Feasibility and efficacy of early lung cancer diagnosis with chest computed tomography in HIV-infected smokers

International audienceOBJECTIVE: Lung cancer screening with chest computed tomography (CT) is beneficial in smokers aged 55 to 74 years. We studied the risks, benefits and feasibility of early lung cancer diagnosis with CT in HIV-infected smokers. DESIGN AND SETTING: French, multicentre, single round chest CT study in France, realized between February 2011 and June 2012. PARTICIPANTS: Patients were HIV-infected smokers at least 40 years, at least 20 pack-years, with a CD4 T-lymphocyte nadir count below 350 cells/μl. INTERVENTION: Single chest CT with a proposed standardized workup algorithm of positive images. MAIN OUTCOME MEASURE: The outcome was the number of histologically proven lung cancers diagnosed by CT with a 2-year follow-up. RESULTS: Median age of the 442 included patients was 49.8 years, 81.6% were under 55 years, 84% were men, median smoking was 30 pack-years, median nadir and last CD4 cell counts were 168 and 574 cells/μl, respectively, and 90% of patients had a plasma HIV RNA below 50 copies/ml. A positive image at baseline was reported in 94 (21%) patients, and 15 (3.4%) patients had 18 invasive procedures with no serious adverse events. Lung cancer was diagnosed in 10 patients (six at early stages), of which nine (2.0%, 95% confidence interval: 0.9-3.8) were CT detected, and eight in patients below 55 years. CONCLUSION: Early lung cancer diagnosis with CT in HIV-infected smokers was feasible, safe, and yielded a significant number of cancers. Lung cancer screening of HIV-infected smokers with an important history of immunodeficiency revealed a substantial number of cancers at younger ages than the targeted range in the general populatio

Correction to: Intra‑articular injections of platelet‑rich plasma in symptomatic knee osteoarthritis: a consensus statement from French‑speaking experts.

peer reviewe

Characterization of intra-articular adipose tissue from osteoarthritis knee and hip and involvement of infrapatellar fat pad, the main adipose tissue of the knee joint, in the pathophysiology of osteoarthritis

Les tissus adipeux (TA) intra-articulaires (TAIA) sont présents dans la majorité des articulations, au contact de la membrane synoviale. Le genou est l'articulation la plus riche en TA, comprenant le TA de Hoffa (TAH) et les TA suprapatellaires (TASP). A l'inverse, la hanche ne comprend qu'un petit TA, le TA acétabulaire (TAA). Le TAH de sujets arthrosiques est une source plus importante de cytokines inflammatoires que les TA sous-cutanés (TASC). Nous émettons l'hypothèse que les cytokines sécrétées par les TAH modifient le phénotype de la membrane synoviale arthrosique et que l'ensemble des TAIA partage des caractéristiques histologiques et biologiques communes les distinguant des TASC. Nous avons d'abord montré que la stimulation par les milieux conditionnés de TAH autologues induisait une expression et une libération plus importantes d'IL-6, d'IL-8, de PGE2, de MMP-1, de MMP-3 et de MMP-9 par les synoviocytes fibroblastiques (SF) comparativement aux TASC. La PGE2, sécrétée en plus grande quantité par les TAIA que les TASC (75 fois plus), joue un rôle central dans l'activation des SF. A l'instar des TAH, les autres TAIA de genou et de hanche sécrétent également plus de médiateurs inflammatoires que les TASC. Ils sont le siège de plus de remaniements fibreux, de vaisseaux et d'infiltrats leucocytaires que les TASC. Au sein des TAIA, les adipocytes sont plus petits et l'expression génique des médiateurs du métabolisme lipidique (ATGL, LPL, FABP4 et CD36) diminuée. Les TAIA de genou et de hanche arthrosiques partagent donc un phénotype commun et ont la capacité d'interagir avec la membrane synoviale, pouvant ainsi contribuer à la maladie arthrosique.Intra-articular adipose tissues (IAAT) are located in most joints, lined by synovial membrane. IAAT within the knee are the most numerous and voluminous. They are principally constituted by the infrapatellar fat pad (IFP) and suprapatellar fat pad (SPFP). Inversely, the hip is only constituted by a small single AT, called acetabular fat pad (AFP). Moreover, several studies brought out that IFP from OA patients were a greater source of inflammatory cytokines as compared to subcutaneous AT (SCAT). So, we hypothesized that cytokines released by IFP could modify the phenotype of synovial membrane and also that all IAAT share similar histological, biological and cellular characteristics distinguishing them from SCAT. First, we showed that synoviocyte stimulation by autologous IFP-conditioned media induced a higher gene expression and release of IL-6, IL-8, PGE2, MMP-1, MMP-3 and MMP-9 as compared to SCAT. We also confirmed that IFP released higher rate of inflammatory cytokines than SCAT, particularly PGE2, whom secretion rate was 75 fold higher and which had a central impact in synoviocyte activation. Next, we demonstrated that other IAAT from knee and hip also released higher levels of IL-6, IL-8, and PGE2 as compared to SCAT. IAAT were composed by greater fibrosis remodeling and higher vessel area and leucocyte infiltration as compared to autologous SCAT. In IAAT, adipocytes were smaller and gene expression for most factors involved in lipid metabolism (ATGL, LPL, FABP4 et CD36) were decreased. The specificity of inflammatory secretion and metabolic phenotype were also observed in preadipocytes isolated from knee IAAT and SCAT. To conclude, IAAT from OA knee and hip share a common phenotype and have the ability to interact with synovial membrane, contributing to the onset and/or the progression of OA disease

