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Moving forward together: collaborative landscapes of research in idiopathic inflammatory myopathies and calcinosis. Rheumatology (Oxford) 2024; 63:1189-1191. [PMID: 37449887 DOI: 10.1093/rheumatology/kead331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023] Open
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Best clinical practice in the treatment of juvenile systemic sclerosis: expert panel guidance - the result of the International Hamburg Consensus Meeting December 2022. Expert Rev Clin Immunol 2024; 20:387-404. [PMID: 38149621 DOI: 10.1080/1744666x.2023.2298354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Juvenile systemic sclerosis (jSSc) is an orphan disease with a prevalence of 3 in 1,000,000 children. Currently there is only one consensus treatment guideline concerning skin, pulmonary and vascular involvement for jSSc, the jSSc SHARE (Single Hub and Access point for pediatric Rheumatology in Europe) initiative, which was based on data procured up to 2014. Therefore, an update of these guidelines, with a more recent literature and expert experience, and extension of the guidance to more aspects of the disease is needed. AREAS COVERED Treatment options were reviewed, and opinions were provided for most facets of jSSc including general management, some of which differs from adult systemic sclerosis, such as the use of corticosteroids, and specific organ involvement, such as skin, musculoskeletal, pulmonary, and gastroenterology. EXPERT OPINION We are suggesting the treat to target strategy to treat early to prevent cumulative disease damage in jSSc. Conclusions are derived from both expert opinion and available literature, which is mostly based on adult systemic sclerosis (aSSc), given shared pathophysiology, extrapolation of results from aSSc studies was judged reasonable.
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Comparison of treatments and outcomes of children with juvenile dermatomyositis followed at two European tertiary care referral centers. Rheumatology (Oxford) 2021; 60:5419-5423. [PMID: 33528490 DOI: 10.1093/rheumatology/keab089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/11/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To compare the treatment approaches and disease outcomes of children with JDM followed in two European tertiary care peadiatric rheumatology centres. METHODS The medical notes of patients with JDM seen at Istituto Giannina Gaslini (IGG) of Genoa, Italy or Great Ormond Street Hospital (GOSH) of London, UK between January 2000 and December 2015 within 6 months after disease onset and followed for at least 6 months were reviewed. Demographic, clinical and therapeutic data were collected. At each visit, the caring physician was asked to rate the disease state subjectively. RESULTS A total of 127 patients were included, 88 at GOSH and 39 at IGG. At 24 months, the median values of muscle strength and disease activity were at the normal end of the scale and around three quarters of patients were said to have inactive disease. Also, at 2 years, 38.6% and 36% of British and Italian patients, respectively, had damage. Cyclophosphamide, azathioprine, infliximab, rituximab and mycophenolate mofetil were used more frequently by UK physicians, whereas ciclosporin, intravenous immunoglobulin and hydroxychloroquine were prescribed by Italian physicians. CONCLUSION This study shows a significant difference in the choice of medications between pediatric rheumatologists practising in the two centres. Despite this, a high proportion of patients had inactive disease at 2 years and there was a low frequency of damage: modern treatments have improved outcomes.
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Development and Testing of Reduced Versions of the Manual Muscle Test-8 in Juvenile Dermatomyositis. J Rheumatol 2020; 48:898-906. [PMID: 33191283 DOI: 10.3899/jrheum.200543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To develop and test shortened versions of the Manual Muscle Test-8 (MMT-8) in juvenile dermatomyositis (JDM). METHODS Construction of reduced tools was based on a retrospective analysis of individual scores of MMT-8 muscle groups in 3 multinational datasets. The 4 and 6 most frequently impaired muscle groups were included in MMT-4 and MMT-6, respectively. Metrologic properties of reduced tools were assessed by evaluating construct validity, internal consistency, discriminant ability, and responsiveness to change. RESULTS Neck flexors, hip extensors, hip abductors, and shoulder abductors were included in MMT-4, whereas MMT-6 also included elbow flexors and hip flexors. Both shortened tools revealed strong correlations with MMT-8 and other muscle strength measures. Correlations with other JDM outcome measures were in line with predictions. Internal consistency was good (0.88-0.96) for both MMT-4 and MMT-6. Both reduced tools showed strong ability to discriminate between disease activity states, assessed by the caring physician or a parent (P < 0.001), and between patients whose parents were satisfied or not satisfied with illness course (P < 0.001). Responsiveness to change (assessed by both standardized response mean and relative efficiency) of MMT-4 and, to a lesser degree, MMT-6, was slightly superior to that of MMT-8. CONCLUSION Overall, the metrologic performance of MMT-4 and MMT-6 was comparable to that of the other established muscle strength tools, which indicates that they may be suitable for use in clinical practice and research, including clinical trials. The measurement properties of these tools should be further tested in other patient populations and evaluated prospectively.
