue (whatever the score used), were included. Data were collected by 2 assessors regarding levels of fatigue and pain at baseline and at the time point closest to 24 weeks after the treatment introduction. Pooled standardized mean differences were calculated using RevMan. RESULTS After screening 295 publications, 7 randomised controlled trials were analysed: they pertained to adalimumab (n=2), certolizumab pegol (n=1), secukinumab (n=2), ustekinumab (n=1) and apremilast (n=1), compared to placebo. The studies included 2341 patients: weighted mean±standard deviation age: 48.6±1.3years, disease duration: 7.7±1.6years, 51.6% were females. Fatigue levels were high at baseline (Functional Assessment of Chronic Illness Therapy score: 28.7±2.4). The pooled standardized mean difference was, for fatigue -0.44 (95% confidence interval: -0.54, -0.35) and for pain, -0.62 (-0.73, -0.52). CONCLUSIONS Biological disease modifying antirheumatic drugs and apremilast had a small effect on fatigue at 24 weeks in psoriatic arthritis randomized controlled trials and a higher effect on pain. These results are important to take into account in shared decision-making.
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Affiliation(s)
- Thomas Reygaerts
- Rheumatology Department, Pitie-Salpétrière Hospital, Sorbonne université, AP-HP, 75013 Paris, France; Université Libre de Bruxelles, Erasme Hospital, Rheumatology and Physical Medicine Department, 1070 Brussels, Belgium; Rheumatology Department, Cantonal Hospital of Fribourg, 1708 Fribourg, Switzerland.
| | - Stéphane Mitrovic
- Rheumatology Department, Pitie-Salpétrière Hospital, Sorbonne université, AP-HP, 75013 Paris, France
| | - Bruno Fautrel
- Rheumatology Department, Pitie-Salpétrière Hospital, Sorbonne université, AP-HP, 75013 Paris, France
| | - Laure Gossec
- Rheumatology Department, Pitie-Salpétrière Hospital, Sorbonne université, AP-HP, 75013 Paris, France
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24
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Jacquemin C, Servy H, Molto A, Sellam J, Foltz V, Gandjbakhch F, Hudry C, Mitrovic S, Fautrel B, Gossec L. Physical Activity Assessment Using an Activity Tracker in Patients with Rheumatoid Arthritis and Axial Spondyloarthritis: Prospective Observational Study. JMIR Mhealth Uhealth 2018; 6:e1. [PMID: 29295810 PMCID: PMC5770578 DOI: 10.2196/mhealth.7948] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/15/2017] [Accepted: 10/30/2017] [Indexed: 01/10/2023] Open
Abstract
Background Physical activity can be tracked using mobile devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) management. The World Health Organization (WHO) recommends at least 150 min per week of moderate to vigorous physical activity (MVPA). Objective The objectives of this study were to assess and compare physical activity and its patterns in patients with RA and axSpA using an activity tracker and to assess the feasibility of mobile devices in this population. Methods This multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a mobile activity tracker, recording the number of steps per minute. The number of patients reaching the WHO recommendations was calculated. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity, and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (ie, adherence), the percentage of wearing time, and by an acceptability questionnaire. Results A total of 157 patients (83 RA and 74 axSpA) were analyzed; 36.3% (57/157) patients were males, and their mean age was 46 (standard deviation [SD] 12) years and mean disease duration was 11 (SD 9) years. RA and axSpA patients had similar physical activity levels of 16 (SD 11) and 15 (SD 12) min per day of MVPA (P=.80), respectively. Only 27.4% (43/157) patients reached the recommendations with a mean MVPA of 106 (SD 77) min per week. The following three trajectories were identified with constant activity: low (54.1% [85/157] of patients), moderate (42.7% [67/157] of patients), and high (3.2% [5/157] of patients) levels of MVPA. A higher body mass index was significantly related to less physical activity (odds ratio 1.12, 95% CI 1.11-1.14). The activity trackers were worn during a mean of 79 (SD 17) days over the 90 days follow-up. Overall, patients considered the use of the tracker very acceptable, with a mean score of 8 out 10. Conclusions Patients with RA and axSpA performed insufficient physical activity with similar levels in both groups, despite the differences between the 2 diseases. Activity trackers allow longitudinal assessment of physical activity in these patients. The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a mobile activity tracker in patients with rheumatic diseases.