Addition of Mannitol to Hyaluronic Acid may Shorten Viscosupplementation Onset of Action in Patients with Knee Osteoarthritis: Post-Hoc Analysis of A Double-blind, Controlled Trial

International audienc

Time to Total Knee Arthroplasty after Intra-Articular Hyaluronic Acid or Platelet-Rich Plasma Injections: A Systematic Literature Review and Meta-Analysis

Intra-articular (IA) hyaluronic acid (HA) and platelet-rich plasma (PRP) injections are increasingly being prescribed for knee osteoarthritis (KOA). However, failure of the medical treatment may result in total knee arthroplasty (TKA). We wondered if IA HA or PRP injections (intervention) may delay the time to TKA (outcome) among KOA patients (population), compared to KOA patients not receiving these injections (comparator). For this systematic literature review (SLR) and meta-analysis, we selected observational studies with at least one group of patients receiving IA HA or PRP and with TKA data available. The main outcome was time from the diagnosis of KOA to TKA. We included 25 articles in the SLR (2,824,401 patients) and four in the meta-analysis. The mean strengthening the reporting of observational studies in epidemiology (STROBE) score was 63%. For patients receiving versus not receiving HA injections, the delay between a declared diagnosis of KOA to TKA was increased by 9.8 months (95% CI (8.2–11.4)). As compared with standard of care, the effect size of HA injections for this outcome was 0.57 (95% CI (0.36–0.76)). Only one study described a median time from PRP injections to TKA of 4.1 years (range 0.3–14.7). IA HA injections were associated with increased time to TKA. Causality cannot be concluded because of missing confounder factors as comorbidities. Data were insufficient to conclude any effect of PRP injections on TKA delay

Evaluation of short-term efficacy of extraspinal cementoplasty for bone metastasis: A monocenter study of 31 patients

Objective: To study the effect on pain of per-cutaneous cementoplasty for painful extraspinal bone metastasis. Method: 43 patients with extraspinal bone metastasis were included between April 2006 and October 2014 in this retrospective monocenter study. The primary endpoint was pain level measured on a 0–10 numeric rating scale at week 1 after cementoplasty as compared with pre-cementoplasty. Secondary endpoints were long-term pain level and impact on quality of life and disability. Results: Mean pain score was 4.2 (SD ±3.6) before cementoplasty and 1.09 (SD ±2.4) at week 1 (p = 0.005) (n = 31 patients). At 22 months after cementoplasty, quality of life and disability improved (according to the patient global assessment) for 47.6% and 52.2% of patients (n = 21patients). We did not find a predictor of good response. Cement leakage was the most common adverse event. Conclusion: Percutaneous cementoplasty of extraspinal bone metastasis is a rapidly efficient treatment with few adverse events. Its efficacy persists over time, with a benefit for disability and quality of life. Although this technique is only palliative, it should be considered in this situation. Keywords: Percutaneous cementoplasty, Bone metastasis, Pain managemen

Contribution of adipocyte precursors in the phenotypic specificity of intra-articular adipose tissues in knee osteoarthritis patients

International audienceBACKGROUND: Intra-articular adipose tissues (IAATs) are involved in osteoarthritis (OA) pathophysiology. We hypothesize that mesenchymal cells residing in IAATs may account for the specific inflammatory and metabolic patterns in OA patients.METHODS: Adipocyte precursors (preadipocytes and dedifferentiated fat cells (DFATc)) from IAATs (infrapatellar and suprapatellar fat pads) and autologous subcutaneous adipose tissues (SCATs) were isolated from knee OA patients. The ability of these precursors to differentiate into adipocytes was assessed by oil red O staining after 14 days of culture in adipogenic medium. The gene expression of adipocyte-related transcription factors (C/EBP-α and PPAR-γ) and development-related factors (EN1 and SFRP2) were analyzed. The inflammatory pattern was assessed by RT-qPCR and ELISA (interleukin 6 (IL-6), IL-8, Cox2, and prostaglandin E2 (PGE2)) after a 24-h stimulation by IL-1β (1 ng/mL) and by conditioned medium from OA synovium.RESULTS: IAAT preadipocytes displayed a significantly higher ability to differentiate into adipocytes and expressed significantly more C/EBP-α mRNA than SCAT preadipocytes. IAAT preadipocytes expressed significantly less EN-1 and SFRP2 mRNA than SCAT preadipocytes. Unstimulated IAAT preadipocytes displayed a less inflammatory pattern (IL-6, IL-8, and Cox2/PGE2) than SCAT preadipocytes. In contrast, the response of IAAT preadipocytes to an inflammatory stimulus (IL-1β and conditioned media of OA synovium) was exacerbated compared to that of SCAT preadipocytes. Similar results were obtained with DFATc.CONCLUSION: IAAT adipocyte precursors from OA patients have a specific phenotype, which may account for the unique phenotype of OA IAATs. The exacerbated response of IAAT preadipocytes to inflammatory stimulation may contribute to OA pathophysiology