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O17 Physiotherapy experience of treating patients with PIMS-TR COVID-19 following stepdown from PICU. Rheumatol Adv Pract 2020. [PMCID: PMC7607307 DOI: 10.1093/rap/rkaa054.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Case report - Introduction It has been reported by the European Centre for Disease Prevention and Control that by May 2020 there were 230 suspected cases of PIMS-TR COVID-19. At Great Ormond Street Hospital NHS Foundation Trust (GOSH) there were 50 suspected cases. This report summarises the physiotherapy input to these patients outside of PICU. The rheumatology team were allocated the COVID-19positive ward and therefore were able to be involved in the evolving understanding of the clinical presentation and management of this new disease. Case report - Case description 50 children were admitted to GOSH with suspected PIMS-TR COVID-19, of these, 36 were admitted to PICU. The mean length of stay in PICU was 4.6 days and the median 3.5 days (Range 1–16 days). The mean total length of stay in hospital was 11 days (range 2–94 days). 42% were male and 57% female and the age ranged from 5 weeks -17 years, but the mean age was 9 yrs. Most were previously well, but 3 had asthma, 2 diabetes, 1 obese, 1 with liver disease and 2 with sickle cell disease. The physiotherapy provided included assessment and relatively quickly it was recognised that these patients had a specific pattern of muscle weakness (proximal>distal) and so the Manual Muscle Test of 8 muscle groups (MMT8) and the Childhood Myositis Assessment Score (CMAS) were adopted as outcomes. The initial mean MMT8 score was 56/80 (42–79) and mean CMAS score 20/52 (4–51) Assessment of respiratory function, mobility and safety of postural changes including sitting to standing, gait and managing the stairs was also included. The treatment provided included breathing exercises and specific muscle strengthening that was progressed as able. Advice to the nursing and medical staff was provided to ensure that patients were safe while they were regaining strength and stability. Gait re-education and stairs assessment was completed before discharge. The patients have now been placed into a multidisciplinary assessment programme to follow up the long-term outcomes including physiotherapy outcomes. At the 2 months follow up the mean MMT8 was 72/80 and the mean CMAS is 46/52 indicating that there may be a long-term impact upon musculoskeletal function in young people. Case report - Discussion At GOSH the rheumatology physiotherapy team were redeployed to the temporary general paediatrics service. This service was responsible for the patients who were diagnosed with this new and evolving disease and who were transferred from the PICU. The physiotherapy team started to recognise the extent of their illness including postural instability, muscle weakness, severe fatigue, and joint involvement. The children also had impairment in respiratory function and cardiac function. It was recognised that mobility was limited for many reasons and care was required in the intensity and frequency of exercise and level of activity. Initially moving around the bed was exhausting and had to be effective and safe before progressing to weight-bearing and walking. Because the physiotherapy team were musculoskeletal specialists, they were able to consider different outcome measures and quickly decided upon using the MMT8 and the CMAS as well as assessing joint range of movement and muscle length. Respiratory assessments were also completed. It was also recognised that as the hospital had rapidly developed the COVID-19ward (Hedgehog ward) and as the staff were from many different areas of the hospital effective communication between this new team had to be established and within weeks a daily MDT meeting was started that ensured all aspects of each patients care were discussed to enable complete co-ordinated treatment of the patient. This meeting allowed staff to contribute to decisions about treatment as well as ensuring the nursing staff were informed about safety for each child regarding mobility. The meeting also allowed for discharge planning to ensure that every child was safe to be discharged and was able to physically manage at home. A weekly psychosocial meeting was also developed and so the psychological and social factors for each child and their family could also be considered and supported. Case report - Key learning points The hospital planned and prepared for the Pandemic and staff were placed together to work in different ways. Because of the diversity of the skills of the staff it was possible to recognise the many systems that were affected by the disease and to pull together the expertise of the staff to be able to provide a high level and holistic clinical management for each and every child. It has also been possible to explore outcome measures and to be able to work with each other and to learn and discuss treatments moving forwards. The speed in which a completely new service was established was impressive especially as there had been a misunderstanding initially that children would probably not be severely affected by COVID-19. The importance of physiotherapy treatment in order to enable these young people to regain strength, mobility and function was apparent and with the longer term follow up it is demonstrating that several of these patients need longer term care and treatment after discharge. The outcome measures that are being used for the longer term follow up; CMAS, MMT8, 6 min walking test as well as neurological examinations and questionnaires to assess function and psychological well-being and fatigue are able to be used if other patients develop this disease and these measures can be used nationwide in order to enable a cohesive approach to managing PIMS-TR COVID-19.