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Affiliation(s)
- Charlotte Jacquemin
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | | | - Anna Molto
- Rheumatology B Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM (U1153), Clinical Epidemiology and Biostatistics, Paris-Descartes University, Sorbonne Paris-Cité, Paris, France
| | - Jérémie Sellam
- Rheumatology Department, St-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,DHU i2B, INSERM UMRS_938, UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Violaine Foltz
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Frédérique Gandjbakhch
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Christophe Hudry
- Rheumatology B Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Stéphane Mitrovic
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Bruno Fautrel
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
| | - Laure Gossec
- Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,GRC-UPMC 08 (EEMOIS), UPMC Univ Paris 06, Sorbonne Université, Paris, France
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25
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Contis A, Mitrovic S, Lavie J, Douchet I, Lazaro E, Truchetet ME, Goizet C, Contin-Bordes C, Schaeverbeke T, Blanco P, Rossignol R, Faustin B, Richez C, Duffau P. Neutrophil-derived mitochondrial DNA promotes receptor activator of nuclear factor κB and its ligand signalling in rheumatoid arthritis. Rheumatology (Oxford) 2017; 56:1200-1205. [PMID: 28340056 DOI: 10.1093/rheumatology/kex041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Indexed: 12/31/2022] Open
Abstract
Objectives Mitochondrial DNA (mtDNA) contains sequestered damage-associated molecular patterns that might be involved in osteoimmunological pathogenesis of RA. Here, we aimed to investigate the cellular source of mtDNA and its role in RANK ligand (RANKL) expression by RA SF neutrophils. Methods The gene expression signature of SF neutrophils was examined by proteomic quantitative analysis. Levels of mtDNA in circulating and SF neutrophils from RA patients and OA control subjects were assessed by real-time PCR. Purified neutrophils were challenged in vitro with Toll-like receptor agonists as well as mtDNA. RANKL expression by neutrophils was studied by flow cytometry. Results SF neutrophils from RA patients displayed a gene expression signature of oxidative stress. This stress signature was associated with the release of mtDNA in SF as observed by a significant increase of mtDNA in the SF of RA patients compared with OA patients. mtDNA in RA SF was correlated with systemic inflammation as assessed by CRP concentrations. We also showed that mtDNA drives neutrophil RANKL expression to the same extent as Toll-like receptor agonists. Conclusion Our data identify SF neutrophils as a cellular source of mtDNA that leads to a subsequent expression of RANKL. This highlights the important role of neutrophils in RA osteoimmunology.
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Affiliation(s)
- Anne Contis
- ImmunoConcept, UMR CNRS 5164, Université de Bordeaux.,Service de médecine interne et immunologie clinique
| | - Stéphane Mitrovic
- ImmunoConcept, UMR CNRS 5164, Université de Bordeaux.,Service de rhumatologie, CHU de Bordeaux
| | - Julie Lavie
- INSERM EA4576, laboratoire MRGM, Université de Bordeaux
| | | | - Estibaliz Lazaro
- ImmunoConcept, UMR CNRS 5164, Université de Bordeaux.,Service de médecine interne, CHU de Bordeaux
| | | | - Cyril Goizet
- INSERM U1211, laboratoire MRGM, Université de Bordeaux.,Service de génétique médicale
| | - Cécile Contin-Bordes
- ImmunoConcept, UMR CNRS 5164, Université de Bordeaux.,Laboratoire d'immunologie, CHU de Bordeaux, Bordeaux, France
| | | | - Patrick Blanco
- ImmunoConcept, UMR CNRS 5164, Université de Bordeaux.,Laboratoire d'immunologie, CHU de Bordeaux, Bordeaux, France
| | | | | | - Christophe Richez
- ImmunoConcept, UMR CNRS 5164, Université de Bordeaux.,Service de rhumatologie, CHU de Bordeaux
| | - Pierre Duffau
- ImmunoConcept, UMR CNRS 5164, Université de Bordeaux.,Service de médecine interne et immunologie clinique
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26
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Khoryati L, Augusto JF, Shipley E, Contin-Bordes C, Douchet I, Mitrovic S, Truchetet ME, Lazaro E, Duffau P, Couzi L, Jacquemin C, Barnetche T, Vacher P, Schaeverbeke T, Blanco P, Richez C. IgE Inhibits Toll-like Receptor 7- and Toll-like Receptor 9-Mediated Expression of Interferon-α by Plasmacytoid Dendritic Cells in Patients With Systemic Lupus Erythematosus. Arthritis Rheumatol 2017; 68:2221-31. [PMID: 26991804 DOI: 10.1002/art.39679] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 03/08/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Plasmacytoid dendritic cells (PDCs) play a central role in pathogenesis of systemic lupus erythematosus (SLE) through their unique ability to produce large amounts of type I interferon (IFN) upon Toll-like receptor 7 (TLR-7) and TLR-9 triggering. PDCs express specific surface regulatory receptors involved in negative regulation of IFNα secretion. These receptors use the γ-chain of high-affinity Fc receptor (FcR) for IgE, FcɛRI. We undertook this study to test our hypothesis that IgE engagement of FcɛRI on PDCs may impact IFNα production in SLE patients. METHODS Serum levels of total IgE were measured in healthy volunteers, SLE patients, and patients with IgE-dependent allergic disorders. FcɛRI expression on PDCs from SLE patients was evaluated by flow cytometry. Purified PDCs were incubated with monoclonal IgE for 24 hours, then stimulated for 18 hours with TLR agonists or immune complexes (ICs). IFNα production by PDCs was detected by quantitative real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay. Expression of TLR-7, TLR-9, and IFN regulatory factor 7 (IRF-7) in PDCs was quantified by quantitative real-time PCR. RESULTS We observed significantly higher IgE levels in SLE patients with quiescent disease than in those with active disease. In SLE patients, IgE levels correlated inversely with disease activity. IgE levels were not associated with the presence of antinuclear IgE. Purified PDCs treated for 24 hours with monoclonal IgE up-regulated FcɛRI expression in an IgE dose-dependent manner. IgE-treated PDCs significantly decreased IFNα secretion and down-regulated CCR7 expression upon stimulation with TLR-7 and TLR-9 ligands and ICs from lupus patients. IgE treatment down-regulated expression of TLR-9 and IRF-7. CONCLUSION Our results support the notion that IgE plays a protective role in SLE pathogenesis through the modulation of inflammatory response by PDCs.
