Nonconventionalmesocaval prosthetic shunt interposition in refractory case with portal hypertension in a 10-kg female infant

Surgical treatment of portal hypertension in infants is challenging because of the high risk of shunt thrombosis. A 10-kg female infant underwent six failed procedures before being successfully treated by interposition of a 10-mm-diameter prosthetic graft between two 3-mm-diameter splanchnic veins and the inferior vena cava. Follow-up at 10 years demonstrates shunt patency and normal development without rebleeding. An aggressive surgical strategy is justified as long as even nonconventional techniques are available to prevent life-threatening complications of portal hypertension. Prosthetic grafts can be used when no autologous vein graft is available. Decellularized allografts with reduced immunogenicity may also be effective alternative materials.Keywords: mesocaval anastomosis, PHT, prosthetic shun

Syndromic (phenotypic) diarrhea in early infancy

Syndromic diarrhea (SD), also known as phenotypic diarrhea (PD) or tricho-hepato-enteric syndrome (THE), is a congenital enteropathy presenting with early-onset of severe diarrhea requiring parenteral nutrition (PN). To date, no epidemiological data are available. The estimated prevalence is approximately 1/300,000–400,000 live births in Western Europe. Ethnic origin does not appear to be associated with SD. Infants are born small for gestational age and present with facial dysmorphism including prominent forehead and cheeks, broad nasal root and hypertelorism. Hairs are woolly, easily removed and poorly pigmented. Severe and persistent diarrhea starts within the first 6 months of life (≤ 1 month in most cases) and is accompanied by severe malabsorption leading to early and relentless protein energy malnutrition with failure to thrive. Liver disease affects about half of patients with extensive fibrosis or cirrhosis. There is currently no specific biochemical profile, though a functional T-cell immune deficiency with defective antibody production was reported. Microscopic analysis of the hair show twisted hair (pili torti), aniso- and poilkilotrichosis, and trichorrhexis nodosa. Histopathological analysis of small intestine biopsy shows non-specific villous atrophy with low or no mononuclear cell infiltration of the lamina propria, and no specific histological abnormalities involving the epithelium. The etiology remains unknown. The frequent association of the disorder with parental consanguinity and/or affected siblings suggests a genetic origin with an autosomal recessive mode of transmission. Early management consists of total PN. Some infants have a rather milder phenotype with partial PN dependency or require only enteral feeding. Prognosis of this syndrome is poor, but most patients now survive, and about half of the patients may be weaned from PN at adolescence, but experience failure to thrive and final short stature

Supporting the Return to Work of Breast Cancer Survivors: From a Theoretical to a Clinical Perspective

International audiencePromoting the return to work of breast cancer survivors is of major interest to patients, healthcare and occupational health professionals, companies, governments, and researchers worldwide. We previously conducted a French consensus study resulting in a model describing the multifactorial process of the return to work of breast cancer survivors (the REWORK-BC model). Other work has identified the transtheoretical model as a relevant theoretical framework for interventions to promote the return to work of cancer survivors. In this opinion paper, we provide a theoretically-based clinical framework describing how to support breast cancer survivors at each stage of the return-to-work process. This clinical framework considers several essential aspects of supportive care for breast cancer survivors returning to work, such as: (i) helping the patient actively self-manage, by considering her to be the main decision-maker; (ii) respecting and adapting to the patient's choice of professional project; (iii) respecting the temporality of the patient's choices; (iv) proposing tailored interventions; (v) implementing simple tools to promote the return to work, shared representation between the patient and a multidisciplinary team, and improvement of working conditions and the knowledge of health and occupational professionals, and managers or employers; and (vi) maintaining certain flexibility aimed at proposing, but never imposing, changes in practices. This clinical framework, specific to breast cancer survivors, could be extrapolated to other tumor types, offering a practical guide for healthcare and occupational health professionals to better understand the return-to-work process of cancer survivors. This clinical framework aims to be a usable tool for any hospital or cancer care center wishing to implement a patient-centered intervention that promotes returning to work, regardless of the country

Care trajectories and return to work in breast cancer survivors: a French population-based cohort study (Constances)