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Development and validation of a composite disease activity score for measurement of muscle and skin involvement in juvenile dermatomyositis. Rheumatology (Oxford) 2019; 58:1196-1205. [DOI: 10.1093/rheumatology/key421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/01/2018] [Indexed: 11/12/2022] Open
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Harmonization of practices between radiotherapy centres in the Nord and Pas-de-Calais regions (France): A three-year evaluation. Cancer Radiother 2019; 23:10-16. [PMID: 30639377 DOI: 10.1016/j.canrad.2018.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 02/18/2018] [Accepted: 03/05/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE The delineation of volumes of interest can be a source of significant interobserver variability. The purpose of this study was to improve the homogeneity of delineation between oncologist-radiotherapists in the territorial departments of Nord and Pas-de-Calais (France) through discussions of clinical cases and the adoption of common published reference documents. MATERIALS AND METHODS All eleven radiotherapy centres in the Nord and Pas-de-Calais departments of France participated. The localizations assessed to date included prostate, head and neck, breast and brain cancers. For each localization, the junior or senior physician(s) in charge of pathology delineated the volumes of interest according to their usual practices. Validated indices, including the Dice similarity coefficient, were used to quantify the delineation differences. The anonymized results were presented at two to three annual meetings. A second delineation of the clinical cases was then carried out to quantify homogenization. An evaluation of dosimetry practices was also conducted for prostate cancer. Wilcoxon assay matched data were used. RESULTS Our work showed either satisfactory delineation concordance after the initial assessment or improved delineation concordance. For prostate cancer, the Dice similarity coefficient values were greater than 0.6 initially in two of the three clinical cases. For head and neck cancers, a statistically significant improvement was observed for only one of the clinical target volumes. More than half of the Dice similarity coefficient values were greater than 0.6 in the first comparison. The study of clinical cases of breast cancer allowed a homogenization of the delineation of five of the six lymph node clinical target volumes. The dosimetry study of prostate cancer allowed for a homogenization of practices. CONCLUSION This work makes it possible to harmonize the delineation practices around validated standards. An extension to the entire Hauts-de-France region is planned.
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Description des interventions visant une perte de poids dans un contexte de cancer du sein : urgent besoin d’un langage commun pour faire progresser les connaissances. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Development and Testing of a Hybrid Measure of Muscle Strength in Juvenile Dermatomyositis for Use in Routine Care. Arthritis Care Res (Hoboken) 2018; 70:1312-1319. [DOI: 10.1002/acr.23491] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 12/05/2017] [Indexed: 11/07/2022]
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2016 ACR-EULAR adult dermatomyositis and polymyositis and juvenile dermatomyositis response criteria-methodological aspects. Rheumatology (Oxford) 2017; 56:1884-1893. [PMID: 28977549 DOI: 10.1093/rheumatology/kex226] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
Objective The objective was to describe the methodology used to develop new response criteria for adult DM/PM and JDM. Methods Patient profiles from prospective natural history data and clinical trials were rated by myositis specialists to develop consensus gold-standard ratings of minimal, moderate and major improvement. Experts completed a survey regarding clinically meaningful improvement in the core set measures (CSM) and a conjoint-analysis survey (using 1000Minds software) to derive relative weights of CSM and candidate definitions. Six types of candidate definitions for response criteria were derived using survey results, logistic regression, conjoint analysis, application of conjoint-analysis weights to CSM and published definitions. Sensitivity, specificity and area under the curve were defined for candidate criteria using consensus patient profile data, and selected definitions were validated using clinical trial data. Results Myositis specialists defined the degree of clinically meaningful improvement in CSM for minimal, moderate and major improvement. The conjoint-analysis survey established the relative weights of CSM, with muscle strength and Physician Global Activity as most important. Many candidate definitions showed excellent sensitivity, specificity and area under the curve in the consensus profiles. Trial validation showed that a number of candidate criteria differentiated between treatment groups. Top candidate criteria definitions were presented at the consensus conference. Conclusion Consensus methodology, with definitions tested on patient profiles and validated using clinical trials, led to 18 definitions for adult PM/DM and 14 for JDM as excellent candidates for consideration in the final consensus on new response criteria for myositis.
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Effective induction therapy for anti-SRP associated myositis in childhood: A small case series and review of the literature. Pediatr Rheumatol Online J 2017; 15:77. [PMID: 29089059 PMCID: PMC5664807 DOI: 10.1186/s12969-017-0205-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/02/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anti-Signal Recognition Particle associated myopathy is a clinically and histopathologically distinct subgroup of Juvenile Idiopathic Inflammatory Myositis, which is under-recognised in children and fails to respond to conventional first line therapies. We present three cases where remission was successfully induced using combination therapy with intensive rehabilitation. CASE PRESENTATIONS Three new patients are reported. All 3 cases presented with profound, rapid-onset, proximal myopathy and markedly raised CK, but no rash. Histology revealed a destructive myopathy characterized by scattered atrophic and necrotic fibres with little or no inflammatory infiltrate. All 3 patients responded to induction with cyclophosphamide, IVIG and rituximab, in conjunction with intensive physiotherapy and methotrexate as the maintenance agent. Our patients regained near-normal strength (MMT > 70/80), in contrast with the current literature where >50% of cases reported severe residual weakness. A literature search on paediatric anti-SRP myositis was performed to June 2016; PubMed was screened using a combination of the following terms: signal recognition particle, autoantibodies, antibodies, myositis, muscular diseases, skeletal muscle, childhood, paediatric, juvenile. Articles in a foreign language were excluded. Nine case studies were found. CONCLUSION This paper supports the hypothesis that anti-SRP myositis is distinct from other JIIM. It is an important differential to JDM and should be considered where there is severe weakness without rash or if highly elevated muscle enzymes (CK > 10,000 U/l) are found. Early identification is essential to initiate aggressive medical and physical therapy. Greater international collaboration and long-term follow-up data is needed to establish the most effective treatment strategy for this rare group of patients.