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Affiliation(s)
- Liliane Khoryati
- Université de Bordeaux and Immuno ConcEpT, CNRS-UMR 5164, Bordeaux, France
| | | | - Emilie Shipley
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Cécile Contin-Bordes
- Université de Bordeaux, Immuno ConcEpT, CNRS-UMR 5164, and Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | - Stéphane Mitrovic
- Immuno ConcEpT, CNRS-UMR 5164, and Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Marie-Elise Truchetet
- Université de Bordeaux, Immuno ConcEpT, CNRS-UMR 5164, and Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Estibaliz Lazaro
- Université de Bordeaux, Immuno ConcEpT, CNRS-UMR 5164, and Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Pierre Duffau
- Université de Bordeaux, Immuno ConcEpT, CNRS-UMR 5164, and Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Lionel Couzi
- Université de Bordeaux, Immuno ConcEpT, CNRS-UMR 5164, and Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Clément Jacquemin
- Université de Bordeaux and Immuno ConcEpT, CNRS-UMR 5164, Bordeaux, France
| | | | - Pierre Vacher
- Université de Bordeaux and INSERM U916, Institut Bergonié, Bordeaux, France
| | - Thierry Schaeverbeke
- Université de Bordeaux and Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Patrick Blanco
- Université de Bordeaux, Immuno ConcEpT, CNRS-UMR 5164, and Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Christophe Richez
- Université de Bordeaux, Immuno ConcEpT, CNRS-UMR 5164, and Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
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Jacquemin C, Molto A, Servy H, Sellam J, Foltz V, Gandjbakhch F, Hudry C, Mitrovic S, Granger B, Fautrel B, Gossec L. Flares assessed weekly in patients with rheumatoid arthritis or axial spondyloarthritis and relationship with physical activity measured using a connected activity tracker: a 3-month study. RMD Open 2017; 3:e000434. [PMID: 28879046 PMCID: PMC5574460 DOI: 10.1136/rmdopen-2017-000434] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 04/03/2017] [Accepted: 05/16/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The evolution of rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) is marked by flares, although their frequency is unclear. Flares may impact physical activity. Activity can be assessed objectively using activity trackers. The objective was to assess longitudinally the frequency of flares and the association between flares and objective physical activity. METHODS This prospective observational study (ActConnect) included patients with definite clinician-confirmed RA or axSpA, owning a smartphone. During 3 months, physical activity was assessed continuously by number of steps/day, using an activity tracker, and disease flares were self-assessed weekly using a specific flare question and, if relevant, the duration of the flare. The relationship between flares and physical activity for each week (time point) was assessed by linear mixed models. RESULTS In all, 170/178 patients (91 patients with RA and 79 patients with axSpA; 1553 time points) were analysed: mean age was 45.5±12.4 years, mean disease duration was 10.3±8.7 years, 60 (35.3%) were men and 90 (52.9%) received biologics. The disease was well-controlled (mean Disease Activity Score 28: 2.3±1.2; mean Bath Ankylosing Spondylitis Disease Activity Index score: 3.3±2.1). Patients self-reported flares in 28.2%±28.1% of the weekly assessments. Most flares (78.9%±31.4%) lasted ≤3 days. Persistent flares lasting more than 3 days were independently associated with less weekly physical activity (p=0.03), leading to a relative decrease of 12%-21% and an absolute decrease ranging from 836 to 1462 steps/day. CONCLUSION Flares were frequent but usually of short duration in these stable patients with RA and axSpA. Persistent flares were related to a moderate decrease in physical activity, confirming objectively the functional impact of patient-reported flares.
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Affiliation(s)
- Charlotte Jacquemin
- Rheumatology Department, UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Anna Molto
- Rheumatology B Department, Cochin Hospital, AP-HP, Paris, France.,INSERM (U1153), Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, Paris Descartes University, Paris, France
| | | | - Jérémie Sellam
- Rheumatology Department, INSERM UMRS_938, Sorbonnes University, UPMC University Paris 06, St-Antoine Hospital, DHU i2B, Paris, France
| | - Violaine Foltz
- Rheumatology Department, UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Frédérique Gandjbakhch
- Rheumatology Department, UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Christophe Hudry
- Rheumatology B Department, Cochin Hospital, AP-HP, Paris, France
| | - Stéphane Mitrovic
- Rheumatology Department, UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Benjamin Granger
- Biostatistics Department, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Bruno Fautrel
- Rheumatology Department, UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Laure Gossec
- Rheumatology Department, UPMC University Paris 06, GRC-UPMC 08 (EEMOIS), Pitié Salpêtrière Hospital, APHP, Paris, France
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Servy H, Jacquemin C, Molto A, Sellam J, Foltz V, Gandjbakhch F, Hudry C, Mitrovic S, Fautrel B, Gossec L. Utilisabilité d’objets connectés en recherche clinique et épidémiologique : résultats d’une étude multicentrique française sur 177 patients en rhumatologie. Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.04.018] [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: 11/16/2022] Open
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Mitrovic S, Gouze H, Gossec L, Schaeverbeke T, Fautrel B. Mucopolysaccharidoses seen in adults in rheumatology. Joint Bone Spine 2017; 84:663-670. [PMID: 28196778 DOI: 10.1016/j.jbspin.2017.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
Mucopolysaccharidoses are a group of rare lysosomal storage diseases including a great number of polymorph syndromes, each being related to a particular mutation responsible for a deficiency of glycosaminoglycan degrading enzymes, leading to an accumulation of glycosaminoglycans in tissues. Many of them are diagnosed in children or teenagers and have a severe prognosis because of organ failure, and are consequently usually not seen by the adult rheumatologist. However, some of them have a more progressive presentation, with musculoskeletal symptoms at the forefront and a lifespan that nearly reaches that of the general population. These milder forms are more likely to be diagnosed in adults, in patients who have suffered for years and sometimes even decades with unrecognized mucopolysaccharidosis. Indeed, they can sometimes mimic inflammatory rheumatic disorders, and therefore be misdiagnosed for a long time. Recognition and diagnosis of these attenuated forms can be a real challenge as they lead to moderate and/or nonspecific symptoms such as joint pain or stiffness. Hence, rheumatologists should know about them. Early diagnostic is essential since specific treatment, like enzyme replacement therapy, is now available for some subtypes and might, if given early, slow down the development of tissue damage, which is unfortunately irreversible. This article provides the opportunity to review the main clinical and radiographic features, the diagnostic strategy and the update of management, which should be multidisciplinary and led by an experienced physician in a reference centre. The contribution of the rheumatologist is important to ensure symptom control and prevent complications.