International audienceBackground: Breast cancer (BC) treatments and their related-adverse effects may affect or delay the return to work (RTW) process. However, most of the studies lacked in considering the temporal and sequential aspects of care trajectories on RTW. Method: Our study population included working-age women diagnosed with a BC from 2012 to 2018 identified in the CONSTANCES French cohort. Patients’ BC treatments, antidepressants/anxiolytic and antalgic deliveries, used as proxy for depression and pain respectively, and daily sickness allowance, used to estimated RTW and time to RTW, were assessed monthly using the French national healthcare system database. BC care trajectories were identified using the sequence analysis method. Time-dependant Cox models were performed to investigate the effect of BC care trajectories and their related effects on both RTW and time to RTW, adjusting for age and socioeconomic characteristics. Results: 85.2% patients returned to work within two years after diagnosis with a median time to RTW of 297 days. Five patterns of BC care trajectories were identified: (i) BC surgery only, (ii) BC surgery & radiotherapy (iii) BC surgery & chemotherapy (iv) BC surgery & chemotherapy & radiotherapy (v) BC surgery & long-term alternative chemotherapy/radiotherapy. Hazards ratios of non-RTW were significantly increased among older (> 55 years-old) patients belonging to the most complex BC care trajectories (pattern v). Time to RTW was significantly increased in patients that underwent chemotherapy in their BC care trajectory (from iii to v) and in patients with antidepressant/anxiolytic and antalgic deliveries. Conversely, time to RTW decreased for BC patients benefiting from high household income or single-parent family. Conclusion: This study highlights the necessity to consider the dynamic, cumulative and temporal reality of BC care trajectories and their related adverse effects to help vulnerable patients in their RTW process. Main implications: This study emphasized the necessity to consider the holistic and sequential aspect of BC care trajectory and its related-adverse events to better target and help vulnerable BC patients in their RTW process

Identifying return-to-work trajectories among breast cancer survivors using sequence analysis

International audienceIntroduction: The return-to-work (RTW) process after breast cancer (BC) can be complex. Simple static measures used to assess RTW may ignore this dynamic multi-stage process that are yet important for targeting interventions aimed at reducing poor RTW outcomes.Objectives: Our aim was to identify RTW trajectories after BC using the sequence analysis method and describe their underpinning personal, medical, psychological and occupational factors. Methods: This study is based on the ELCCA II cohort (Angers, France) that recruited 128 women diagnosed with BC between February 2015 and April 2016. Among them, 96 were still participating at the four-year follow-up. An occupational calendar was used to assess their situation every 6 months from their diagnostic up to 4 years later. Women that did not completed their occupational calendar, that were inactive (retired, disability pension) at the time of their diagnostic were excluded leading to a final sample of 52 breast cancer survivors (BCS). Sequence analysis was used to identify RTW trajectories among BCS. Patterns of RTW trajectories were described by socio-demographic, medical,occupational and the functional scales of the EORTC-QLQ-C30.Results: Three types of RTW trajectories were identified among BCS by sequence analysis: long sickness absence with progressive RTW (n=18), short sickness absence and full time RTW (≤ 6 months) (n=27), short sickness absence with progressive RTW (n=18), short sickness absence and full time RTW (≤ 6 months) (n=27), short sickness absence with part-time RTW (n=7). Socio-demographic, medical and trend in functional scales during the first year after diagnosis were shown to vary according RTWtrajectories.Conclusion: The application of sequence analysis highlights the dynamic process of RTW among BCS. It captures trajectories of multiple states and transitions that provided a holistic and diachronic approach of RTW. Three different patterns of RTW trajectories after breast cancer were identified. However, these results have to be confirmed by using a larger sample of BC

Identifying return-to-work trajectories among breast cancer survivors using sequence analysis

International audienceIntroduction: The return-to-work (RTW) process after breast cancer (BC) can be complex. Simple static measures used to assess RTW may ignore this dynamic multi-stage process that are yet important for targeting interventions aimed at reducing poor RTW outcomes.Objectives: Our aim was to identify RTW trajectories after BC using the sequence analysis method and describe their underpinning personal, medical, psychological and occupational factors. Methods: This study is based on the ELCCA II cohort (Angers, France) that recruited 128 women diagnosed with BC between February 2015 and April 2016. Among them, 96 were still participating at the four-year follow-up. An occupational calendar was used to assess their situation every 6 months from their diagnostic up to 4 years later. Women that did not completed their occupational calendar, that were inactive (retired, disability pension) at the time of their diagnostic were excluded leading to a final sample of 52 breast cancer survivors (BCS). Sequence analysis was used to identify RTW trajectories among BCS. Patterns of RTW trajectories were described by socio-demographic, medical,occupational and the functional scales of the EORTC-QLQ-C30.Results: Three types of RTW trajectories were identified among BCS by sequence analysis: long sickness absence with progressive RTW (n=18), short sickness absence and full time RTW (≤ 6 months) (n=27), short sickness absence with progressive RTW (n=18), short sickness absence and full time RTW (≤ 6 months) (n=27), short sickness absence with part-time RTW (n=7). Socio-demographic, medical and trend in functional scales during the first year after diagnosis were shown to vary according RTWtrajectories.Conclusion: The application of sequence analysis highlights the dynamic process of RTW among BCS. It captures trajectories of multiple states and transitions that provided a holistic and diachronic approach of RTW. Three different patterns of RTW trajectories after breast cancer were identified. However, these results have to be confirmed by using a larger sample of BC