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Are dietary reports in a case-control study on thyroid cancer biased by risk perception of Chernobyl fallout? Rev Epidemiol Sante Publique 2017; 65:301-308. [PMID: 28579185 DOI: 10.1016/j.respe.2017.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 02/07/2017] [Accepted: 02/13/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND In retrospective case-control studies performed following nuclear tests or nuclear accidents, individual thyroid radiation dose reconstructions are based on fallout and meteorological data from the residential area, demographic characteristics, and lifestyle as well as dietary information. Collecting the latter is a controversial step, as dietary declarations may be affected by the subjects' beliefs about their risk behavior. This report analyses the potential for such bias in a case-control study performed in eastern France. METHODS The study included 765 cases of differentiated thyroid carcinoma matched with 831 controls. Risk perceptions and beliefs of cases and controls were compared using Chi2 tests and differences in dietary reports were analyzed using a two-way ANOVA. RESULTS In general, atmospheric pollution and living near a nuclear power plant were the two major risks that may influence thyroid cancer occurrence cited by cases and controls. When focusing in particular on the consequences of the Chernobyl accident, cases were more likely to think that the consequences were responsible for thyroid cancer occurrence than controls. Vegetable consumption during the two months after the Chernobyl accident was correlated with the status of subjects, but not to their beliefs. Conversely, consumption of fresh dairy products was not correlated with the status or beliefs of subjects. CONCLUSION We found no evidence of systematic bias in dietary reports according to the status or beliefs held by subjects about the link between thyroid cancer occurrence and Chernobyl fallout. As such, these dietary reports may be used in further studies involving individual dosimetric reconstructions.
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EP-1122: Efficacy and safety of stereotactic reirradiation for recurrent brain metastases. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Echinococcus granulosus infection dynamics in livestock of Greece. Acta Trop 2015; 150:64-70. [PMID: 26123192 DOI: 10.1016/j.actatropica.2015.06.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 06/17/2015] [Accepted: 06/20/2015] [Indexed: 12/28/2022]
Abstract
An epidemiological and molecular survey on the occurrence of Echinococcus hydatid cysts in livestock was conducted in Greece. In total 898 sheep, 483 goats, 38 buffaloes, 273 wild boars and 15 deer were examined and 30.2% (6.45% cyst fertility), 7.86% (3.2% cyst fertility), 42% (7.9% cyst fertility), 1.1% (0% cyst fertility), 0% of them were found infected, respectively. Infection rate in different geographical regions varied between 26.1 and 53.8% (cyst fertility 2.04 and 34.6%) in sheep, 7.33 and 13.3% (cyst fertility 0 and 3.2%) in goats. Genotyping, based on cox1 and nad1 analyses, demonstrated the predominance of E. granulosus s.s. (G1 genotype). The presence of one single genotype-complex within a relatively large spectrum of intermediate host species in Greece indicates the presence of a dominant transmission dog-sheep cycle involving additional host species which may act as disease reservoir for human infections.
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OP0150 Development and Preliminary Validation of a New Composite Disease Activity Measure for Juvenile Dermatomyositis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Measuring joint hypermobility using the hospital del mar criteria—a reliability analysis using secondary data analysis. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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EP-1602: Overall treatment time and tumor sterilization in cervix cancer treated with chemoradiation and brachytherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41594-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Une leucoencéphalopathie régressive après une première perfusion d’etanercept. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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PReS-FINAL-2012: Introducing a new approach to clinical care of juvenile dermatomyositis: the juvenile dermatomyositis multidimensional assessment report. Pediatr Rheumatol Online J 2013. [PMCID: PMC4044786 DOI: 10.1186/1546-0096-11-s2-p25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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PReS13-SPK-1572: The therapy management of pain amplification syndrome. Pediatr Rheumatol Online J 2013. [PMCID: PMC4045595 DOI: 10.1186/1546-0096-11-s2-i36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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PReS-FINAL-2047: Exploring the effectiveness of stretch and cast treatment of fixed flexion deformity in children with active JIA. Pediatr Rheumatol Online J 2013. [PMCID: PMC4044983 DOI: 10.1186/1546-0096-11-s2-p60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
ABSTRACTWe model the dissolution of a soluble matrix protected by a diffusion barrier. The dissolution, driven by a first order kinetics law, allows the solute to diffuse in the barrier with sorption and precipitation interactions. The dissolved mass evolution and the lifetime of the wasteform can be expressed in a closed form and as a function of relevant length scales, reflecting the phenomenon controlling the dissolution. Application to a nuclear glass in a clay barrier shows that diffusion in the barrier is the main phenomenon unless precipitation of chalcedony occurs or silicon is very strongly sorbed in the barrier. This requires further experimental investigation of silicon/clay interaction.