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Affiliation(s)
- Stéphane Mitrovic
- UPMC university Paris 06, institut Pierre-Louis d'épidémiologie et de santé publique, GRC-UPMC 08 (EEMOIS), Sorbonne universités, 75005 Paris, France; Department of rheumatology, Pitié-Salpêtrière hospital, AP-HP, 75013 Paris, France.
| | - Hélène Gouze
- UPMC university Paris 06, institut Pierre-Louis d'épidémiologie et de santé publique, GRC-UPMC 08 (EEMOIS), Sorbonne universités, 75005 Paris, France; Department of rheumatology, Pitié-Salpêtrière hospital, AP-HP, 75013 Paris, France
| | - Laure Gossec
- UPMC university Paris 06, institut Pierre-Louis d'épidémiologie et de santé publique, GRC-UPMC 08 (EEMOIS), Sorbonne universités, 75005 Paris, France; Department of rheumatology, Pitié-Salpêtrière hospital, AP-HP, 75013 Paris, France
| | - Thierry Schaeverbeke
- Department of rheumatology, Pellegrin hospital, Bordeaux university hospital, 33076 Bordeaux, France
| | - Bruno Fautrel
- UPMC university Paris 06, institut Pierre-Louis d'épidémiologie et de santé publique, GRC-UPMC 08 (EEMOIS), Sorbonne universités, 75005 Paris, France; Department of rheumatology, Pitié-Salpêtrière hospital, AP-HP, 75013 Paris, France
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Ravic-Nikolic A, Djurdjevic P, Mitrovic S, Milicic V, Petrovic D. Atrophoderma of Pasini and Pierini associated with extramedullary plasmacytoma. Clin Exp Dermatol 2016; 41:837-9. [PMID: 27443586 DOI: 10.1111/ced.12906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A Ravic-Nikolic
- Department of Dermatology, Faculty of Medical Science, University of Kragujevac, Kragujevac, Serbia.
| | - P Djurdjevic
- Department of Haematology, Faculty of Medical Science, University of Kragujevac, Kragujevac, Serbia
| | - S Mitrovic
- Department of Pathology, Faculty of Medical Science, University of Kragujevac, Kragujevac, Serbia
| | - V Milicic
- Department of Dermatology, Faculty of Medical Science, University of Kragujevac, Kragujevac, Serbia
| | - D Petrovic
- Department of Internal Medicine, Faculty of Medical Science, University of Kragujevac, Kragujevac, Serbia
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Mitrovic S, Contis A, Faustin B, Rossignol R, Goizet C, Truchetet ME, Lazaro E, Contin-Bordes C, Duffau P, Richez C. THU0049 Involvement of Mitochondrial DNA in Rheumatoid Arthritis Pathogenesis Through Up-Regulation of RANK-L Expression by Neutrophils. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5208] [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: 11/03/2022]
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Gaujoux-Viala C, Mitrovic S, Barnetche T, Schaeverbeke T, Gossec L. THU0116 Efficacy of Glucocorticoids for Early Rheumatoid Arthritis (RA): A Meta-Analysis of Randomised Controlled Trials:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mitrovic S, Fardet L, Vatier C, Barnetche T, Schaeverbeke T, Gaujoux-Viala C. THU0142 Safety of Glucocorticoids for Early Rheumatoid Arthritis: A Meta-Analysis of Randomised Controlled Trials:. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Nedovic J, Protrka Z, Ninkovic S, Mitrovic S, Vojinovic R, Glisic J, Markovic-Filipovic B, Milosevic B, Peulic M, Cvetkovic A. Cisplatin monotherapy with concurrent radiotherapy versus combination of cisplatin and 5-fluorouracil chemotherapy with concurrent radiotherapy in patients with locoregionally advanced cervical carcinoma. J BUON 2012; 17:740-745. [PMID: 23335535] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To compare the efficacy, toxicity and survival of cisplatin monotherapy with concurrent radiotherapy ver-sus combination of cisplatin and 5-fluorouracil (5-FU) with concurrent external beam radiotherapy (EBRT) in patients with locoregionally advanced cervical carcinoma FIGO stages IIB-IV. METHODS 134 patients with locoregionally advanced, histologically confirmed carcinoma of the uterine cervix were analysed. The first group of patients (n=70; 52.24%) started concomitant chemotherapy on the second day of radiotherapy with single-agent cisplatin 40 mg/m(2) given 2 h before radiotherapy, once a week for 6 courses. The second group of patients (n=64; 47.76%) started concomitant chemotherapy on the second day of radiotherapy with cisplatin 75 mg/m(2). Treatment was continued with 96-h infusion of 5-FU 4 g/m(2) (1 g/ m(2) per day for 5 consecutive days). The patients were irradiated by EBRT followed by intracavitary brachytherapy (ICB). RESULTS 24- and 42-month survival in the first group were 71.9 and 57.81% and 52.5 and 35.4% in the second group, respectively (p=0.012). Mean time to progression in the first group was 24 months and in second group it was 15.9 months (p=0.012). After 2 years progression was noted in 38.3% of the first and in 62.9% of second group patients (p=0.003). After 40 months 60 patients were without relapse, 35 (57.81%) patients in the first group and 25 (37.147percnt;) patients in the second group (p=0.018). CONCLUSION Treatment with combined cisplatin and 5-FU with concurrent EBRT was more efficient in comparison to cisplatin monotherapy with concurrent radiotherapy in patients with locoregionally advanced cervical carcinoma, in terms of 12- and 24-month overall survival and disease relapse after 2 years.