Association between patterns of return-to-work trajectories and long-term depressive symptoms among breast cancer survivors

International audienceIntroduction Depressive symptoms and fatigue are well known factors affecting return-to-work (RTW) after breast cancer (BC). However, the RTW process may in turn have a positive impact on long-term health and psychological well-being among breast cancer survivors (BCS).Objective Our aim was to identify RTW trajectories within the 5-years following BC using a multi-phase and diachronic process and to assess their associations with depressive symptoms measured at least five year after their BC diagnostic.Methods We used data from the French Constances cohort that included more than 200,000 participants from 2012 to 2020. Our study relied on a sub-sample of women aged up to 55 years at the time of their diagnostic, who were working at the time of their diagnostic and who fully completed their occupational calendar up to five years after their diagnostic (n=939). Sequence analysis was used to identify RTW trajectories among BCS from their diagnosis up to 5 years later. Depressive symptoms were assessed using the 20-items CES-D scale. Adjusted logistic regression analyses were performed to assess the association between RTW trajectories and depressive symptoms.Results In our sample, 12.8% of BCS suffered from depressive symptoms at their inclusion in the cohort. Four types of RTW trajectories were identified: full-time RTW (n=645), late or no RTW (n=114), early and progressive RTW (n=134), full time RTW before early retirement (n=46). BCS that had a late or did not RTW within the five years following their diagnostic were associated with an increased risk of long-term depressive symptoms (OR : 2.73, 95% CI [1.47–5.04]).Conclusion This study highlighted that a late or absence of RTW within the 5 years after BC was associated with poorer long-term psychosocial factors and confirmed the potential of using sequence analysis to capture the multi-state aspect of RTW trajectories

Association between patterns of return-to-work trajectories and long-term depressive symptoms among breast cancer survivors

International audienceBackground : Depressive symptoms and fatigue are well known factors affecting return-to-work (RTW) after breast cancer (BC). However, RTW is mainly assess using static measures that do not capture the dynamic and multi-phase process of RTW, while this diachronic process may in turn have an impact on later health and psychological well-being. Our aim was to identify RTW trajectories in breast cancer survivors (BCS) within the 5-years following their and assess their associations with long-term depressive symptoms. Methods: We used data from the French Constances cohort that included more than 200 000 participants from 2012 to 2020,. Our study relies on a sub-sample of women aged up to 55 years at the time of their diagnostic, who were working at the time of their diagnostic and for whom 5 years RTW trajectories could be collected based on the National Retirement Insurance system (CNAV) (n=381). Sequence analysis was used to identify RTW trajectories among BCS from their diagnosis up to 5 years later. Depressive symptoms were assessed using the 20-items CES-D scale. Adjusted logistic regression were performed to assess the association between RTW trajectories and depressive symptoms. Results: In our sample, 18 % of BCS suffered from depressive symptoms at their inclusion in the cohort. Four patterns of RTW trajectories were identified: Short sickness absence and RTW, long sickness absence and RTW (n=134), sickness absence and invalidity, Sickness absence and unemployment. BCS that had a late RTW or no RTW within their five years following their diagnostic were significantly associated with an increased risk of long-term depressive symptoms. Conclusion: This study shows the potential of using sequence analysis to capture the temporal and multi-state aspects of RTW trajectories and highlights the importance of work resumption after BC on long-term health and well-being. Main implication: This study highlights the importance of sustainable work resumption after BC on long-term patients’ well-being

Understanding the process of returning to work of breast cancer survivors: emergence of a conceptual, integrative, transactional and ergonomic model

International audienc

Proposition d’un outil de repérage des patientes à risque de présenter des difficultés de retour à l’emploi et/ou de maintien en emploi durable après l’annonce d’un cancer du sein – Projet REWORK-BC

National audienc