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Comparison of clinical features and drug therapies among European and Latin American patients with juvenile dermatomyositis. Clin Exp Rheumatol 2011; 29:117-124. [PMID: 21345298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 10/05/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To compare the demographic features, presenting manifestations, diagnostic investigations, disease course, and drug therapies of children with juvenile dermatomyositis (JDM) followed in Europe and Latin America. METHODS Patients were inception cohorts seen between 1980 and 2004 in 27 paediatric rheumatology centres. The following information was collected through the review of patient charts: sex; age at disease onset; date of disease onset and diagnosis; onset type; presenting clinical features; diagnostic investigations; course type; and medications received during disease course. RESULTS Four hundred and ninety patients (65.5% females, mean onset age 7.0 years, mean disease duration 7.7 years) were included. Disease presentation was acute or insidious in 57.1% and 42.9% of the patients, respectively. The course type was monophasic in 41.3% of patients and chronic polycyclic or continuous in 58.6% of patients. The more common presenting manifestations were muscle weakness (84.9%), Gottron's papules (72.9%), heliotrope rash (62%), and malar rash (56.7%). Overall, the demographic and clinical features of the 2 continental cohorts were comparable. European patients received more frequently high-dose intravenous methylprednisolone, cyclosporine, cyclophosphamide, and azathioprine, while methotrexate and antimalarials medications were used more commonly by Latin American physicians. CONCLUSIONS The demographic and clinical characteristics of JDM are similar in European and Latin American patients. We found, however, several differences in the use of medications between European and Latin American paediatric rheumatologists.
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Failure to observe cross-fertilization between the Echinococcus granulosus G1 and G6 strains after an experimental mixed infection of the definitive host. Vet Parasitol 2010; 175:80-3. [PMID: 20965659 DOI: 10.1016/j.vetpar.2010.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 09/07/2010] [Accepted: 09/15/2010] [Indexed: 11/15/2022]
Abstract
The classification within Echinococcus granulosus is currently under debate. To assess the reproductive potential between the G1 and G6 strains, an experimental double infection was carried out in a dog. First, two fertile hydatid cysts were collected in Algeria from a cow and a dromedary. They were identified as being G1 and G6 with the markers coxI and nadI. Subsequently, a dog was inoculated with protoscoleces from these two cysts. Sixty days after infection, 85 adult worms were recovered from the intestine of the dog. Then, the two cysts and each of these individual parasites were characterized with the multilocus microsatellite EmsB and compared. For all worms, the scolex and the gravid proglottids, separately analyzed, provided an identical profile: the G1 profile was observed in 70 adults, and the G6 profile in the 15 others. No single worm exhibited a hybrid G1/G6 profile. This result suggests the absence of cross-fertilizing between the two taxa under the given experimental conditions, and so, the presence of a strong cross-reproductive barrier. This observation corroborates with the recent reclassification of G1 and G6 within two distinct species.
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Évaluation économique de la curiethérapie de débit pulsé gynécologique (PDR) avec optimisation de la dose pour les cancers du col utérin. Cancer Radiother 2010; 14:161-8. [DOI: 10.1016/j.canrad.2009.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 06/18/2009] [Accepted: 11/19/2009] [Indexed: 10/19/2022]
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Comparing different revisions of the Childhood Health Assessment Questionnaire to reduce the ceiling effect and improve score distribution: Data from a multi-center European cohort study of children with JIA. Pediatr Rheumatol Online J 2010; 8:16. [PMID: 20478036 PMCID: PMC2885385 DOI: 10.1186/1546-0096-8-16] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Accepted: 05/17/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The original version of the Childhood Health Assessment Questionnaire (CHAQ30orig) suffers from a ceiling effect and hence has reduced clinical validity. The purpose of this study was to evaluate the effect of adding eight more demanding items (CHAQ38) and a new categorical response option (CATII) on discriminant validity and score distribution in a European patient sample. METHODS Eighty-nine children with Juvenile Idiopathic arthritis (JIA) and 22 healthy controls, aged 7-16 years, were recruited from eight centres across Europe. Eight new CHAQ items and scoring option were translated back and forth for the countries in which they were not already present. Demographic, clinical, and CHAQ data were collected on-site. Subsequently, five different scoring methods were applied, i.e. the original method (CHAQ30orig) and four alternatives. These alternatives consisted of the mean item scores for the 30 and 38-question versions with either the original (CATI), or the new categorical response option (CATII). The five versions were tested for their ability to distinguish between patients and controls. Furthermore score distributions were evaluated and visualized by box and whisker plots. RESULTS Two CHAQ revisions with the new response option showed poor discriminative ability, whereas one revised version (CHAQ38CATI) had comparable discriminative ability comparable to the original CHAQ. A profound ceiling effect was observed in the original scoring method of the CHAQ (27%). The addition of eight more demanding items and application of a plain mean item score reduced this significantly to 14% (chi2 = 4.21; p < 0.05). CONCLUSIONS Revising the CHAQ by adding eight more demanding items and applying a plain mean item scoring (CHAQ38CATI) maintained discriminant ability and reduced the ceiling effect in a European patient sample. The new categorical response option (CATII) seemed promising, but was less able to distinguish children with JIA from healthy controls and had less favourable distribution characteristics. The CHAQ38CATI is advocated for future use in mildly affected JIA patients.