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Affiliation(s)
- J Nedovic
- Clinical Center Kragujevac, Department of Oncology, Kragujevac, Serbia
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Woolcott JC, Khan KM, Mitrovic S, Anis AH, Marra CA. The cost of fall related presentations to the ED: a prospective, in-person, patient-tracking analysis of health resource utilization. Osteoporos Int 2012; 23:1513-9. [PMID: 21892675 DOI: 10.1007/s00198-011-1764-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 06/28/2011] [Indexed: 12/19/2022]
Abstract
UNLABELLED We prospectively collected data on elderly fallers to estimate the total cost of a fall requiring an Emergency Department presentation. Using data collected on 102 falls, we found the average cost per fall causing an Emergency Department presentation of $11,408. When hospitalization was required, the average cost per fall was $29,363. INTRODUCTION For elderly persons, falls are a major source of mortality, morbidity, and disability. Previous Canadian cost estimates of seniors' falls were based upon administrative data that has been shown to underestimate the incidence of falls. Our objective was to use a labor-intensive, direct observation patient-tracking method to accurately estimate the total cost of falls among seniors who presented to a major urban Emergency Department (ED) in Canada. METHODS We prospectively collected data from seniors (>70 years) presenting to the Vancouver General Hospital ED after a fall. We excluded individuals who where cognitively impaired or unable to read/write English. Data were collected on the care provided including physician assessments/consultations, radiology and laboratory tests, ED/hospital time, rehabilitation facility time, and in-hospital procedures. Unit costs of health resources were taken from a fully allocated hospital cost model. RESULTS Data were collected on 101 fall-related ED presentations. The most common diagnoses were fractures (n = 33) and lacerations (n = 11). The mean cost of a fall causing ED presentation was $11,408 (SD: $19,655). Thirty-eight fallers had injuries requiring hospital admission with an average total cost of $29,363 (SD: $22,661). Hip fractures cost $39,507 (SD: $17,932). Among the 62 individuals not admitted to the hospital, the average cost of their ED visit was $674 (SD: $429). CONCLUSIONS Among the growing population of Canadian seniors, falls have substantial costs. With the cost of a fall-related hospitalization approaching $30,000, there is an increased need for fall prevention programs.
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Affiliation(s)
- J C Woolcott
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
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Trsan M, Mitrovic S, Puncuh A. The development of hospital manufactured ready to use heparin solution to flush catheters. Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2012-000074.145] [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: 11/04/2022] Open
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Protrka Z, Arsenijevic S, Dimitrijevic A, Mitrovic S, Stankovic V, Milosavljevic M, Kastratovic T, Djuric J. Co-overexpression of bcl-2 and c-myc in uterine cervix carcinomas and premalignant lesions. Eur J Histochem 2011; 55:e8. [PMID: 21556123 PMCID: PMC3167343 DOI: 10.4081/ejh.2011.e8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 02/08/2011] [Accepted: 02/16/2011] [Indexed: 02/06/2023] Open
Abstract
To establish the role of co-overexpression of bcl-2 and c-myc protooncogenes in uterine cervix carcinogenesis, we examined 138 tissue samples of low grade cervical squamous intraepithelial lesions (SIL), high grade SIL, portio vaginalis uteri (PVU) carcinoma in situ and PVU invasive carcinoma, stage IA-IIA (study group) and 36 samples without SIL or malignancy (control group). The expression of bcl-2 and c-myc was detected immunohistochemically using a monoclonal antibody. Fisher's exact test (P<0.05) was used to assess statistical significance. Overexpression of bcl-2 was found to increase in direct relation to the grade of the cervical lesions. High sensitivity was of great diagnostic significance for the detection of these types of changes in the uterine cervix. On the basis of high predictive values it can be said that in patients with bcl-2 overexpression there is a great possibility that they have premalignant or malignant changes in the uterine cervix. Co-overexpression of bcl-2 and c-myc oncogenes was found only in patients with PVU invasive carcinoma (6/26-23.0%). Statistically significant difference was not found in the frequency of co-overexpression in patients with PVU invasive carcinoma in relation to the control group (Fisher's test; P=0.064). The method's sensitivity of determining these oncogenes with the aim of detecting PVU invasive carcinoma was 23%, while specificity was 72.2%. On the basis of high predictive values (100%), speaking in statistical terms, it can be concluded that all patients with co-overexpression of bcl-2 and c-myc oncogenes will have PVU invasive carcinoma. We confirmed in our research that co-overexpression of bcl-2 and c-myc oncogenes was increased only in PVU invasive carcinoma. However, a more extensive series of samples and additional tests are required to establish the prognostic significance of bcl-2 and c-myc co-overexpression in cervical carcinogenesis.
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Affiliation(s)
- Z Protrka
- Department of Obstetrics andGynecology, University of Kragujevac, Serbia.
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Dordevic M, Jovanovic B, Mitrovic S, Dordevic G, Radovanovic D, Sazdanovic P. Abdominal rectus muscle endometriosis after Cesarean section. Extrapelvic localization of endometriosis. BRATISL MED J 2010; 111:345-348. [PMID: 20635680] [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: 05/29/2023]
Abstract
INTRODUCTION Endometriosis is defined by the presence of functional endometrial tissue outside the uterus, where it is normally located. Endometriosis could has intra and extra pelvic localization. Abdominal endometriosis is the most common localization of extrapelvic endometriosis and is usually developed in the connective tissue surrounding the operation. Very rarely this could be found in the muscle tissue. The mechanical transplantation theory is responsible for the development of scar endometriosis. CASE REPORT The patient, 35 years old, three years after caesarian section had an operation because of the assumption for the presence of front abdominal hernia, located at the place of previous section. The egg-sized tumor was removed from the abdominal rectus muscle and sent for PH and immunohistochemical analyses. The results showed endometriosis of the muscle with positive estrogen and progesterone receptors. One year after the operation, due to the repeated pains in the scar area, the treatment continued by GNRH analogues and control was performed by serial ultrasound and biochemical markers CA 125. CONCLUSION Clinical diagnoses of scar endometriosis could be provided by an accurate anamnesis and physical, ultrasound and biochemical examinations. Scar endometriosis should always be considered when the symptoms are present in cyclic manner, hormone depending, mostly after gynecological operations and worsening during menstruation. The problem was diagnosed by pathohistological analyses (Fig. 4, Ref. 20).
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Affiliation(s)
- M Dordevic
- Obstetric/Gynecologic Clinic, Clinical Centre Kragujevac, Serbia.
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Tsukahara M, Mitrovic S, Gajdosik V, Margaritondo G, Pournin L, Ramaioli M, Sage D, Hwu Y, Unser M, Liebling TM. Coupled tomography and distinct-element-method approach to exploring the granular media microstructure in a jamming hourglass. Phys Rev E Stat Nonlin Soft Matter Phys 2008; 77:061306. [PMID: 18643256 DOI: 10.1103/physreve.77.061306] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 03/18/2008] [Indexed: 05/26/2023]
Abstract
We describe an approach for exploring microscopic properties of granular media that couples x-ray microtomography and distinct-element-method (DEM) simulations through image analysis. We illustrate it via the study of the intriguing phenomenon of instant arching in an hourglass (in our case a cylinder filled with a polydisperse mixture of glass beads that has a small circular shutter in the bottom). X-ray tomography provides three-dimensional snapshots of the microscopic conditions of the system both prior to opening the shutter, and thereafter, once jamming is completed. The process time in between is bridged using DEM simulation, which settles to positions in remarkably good agreement with the x-ray images. Specifically designed image analysis procedures accurately extract the geometrical information, i.e., the positions and sizes of the beads, from the raw x-ray tomographs, and compress the data representation from initially 5 gigabytes to a few tens of kilobytes per tomograph. The scope of the approach is explored through a sensitivity analysis to input data perturbations in both bead sizes and positions. We establish that accuracy of size--much more than position--estimates is critical, thus explaining the difficulty in considering a mixture of beads of different sizes. We further point to limits in the replication ability of granular flows away from equilibrium; i.e., the difficulty of numerically reproducing chaotic motion.
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Affiliation(s)
- M Tsukahara
- Mathematics Institute, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Abrecht M, Ariosa D, Cloetta D, Mitrovic S, Onellion M, Xi XX, Margaritondo G, Pavuna D. Strain and high temperature superconductivity: unexpected results from direct electronic structure measurements in thin films. Phys Rev Lett 2003; 91:057002. [PMID: 12906624 DOI: 10.1103/physrevlett.91.057002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2002] [Indexed: 05/24/2023]
Abstract
Angle-resolved photoemission spectroscopy reveals very surprising strain-induced effects on the electronic band dispersion of epitaxial La(2-x)Sr(x)CuO(4-delta) thin films. In strained films we measure a band that crosses the Fermi level (E(F)) well before the Brillouin zone boundary. This is in contrast to the flat band reported in unstrained single crystals and in our unstrained films, as well as in contrast to the band flattening predicted by band structure calculations for in-plane compressive strain. In spite of the density of states reduction near E(F), the critical temperature increases in strained films with respect to unstrained samples. These results require a radical departure from commonly accepted notions about strain effects on high temperature superconductors, with possible general repercussions on superconductivity theory.