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Long-term outcome and prognostic factors of juvenile dermatomyositis: a multinational, multicenter study of 490 patients. Arthritis Care Res (Hoboken) 2010; 62:63-72. [PMID: 20191492 DOI: 10.1002/acr.20015] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To investigate the long-term outcome and prognostic factors of juvenile dermatomyositis (DM) through a multinational, multicenter study. METHODS Patients consisted of inception cohorts seen between 1980 and 2004 in 27 centers in Europe and Latin America. Predictor variables were sex, continent, ethnicity, onset year, onset age, onset type, onset manifestations, course type, disease duration, and active disease duration. Outcomes were muscle strength/endurance, continued disease activity, cumulative damage, muscle damage, cutaneous damage, calcinosis, lipodystrophy, physical function, and health-related quality of life (HRQOL). RESULTS A total of 490 patients with a mean disease duration of 7.7 years were included. At the cross-sectional visit, 41.2-52.8% of patients, depending on the instrument used, had reduced muscle strength/endurance, but less than 10% had severe impairment. Persistently active disease was recorded in 41.2-60.5% of the patients, depending on the activity measure used. Sixty-nine percent of the patients had cumulative damage. The frequency of calcinosis and lipodystrophy was 23.6% and 9.7%, respectively. A total of 40.7% of the patients had decreased functional ability, but only 6.5% had major impairment. Only a small fraction had decreased HRQOL. A chronic course, either polycyclic or continuous, consistently predicted a poorer outcome. Mortality rate was 3.1%. CONCLUSION This study confirms the marked improvement in functional outcome of juvenile DM when compared with earlier literature. However, many patients had continued disease activity and cumulative damage at followup. A chronic course was the strongest predictor of poor prognosis. These findings highlight the need for treatment strategies that enable a better control of disease activity over time and the reduction of nonreversible damage.
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[In reference to the article: "Neck dissection following chemoradiation for node positive head and neck carcinomas" by Thariat et al. Cancer Radiother 2009;13:758-770]. Cancer Radiother 2010; 14:222; author reply 222-4. [PMID: 20189432 DOI: 10.1016/j.canrad.2010.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 01/08/2010] [Accepted: 01/11/2010] [Indexed: 10/19/2022]
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Health-related quality of life of patients with juvenile dermatomyositis: results from the Pediatric Rheumatology International Trials Organisation multinational quality of life cohort study. ACTA ACUST UNITED AC 2009; 61:509-17. [PMID: 19333974 DOI: 10.1002/art.24343] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the health-related quality of life (HRQOL) change over time, as measured by the Child Health Questionnaire (CHQ), and its determinants in patients with active juvenile dermatomyositis (DM). METHODS We assessed patients with juvenile DM at both baseline and 6 months of followup, and healthy children age < or =18 years. Potential determinants of poor HRQOL included demographic data, physician's and parent's global assessments, muscle strength, functional ability as measured by the Childhood Health Assessment Questionnaire (C-HAQ), global disease activity assessments, and laboratory markers. RESULTS A total of 272 children with juvenile DM and 2,288 healthy children were enrolled from 37 countries. The mean +/- SD CHQ physical and psychosocial summary scores were significantly lower in children with juvenile DM (33.7 +/- 11.7 versus 54.6 +/- 4.1) than in healthy children (45.1 +/- 9.0 versus 52 +/- 7.2), with physical well-being domains being the most impaired. HRQOL improved over time in responders to treatment and remained unchanged or worsened in nonresponders. Both physical and psychosocial summary scores decreased with increasing levels of disease activity, muscle strength, and parent's evaluation of the child's overall well-being. A C-HAQ score >1.6 (odds ratio [OR] 5.06, 95% confidence interval [95% CI] 2.03-12.59), child's overall well-being score >6.2 (OR 5.24, 95% CI 2.27-12.10), and to a lesser extent muscle strength and alanine aminotransferase level were the strongest determinants of poor physical well-being at baseline. Baseline disability and longer disease duration were the major determinants for poor physical well-being at followup. CONCLUSION We found that patients with juvenile DM have a significant impairment in their HRQOL compared with healthy peers, particularly in the physical domain. Physical well-being was mostly affected by the level of functional impairment.
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High Rate of Severe Radiation Dermatitis during Radiation Therapy with Cetuximab in Head and Neck Cancer Patients. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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A review of the management of Complex Regional Pain Syndrome; an experience of an inpatient rehabilitation unit. Pediatr Rheumatol Online J 2008. [PMCID: PMC3333972 DOI: 10.1186/1546-0096-6-s1-p171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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A qualitative investigation into the variables which affect the physiotherapy group treatment sessions in the rheumatology unit. Pediatr Rheumatol Online J 2008. [PMCID: PMC3333965 DOI: 10.1186/1546-0096-6-s1-p165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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8.5 Predictors of long-term outcome of Juvenile Dermatomyositis (JDM): a Multicenter, Multinational Study of 490 patients. Pediatr Rheumatol Online J 2008. [PMCID: PMC3334175 DOI: 10.1186/1546-0096-6-s1-s19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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6.4 Spondylo-epiphyseal dysplasia – a physiotherapy approach. Pediatr Rheumatol Online J 2008. [PMCID: PMC3334166 DOI: 10.1186/1546-0096-6-s1-s10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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The prospective juvenile systemic sclerosis inceptions cohort – http://www.juvenile-scleroderma.com. Pediatr Rheumatol Online J 2008. [PMCID: PMC3334030 DOI: 10.1186/1546-0096-6-s1-p226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Differences in therapeutic approach to juvenile dermatomyositis between Europe and Latin America. Pediatr Rheumatol Online J 2008. [PMCID: PMC3334019 DOI: 10.1186/1546-0096-6-s1-p214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Long term follow up of children with rheumatological conditions who participated in a two week rehabilitation programme. Pediatr Rheumatol Online J 2008. [PMCID: PMC3333963 DOI: 10.1186/1546-0096-6-s1-p163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Exploring the ceiling effect of the revised Childhood Health Assessment Questionnaire in a European patient sample. Pediatr Rheumatol Online J 2008. [PMCID: PMC3333897 DOI: 10.1186/1546-0096-6-s1-p102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Assessment of Echinococcus granulosus polymorphism in Qinghai Province, People’s Republic of China. Parasitol Res 2008; 102:1201-6. [DOI: 10.1007/s00436-008-0894-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Accepted: 01/16/2008] [Indexed: 11/24/2022]
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Assessment of use of microsatellite polymorphism analysis for improving spatial distribution tracking of echinococcus multilocularis. J Clin Microbiol 2007; 45:2943-50. [PMID: 17634311 PMCID: PMC2045259 DOI: 10.1128/jcm.02107-06] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Alveolar echinococcosis (AE)--caused by the cestode Echinococcus multilocularis--is a severe zoonotic disease found in temperate and arctic regions of the northern hemisphere. Even though the transmission patterns observed in different geographical areas are heterogeneous, the nuclear and mitochondrial targets usually used for the genotyping of E. multilocularis have shown only a marked genetic homogeneity in this species. We used microsatellite sequences, because of their high typing resolution, to explore the genetic diversity of E. multilocularis. Four microsatellite targets (EmsJ, EmsK, and EmsB, which were designed in our laboratory, and NAK1, selected from the literature) were tested on a panel of 76 E. multilocularis samples (larval and adult stages) obtained from Alaska, Canada, Europe, and Asia. Genetic diversity for each target was assessed by size polymorphism analysis. With the EmsJ and EmsK targets, two alleles were found for each locus, yielding two and three genotypes, respectively, discriminating European isolates from the other groups. With NAK1, five alleles were found, yielding seven genotypes, including those specific to Tibetan and Alaskan isolates. The EmsB target, a tandem repeated multilocus microsatellite, found 17 alleles showing a complex pattern. Hierarchical clustering analyses were performed with the EmsB findings, and 29 genotypes were identified. Due to its higher genetic polymorphism, EmsB exhibited a higher discriminatory power than the other targets. The complex EmsB pattern was able to discriminate isolates on a regional and sectoral level, while avoiding overdistinction. EmsB will be used to assess the putative emergence of E. multilocularis in Europe.
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Taxonomic position and geographical distribution of the common sheep G1 and camel G6 strains of Echinococcus granulosus in three African countries. Parasitol Res 2006; 100:495-503. [PMID: 17016727 DOI: 10.1007/s00436-006-0286-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Accepted: 07/11/2006] [Indexed: 10/24/2022]
Abstract
The taxonomic and phylogenetic status of Echinococcus granulosus strains are still controversial and under discussion. In the present study, we investigated the genetic polymorphism of E. granulosus isolates originating from three countries of Africa, including a region of Algeria, where the common G1 sheep and the camel G6 strains coexist sympatrically. Seventy-one hydatid cysts were collected from sheep, cattle, camels, and humans. Two mitochondrial markers (cox1 and nad1) were used for strain identification. Two nuclear markers (actII and hbx2) were used to study the possible occurrence of cross-fertilization. Despite the heterogeneity observed among the G1 isolates, they were all localized within one robust cluster. A second strong cluster was also observed containing all of the G6 isolates. Both strains appeared as two distinct groups, and no cases of interbreeding were found. Thus, the attribution of a species rank can be suggested. We also found the Tasmanian sheep G2 strain for the first time in Africa. Because of the slight variations observed between the common sheep and the Tasmanian sheep strains, further studies should be carried out to elucidate the epidemiological relevance of this genetic discrimination.
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EmsB, a tandem repeated multi-loci microsatellite, new tool to investigate the genetic diversity of Echinococcus multilocularis. INFECTION GENETICS AND EVOLUTION 2006; 6:390-400. [PMID: 16504596 DOI: 10.1016/j.meegid.2006.01.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2004] [Revised: 01/12/2006] [Accepted: 01/19/2006] [Indexed: 10/25/2022]
Abstract
In order to explore the genetic diversity within Echinococcus multilocularis (E. multilocularis), the cestode responsible for the alveolar echinococcosis (AE) in humans, a microsatellite, composed of (CA) and (GA) repeats and designated EmsB, was isolated and characterized in view of its nature and potential field application. PCR-amplification with specific primers exhibited a high degree of size polymorphism between E. multilocularis and Echinococcus granulosus sheep (G1) and camel (G6) strains. Fluorescent-PCR was subsequently performed on a panel of E. multilocularis isolates to assess intra-species polymorphism level. EmsB provided a multi-peak profile, characterized by tandemly repeated microsatellite sequences in the E. multilocularis genome. This "repetition of repeats" feature provided to EmsB a high discriminatory power in that eight clusters, supported by bootstrap p-values larger than 95%, could be defined among the tested E. multilocularis samples. We were able to differentiate not only the Alaskan from the European samples, but also to detect different European isolate clusters. In total, 25 genotypes were defined within 37 E. multilocularis samples. Despite its complexity, this tandem repeated multi-loci microsatellite possesses the three important features for a molecular marker, i.e. sensitivity, repetitiveness and discriminatory power. It will permit assessing the genetic polymorphism of E. multilocularis and to investigate its spatial distribution in detail.