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Affiliation(s)
- M Abrecht
- IPMC, Faculty of Basic Sciences, Ecole Polytechnique Federale de Lausanne, EPFL CH-1015 Lausanne, Switzerland
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Perfetti L, Georges A, Florens S, Biermann S, Mitrovic S, Berger H, Tomm Y, Höchst H, Grioni M. Spectroscopic signatures of a bandwidth-controlled Mott transition at the surface of 1T-TaSe2. Phys Rev Lett 2003; 90:166401. [PMID: 12731984 DOI: 10.1103/physrevlett.90.166401] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2002] [Indexed: 05/24/2023]
Abstract
High-resolution angle-resolved photoemission data show that a metal-insulator Mott transition occurs at the surface of the quasi-two-dimensional compound 1T-TaSe2. The transition is driven by the narrowing of the Ta 5d band induced by a temperature-dependent modulation of the atomic positions. A dynamical mean-field theory calculation of the spectral function of the half-filled Hubbard model captures the main qualitative feature of the data, namely, the rapid transfer of spectral weight from the observed quasiparticle peak at the Fermi surface to the Hubbard bands, as the correlation gap opens up.
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Affiliation(s)
- L Perfetti
- Institut de Physique des Nanostructures, Ecole Polytechnique Fédérale (EPFL), CH-1015 Lausanne, Switzerland
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Abstract
Conduction velocity (CV), relative twitch force (RTF) and contraction time (CT) of single muscle fibers (SF) and small muscle fiber bundles (FB) were measured at different states of isotonic contraction with double impulse stimuli at varying interstimulus intervals (ISI) from 0 to 1000 ms in the biceps brachii muscle in vivo. During an isotonic contraction, muscle fibers conducted the action potential on average 0.18 m/s faster along the muscle fiber membrane than did relaxed muscle fibers. This difference was statistically significant (P < 0.001). There was a significant positive correlation between the degree of isotonic contraction and fiber bundle conduction velocity (FBCV) with a first peak at the maximum RTF at an ISI of 9 ms and a second peak at the maximum CT at an ISI of 100 ms.
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Affiliation(s)
- S Mitrovic
- Neurologische Universitätsklinik, Langenbeckstrasse 1, 55131 Mainz, Germany
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Arsic V, Mitrovic S, Kranjčić-Zec I, Dzamić A, Jovanovi V, Milobratović D. Epidemiology of infection with toxoplasma gondii at fertile women. Parasitol Int 1998. [DOI: 10.1016/s1383-5769(98)80429-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
We describe a patient with isolated voluntary facial paresis due to a unilateral lacunar lesion in the contralateral mediodorsal middle base of the pons. Transcranial magnetic stimulation confirmed the involvement of supranuclear corticofacial tract fibers and sparing of the corticolingual and corticospinal connections. This observation demonstrates that the fibers conveying voluntary orofacial activation descend mediodorsally at the level of the middle pons and that the fibers conveying emotional activation may be assumed to converge below this level.
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Affiliation(s)
- P P Urban
- Department of Neurology, University of Mainz, Germany
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Zagar I, Han R, Mitrovic S. Meta-[131I]iodobenzylguanidine in the scintigraphic evaluation of neural crest tumors. Q J Nucl Med 1995; 39:13-6. [PMID: 9002742] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Since February 1990, 74 patients (116 studies) underwent scintigraphy with meta-[131I]iodobenzylguanidine ([131I]MIBG). Eighteen patients had pheochromocytomas, 2 paragangliomas, 2 malignant insulinomas, 1 carcinoid, 2 medullary thyroid carcinoma and 49 children had neuroblastomas. Scintigraphy was performed following a thyroid blockade, at 24 and 48 hours after i.v. injection of 0.5 mCi/1.7 m2 [131I]MIBG. Grade of heart intensity (GHI) uptake and the intensity of salivary gland visualization (SGI) were estimated semiquantitatively, according to the method of Nakajo et al. Sensitivity in the primary pheochromocytomas was 93.9%; sensitivity and specificity in the primary neuroblastomas were 93.7% and 100% respectively; in the secondary neuroblastomas they were 100%, and 100%. Metastases in 2 malignant insulinomas and in 1 case of medullary thyroid carcinoma were also demonstrated. Only one false negative (in pheochromocytoma) and one false positive (Conn's syndrome) result was obtained. Mean values and range of MIBG uptake measured according to Shulkin's procedure were: for pheochromocytoma 3.95% (0.1-15), primary neuroblastoma 0.7% (0.05-1.92%), and neuroblastoma metastases 0.12% (0.002-0.83%). Assessment of [131I]MIBG uptake seems to be helpful in the follow-up of some neural crest tumors and is essential as a prelude to [131I]MIBG therapy.