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Abstract
Autism is a developmental disorder characterized by impairments in social interaction and communication associated with repetitive patterns of interest or behavior. Autism is highly influenced by genetic factors. Genome-wide linkage and candidate gene association approaches have been used to try and identify autism genes. A few loci have repeatedly been reported linked to autism. Several groups reported evidence for linkage to a region on chromosome 16p. We have applied a direct physical identity-by-descent (IBD) mapping approach to perform a high-density (0.85 megabases) genome-wide linkage scan in 116 families from the AGRE collection. Our results confirm linkage to a region on chromosome 16p with autism. High-resolution single-nucleotide polymorphism (SNP) genotyping and analysis of this region show that haplotypes in the protein kinase c-beta gene are strongly associated with autism. An independent replication of the association in a second set of 167 trio families with autism confirmed our initial findings. Overall, our data provide evidence that the PRKCB1 gene on chromosome 16p may be involved in the etiology of autism.
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Radiothérapie postopératoire des cancers laryngés classés N0. Cancer Radiother 2005; 9:285-92. [PMID: 16168697 DOI: 10.1016/j.canrad.2005.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Revised: 04/29/2005] [Accepted: 05/16/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE A retrospective study to re-assess the indications for postoperative radiation therapy in squamous cell carcinoma of the larynx staged N0 after gross resection. PATIENTS AND METHODS Between January 1975 and December 2000, 166 patients with squamous cell carcinoma of the larynx were treated by total laryngectomy with or without neck dissection. Surgery was completed by external radiotherapy delivering 45 to 65 Gy to the tumour bed and 45 to 50 Gy to cervical lymphatic chains. Minimal follow-up was 36 months and median follow-up was 98 months. RESULTS The rate of nodal recurrence was 6% (median time for relapse was 9 months). The survival rates at 1, 2, 3 and 5 years were 93.5, 84, 80 and 69% respectively, with a 8 year 3 month median survival. The univariate analysis showed 4 parameters, which significantly increased the risk of local recurrence: the medical necessity for immediate tracheotomy, the subglottic involvement, the involvement of the whole larynx and the presence of lymphatic embols in the neck dissection. There was no statistically significant difference between the patients with or without a neck dissection. Fifty-nine secondary cancers were observed, 15 of them occurring in the head and neck area. The late complications consisted of cervical subcutaneous fibrosis (7%), oesophageal stricture (4%), oeso-tracheal fistula (l%), hypothyroidism (3%), bone necrosis (1%). CONCLUSION Prophylactic cervical radiotherapy in laryngeal cancers resulted in 6% cervical node recurrence rate. This value may represent the maximal rate to accept if one would favour new therapeutic strategies based on restricted indications for radiotherapy.
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Present status of computerized tomography and angiography in the diagnosis of cerebral thrombophlebitis cavernous sinus thrombosis excluded. J Neuroradiol 1994; 21:59-71. [PMID: 8014659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In order to evaluate the contribution of computerized tomography (CT) to the diagnosis of cerebral thrombophlebitis, a series of 28 cases was reviewed and compared with data from the literature. In an examination carried out 4 to 5 days of its constitution the thrombus may be directly visualized as a spontaneous hyperdensity. This early but very transient sign, called "cord sign", can easily be overlooked, which explains why it was found in only 5 of our 28 cases and in 2% of the largest series of the literature. The thrombus thereafter becomes hypodense and can be intensified by peripheral contrast enhancement which produces the classical "delta sign". This sign is more frequent: 13/28 in our series and 16 to 30% in published cases. It is usually found in the superior sagittal sinus and must be distinguished from anatomical variations which are common at that level. These two direct signs acquire a greater value when associated with such indirect signs as diffuse or localized cerebral oedema (12 to 52%) and venous ischaemia (22 to 59%). Venous ischaemia is characterized by its strong bleeding potential (more than 50% of the cases) and by its usually favourable course; these two elements and its site differentiate it from arterial ischaemia. Finally, venous stasis is responsible, in 5 to 19% of the cases, for intense enhancement of the tentorium cerebelli; this sign is not specific but easy to evidence and of great value when associated with a direct sign. Dilatation of cortical veins, found in 4 of our 28 cases, also seems to be an interesting sign which, to our knowledge, has not yet been mentioned in the literature. Since in 3.6 to 26% of the cerebral thrombophlebitis the CT scan is normal, a negative CT examination does not rule out this disease, and in many cases the exploration must be rapidly completed by angiography or MRI. Because it is non-invasive and very sensitive to flows, MRI has become the key examination to assert the diagnosis. Angiography is now restricted to those cases where cases where MRI cannot be performed promptly or to certain, purely cortical thrombophlebitis which might pass unnoticed at MRI. When carried out and interpreted cautiously, angiography always shows the venous thrombosis, its exact size and its suppletive network. The results of this study show that MRI alone can diagnose cerebral thrombophlebitis in most patients, that CT well done and interpreted often provides useful but seldom sufficient indices, and that angiography should be reserved for difficult cases.
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