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Affiliation(s)
- I Zagar
- Institute of Nuclear Medicine, University Clinical Centre, Belgrade, Jugoslavia
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Arsic V, Mitrovic S, Kranjcic-Zec I, Dzamic A. Isolates of Cryptococcus neoformans serotype A or D from cerebrospinal fluid resistant to 5-fluorocytosine. J Chemother 1995; 7 Suppl 4:90-2. [PMID: 8904119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- V Arsic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Yugoslavia
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Mitrovic S, Kranjcic-Zec I, Arsic V, Dzamic A. Candida adherence to human epithelial cells with regard to its pathogenicity. J Chemother 1995; 7 Suppl 4:18-20. [PMID: 8904092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- S Mitrovic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Yugoslavia
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Mitrovic S, Kranjcic-Zec I, Arsic V, Dzamic A. In vitro proteinase and phospholipase activity and pathogenicity of Candida species. J Chemother 1995; 7 Suppl 4:43-5. [PMID: 8904102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- S Mitrovic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Yugoslavia
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Calleary J, Tansey C, McCormack J, Kapur S, Doyle J, Flynn J, Curran AJ, Smyth D, Kane B, Toner M, Timon CVI, Cronin KJ, O’Donoghue J, Darmanin FX, McCann J, Campbell F, Redmond HP, Condron C, Bouchier-Hayes D, Aizaz K, MacGowan SW, O’Donnell AF, Luke DA, McGovern E, Morrin M, Khan F, Delaney PV, Lavelle SM, Kanagaratnam B, Cuervas-Mons V, Gauthier A, Gips C, Santos RMD, Molino GP, Theodossi A, Tsiftsis DD, Boyle CJO, Boyle TJ, Kerin MJ, Courtney DM, Quill DS, Given HF, O’Brien DF, Kelly EJ, Kelly J, Richardson D, Fanning NF, Brennan R, Horgan PG, Keane FBV, Reid S, Walsh C, Patock R, Hall J, Evoy D, Magd-Eldin M, Curran D, Keeling P, Ade-Ajayi N, Spitz L, Kiely E, Drake D, Klein N, O’Hanlon DM, Karat D, Callanan K, Crisp W, Griffin SM, Murchan PM, Mancey-Jones B, Sedman P, Mitchell CJ, Macfie J, Scott D, Raimes S, O’Boyle CJ, Maher D, Willsher PC, Robertson JFR, Hilaly M, Blarney RW, Shering SG, Mitrovic S, Rahim A, McDermott EW, O’Higgins NJ, Murphy CA, Morgan D, Elston CW, Ellis IO, O’Sullivan MP, O’Riordain MG, Stack JP, Barry MK, Ennis JT, Fitzpatrick JM, Gorey TF, Kollis J, Mullet H, Smith DF, Zbar A, Murray MJ, McDermott EWM, Smyth PPA, Kapucouglu N, Holmes S, Holland P, McCollum PT, da Silva A, de Cossart L, Hamilton D, Kelly CJ, Stokes K, Broe P, Crinnion J, Grace PA, Morton N, Ross N, Naidu S, Gervaz P, Holdsworth RJ, Stonebridge PA, O’Donnell A, Carson K, Phelan D, McBrinn S, McCarthy D, Javadpour H, McCarthy J, Neligan M, Caldwell MTP, McGrath JP, Byrne PJ, Walsh TN, Lawlor P, Timon C, Stuart RC, Murray K, Carney A, Johnston JG, Egan B, O’Connell PR, Donoghue J, Pollock A, Hyde D, Hourihan D, Tanner WA, Donohue J, Fanning N, Horgan P, Mahmood A, Dave K, Stewart J, Cole A, Hartley R, Brennan TG, O’Donoghue JM, O’Sullivan ST, Beausang E, Panchal J, O’Shaughnessy M, O’Grady P, Watson RWG, Johnstone D, O’Donnell J, McCarthy E, Flynn N, O’Dwyer T, Curran C, Duggan S, Tierney S, Qian Z, Lipsett PA, Pitt HA, Lillemoe KD, Kollias J, Morgan DAL, Young IS, Regan MC, Geraghty JG, Suilleabhain CBO, Rodrick ML, Horgan AF, Mannick JA, Lederer JA, Hennessy TPJ, Canney M, Feeley K, Connolly CE, Abdih H, Finnegan N, Da Costa M, Shafii M, Martin AJ, Mulcahy D, Dolan M, Stephens M, McManus F, Walsh M, O’Brien DP, Phillips JP, Carroll TA, O’Brien D, Rawluk D, Sullivan T, Herbert K, Kerins M, O’Donnell M, Lawlor D, McHugh M, Edwards G, Rice J, McCabe JP, Sparkes J, Hayes S, Corcoran M, Bredin H, O’Keeffe D, Candon J, Mulligan ED, Lynch TH, Mulvin D, Vingers L, Smith JM, Corby H, Barry K, Eardley I, Frick J, Goldwasser B, Wiklund P, Rogers E, Weaver R, Scardino PT, Kumar R, Puri P, Adeyoju AB, Lynch T, Corr J, McDermott TED, Grainger R, Thornhill J, Butler M, Keegan D, Hegarty N, McCarthy P, Mirza AH, O’Sullivan M, Neary P, O’Connor TPF, McCormack D, Cunningham K, Cassidy N, Sullivan T, Mulhall K, Murphy M, Puri A, Dhaif B, Carey PD, Delicata RJ, Abbasakoor F, Stephens RB, Hussey AJ, Garrihy B, Nolan DJ, McAnena OJ, Fitzgerald R, Watson D, Coventry BJ, Malycha P, Ward SC, Kwok SPY, Lau WY, Bergman JW, Hacking GEB, Metreweli C, Li AKC, Madhavan P, Donohoe J, O’Donohue M, McNamara DA, O’Donohoe MK. Sir Peter Freyer Memorial Lecture and Surgical Symposium 15th and 16th September, 1995. Ir J Med Sci 1995. [DOI: 10.1007/bf02969896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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